U.S. Government Crafted OSS 247
matthewg writes "According to the New York Times the federal government has developed an open-source medical records system. It was originally developed for the Department of Veterans Affairs, and doctors started obtaining it under FOIA requests. Some good information on the process of converting it from an internal project to a deployable system exists, and how its open nature has made the system better is available at the WorldVista site." From the article: "Medicare has not estimated what its software giveaway is worth. But Duncan Pringle, chief Vista technologist at Perot Systems, said that each doctor in a practice paid about $20,000 to $25,000 to get started with a commercial system, including costs of software, a license fee charged to each doctor, installation and servicing."
Vista (Score:3, Insightful)
Re:Vista (Score:5, Funny)
I mean it's incredible, the new windoze name has only been known for half a day, and already evil linux commies are trying to cash in on their intellectual properties.
Re:Vista (Score:3, Interesting)
Shocking! (Score:2, Funny)
Oh shit, sorry, its not April 1st.
Re: (Score:2, Funny)
Note to self: (Score:5, Funny)
Nice to know in case my current day job comes to an unfortunate end.
Re:Note to self: (Score:3, Insightful)
Doctors (Score:2)
Re:Note to self: (Score:5, Informative)
It's not exactly an install-and-forget situation -- not remotely. The hardware is expensive, the support is labor-intensive (and most often involves sending people on-site to fix things that don't belong to us), and the set of 3rd-party software we need to write integrations for is massive.
Oh -- and from what I hear, this particular system is much despised by most of the MDs who use it. Certainly, the ones we have on staff have little but contempt (granted, we're a competitor) and one of my coworkers who's spent some time as a VA patient has repeatedly heard similar sentiments.
Re:Note to self: (Score:5, Informative)
Which is the reverse of what I hear. I was at a medical conference recently trying to pitch our own wares, and it seemed to me that half the people at the conference were from the state penitentiary system and used the state's software, and the other half were from VA hospitals and used Vista. I was told fairly consistently by the VA docs that they loved the system and that they'd never use anything else. Of course, the hospital set it up for these doctors, so they never had to deal with any of the guts.
Looking at the system myself, it looks like 99% of the headache is in setting it up. Once it's configured correctly, that's when you get the doctors praising it like it was the best thing since sliced bread.
The most interesting thing about the article is that the software's been Free all along, some group issued a FOIA request for the source code and got it, and it's been an opensource project for at least a year now.
Re:Note to self: (Score:4, Informative)
Let me tell you, there is night and day differences between the accessability and the readability of patient information in these two places. First, patient history of several years length is instantly available with the computerized system. Which is important when you're looking at the treatment path of someone who has been chronically ill and you don't want to restart a prior treatment that aparently did not help the patient. In the other hospital (a county hospital) system, we'd have a written binder of the current visit (usually up to a month or two), and later records we'd have to request from another department further information when needed.
Second, the vast majority of the doctor-entered information is in a standardized layout. At my prior location, there were several different layouts for the same SOAP (Subjective compliant, Objective evaluation, Assessment/Treatment, Plan) notes. With Vista, the notes I saw were all organized in much the same way, regardless of the care provider. (And don't get me started on doctor's handwriting
And on another note - At the VA system I work in, I can expect about a monthly email saying when the Outlook system is going down for an upgrade or patch, and how we can expect outages over a couple of days. It seems like we get fewer emails about how Vista will be out for maybe a few hours (usually like 2am to 6am) with far less frequency. Again, it seems like it is much more stable once it's set up.
Re:Note to self: (Score:2)
So in other words, it's pretty much like every other piece of software out there with a fairly complex task to do. Just take a guess whether the praise or the complaints will get the most airtime...
Re:Note to self: (Score:4, Insightful)
Even where I live now, in a different country that has a national health care system, every time I have a doctor's appointment, they're OK with swiping my card across the reader at the beginning, but they all have sour faces and bang on the keyboard with two fingers as they fill out the necessary forms. I've been here 8 years and never yet saw a doctor who was comfortable with the system. And I've seen doctors of all ages from quite a number of different countries, India, Russia, Canada, South Africa, Australia, France, England, Cuba, and they all react in the same way.
Re:Note to self: (Score:3, Insightful)
Re:Note to self: (Score:3, Informative)
It is an extremely complex piece of software, which is highly modular. With that said...
(1) It is comprehensive in that it includes everything about a patient's medication history, treatment history, all progress notes, labs, im
Re:Note to self: (Score:2)
No shit.
I mean, I know you were being funny, but I did some digging in to what it actually makes it so difficult to install that the docs are willing to pay ten large.
Here's [geocities.com] what I came up with.
A basic installation doesn't look like anything tougher than an afternoon's work.
