Is open source the cure for what ails VA's e-records?

Modernization plan would phase out MUMPS language

 An industry advisory group today recommended that the Veterans Affairs Department modernize its legacy VistA electronic health record system by moving it to an open-source and open-standards platform and phasing out use of the MUMPS computer language.

“Open source provides the best way forward in terms of engaging the entire community,” Ed Meagher, who chaired the American Council for Technology-Industry Advisory Council VistA Modernization Working Group, said in a news conference today releasing the group's report. “Open source was the obvious answer.”

In October, VA Chief Information Officer Roger Baker asked the working group for advice on updating VA's Health Information Systems and Technology Architecture, which contains records for 8 million veterans. VistA, which has been in development and use for three decades, is considered one of the premier medical record systems in the world. However, the MUMPS computer language it uses is no longer popular.

“Our task was complex: We were asked to produce substantive recommendations to modernize a system that works very well but is outdated and difficult to maintain,” said Meagher, who is a former deputy CIO at the VA.

The 34 members of the working group made the recommendation unanimously.

“That unanimity is a real credit to the cohesiveness of this working group. That we recommended an open-source solution is a real ‘game changer’ from the business as usual approach to systems development,” Meagher said.

Under the recommendation, the VA would continue to operate the current VistA while beginning a parallel, open-source development project for VistA 2.0. The application development would occur in an open source ecosystem and the final product would be managed and maintained by a newly created non-profit Open Source Foundation.

An open-source VistA would be more flexible, and more able to be modified, grown or enhanced, Meagher said. It also would be more readily linked to new information-exchange platforms such as the Health and Human Services Department’s Nationwide Health Information Network, he said. Currently, VA and Defense Department are testing a Virtual Lifetime Electronic Record for each service member by sharing data on the nationwide health information network.

Moving to open source “was not a big stretch,” Meagher said. “It reflects the high level of sophistication that open source has achieved.”

At the same time, the existing MUMPS platform for VistA would be phased out over time, Meagher said. “Moving to a new environment, we don’t think MUMPS is the answer,” he said.

The industry group consulted with VA physicians and other clinicians as it prepared its recommendations, and those “end users” of Vista 2.0 would be included in the open source environment to provide input, Meagher added.

“One of the principles is that what gets done must be at least as good as (current) VistA,” Meagher said. Physicians should be involved in approving changes to work processes that might be part of the new system, and the new system ought to accommodate changes recommended by the VA clinicians, he said.

In the recent past, some supporters of VistA and MUMPS have strongly defended the existing system and resisted the idea of phasing out MUMPS. But Meagher said he does not anticipate major resistance to the changes proposed in the report.

“Change is inevitable. Most people acknowledge that change was necessary. There is general agreement that VistA cannot continue much longer,” Meagher said. “There will be questions and discussion, but I don’t see resistance.”

 

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Reader comments

Tue, Nov 16, 2010 misleading article usa

"...However, the MUMPS computer language it uses is no longer popular." 8 track tapes were once popular and we know how that worked out. MUMPS is a purpose built text processing language that is superior to all modern languages and its integrated database is not only faster than all the other databases in the world it consumes less space and needs little to no maintenance. For database scalability and the number of users it can simultaneously support MUMPS has no competition. The newest WEB databases like GoogleDB are modeled after the MUMPS DB. MUMPS, Cache and MiniMDB have been and still are decades ahead of the popular trends that come and go like the wind.

Sat, May 15, 2010

This is a nonsense article. "Open source" is not a program, a database language, or an operating system. It merely means that the code can be read (and is not distributed in binary. Some connotations of open source mean the software can be freely redistributed, as well. MUMPS comes in a proprietary version (Cache) and a free open source version (GT.M). MUMPS is an older, less intuitive database and scripting language, compared to more modern languages including C+ and scripting languages like PHP, Perl, Python, and others. That has nothing to do with "open source," though. This is a buzzword article that is devoid of real understanding of software. Medsphere has an open source version of VistA (OpenVistA) as does WorldVistA. Astronaut has put that into a widely distributable Linux framework, and Ubuntu-Med has even pre-packaged it with an Ubuntu server operating system. All of this is open source already. While I am not a big fan of MUMPS programming, it has nothing to do with whether it is being open source or not. I think it is important that whatever the government develops be public domain so that the rest of the country's health care structure can benefit (since it benefits from so little else that the government does). This was the problem with VistA Imaging -- it has so many proprietary modules that even though it was developed by the VA and is one of the best PACS-type systems available, no one can use it outside the VA without spending a fortune of licensing the proprietary modules. The same specter occurs when buying Cerner or some other proprietary system. Instead of a health IT leader, the VA would become a mere IT consumer, beholden to whichever vendor it buys from. That is a certain track to fragmentation of the health care system, not unification.

Sun, May 9, 2010

I'll be glad when Cache, Mumps, M, whatever is replaced with a legitimate, non-proprietary, modern programming language.

Fri, May 7, 2010 Dr. Bokhari Arizona

VA use mumps. Cache is interpreter of mumps. GT.M is an open source counterpart of Cache. VISTA is a robust system I have ever seen. Running VistA in Linux environment along with GT.M makes it a perfect open source which no one can compete. Regards

Fri, May 7, 2010 inaccurate va

Mr. Meaghers comments are not correct. There have been many attempts to get rid of Mumps. The committe certainly was not unanimous. The VA doesn't use mumps they use Cache -- it has objects, SQL, web services and runs M(umps) code as well. It is a modern language. It has storage structures that are easily partitioned similar but better than popular DB's like HADOOP without changing application code. Mr Meagher is a vendor and as a vendor would like nothing more than to get a contract to rewrite 25 years of code by the hour. VistA needs a hardware refresh and the software like any large system needs more development but not a radical forklift.

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