Maybe it's time to pick up a part time job...
missing hyphen? (Score:3, Interesting)
Re:missing hyphen? (Score:2)
Now I understand... (Score:4, Funny)
How the U.S. Government has been saying "asta la VISTA" to our taxpayer dollars.
Sorry. Had to say it...
Re:Now I understand... (Score:2, Informative)
Cool - I'm a spelliing nazi in another language now!
Re:Now I understand... (Score:3, Funny)
Don't Forget (Score:5, Insightful)
Let's not forget that the Government was doing OSS before OSS existed. The Berkeley Software Distribution (BSD) was funded by DARPA during the creation of the Internet. Due to the rules behind government funding, the BSD Operating System (it was originally just some tools) was released free to the public.
It makes sense if you think about it. Public funds are going into making the software. So who should own the design? The public, of course! Entities like NASA have the same requirements, save for when NASA pays third parties to do the development (in which case the developer owns the rights).
Re:Don't Forget (Score:2)
Re:Don't Forget (Score:2)
Actually, that persisted throughout the history of mainframes. The primary reason was that the code had to be linked directly against the database. (Abstraction was not a feature anyone wanted to pay for.) I was still using a mainframe that derived from third party source code in the late 1990's.
However, these companies weren't really OSS as OSS is defined by the OSI. [opensource.org] The OSI defines Open Source as both having the code and being able to for
Re:Don't Forget (Score:2)
But you are correct. It was not true OSS. But we did have access to the code and could make changes as well as see why we were having problems. And yes, all the code back then had something to say that we could not release the code to others.
Re:Don't Forget (Score:5, Informative)
The Feds are also increasingly using contractors to assemble and produce various sensitive information and products - a legal loophole that makes sure that the FOIA doesn't apply.
Just FWIW.
Re:Don't Forget (Score:4, Insightful)
Well, public funds helped finance the development of CHEETAH, for example. But, you cannot get a copy of it unless you are ALREADY a government contactor. You are out of luck if you want to use it to do proof-of-concept to GET a contract.
Also, our tax dollars fund all that wonderful NSF and DOE research in academia. BUT, if I want to read the results of that research, I need a subscription to a privately published journal. I can read the abstract online, but the 'buy the article,' one lousy article is about a third of the cost of an annual subscription.
(And yes, I am a proponent of open publication of scientific results. And yes, I know I can got the university library, a 40 mile trip, and probably read the articles I want).
I'd be willing to bet you could name many other examples of publicly generated intellectual property that is not freely available.
Re:Don't Forget (Score:2, Interesting)
Re:Don't Forget (Score:2)
Consider another example. There is a protein docking package that was developed in academia. Academic researchers can get it FOR FREE, but as a private
US Gvt. develops a medical software system... (Score:4, Insightful)
now, if you can tell me anything that should be MORE open source than this, I don't know what it is. Its based on GPL software and developed with my tax dollars. Hells yeah, I should get a copy of this as a US citizen and taxpayer.
I know that there are some very good medical records software pacakages out there... either they innovate or they die. Meaning, either they go to work, work and make their software better, or they die.
That sounds pretty much like why i go to work every day.... i don't see why software developers should get a free pass.
Huh? Wuzzat about the GPL? (Score:2)
ANYTHING?!? (Score:2)
With Public-Domain software I can do ANYTHING?!?
Doe that include slapping a GPL onto it...
(ie, even if I didn't write it?!?
Re:ANYTHING?!? (Score:3, Informative)
With Public-Domain software I can do ANYTHING?!? Doe that include slapping a GPL onto it... (ie, even if I didn't write it?!?
I don't think so. You can certainly distribute it and claim that you're doing so under the GPL, no problem. But if someone then decides to, say, take your version and sell it as closed source, you probably don't have any legal recourse, because the GPL derives its power from the privileges granted to the copyright holder, and you do not own that copyright. No one does, act
Is public domain viral? (Score:2)
Re:Is public domain viral? (Score:2)
So long as the publishers of the book didn't change the rhymes at all (ie. modernizing the spelling), sure.
Re:Is public domain viral? (Score:2)
Re:Is public domain viral? (Score:2)
Maybe. Some of the rhymes that everyone knows are not as old as you think - someone holds copyright on them. (The song Happy Birthday is an obvious example)
Many books will change one word here and there. They may be able to copyright that change, see a lawyer. (In theory only substantial changes can be copyrighted)
They can copyright their layout even if everything (even the art) is public domain. You could potentially get in trouble for publishing a book with exactly the same public domain poems
Re:Is public domain viral? (Score:2)
Re:ANYTHING?!? (Score:2)
Re:US Gvt. develops a medical software system... (Score:3, Interesting)
Ahhh, but the question is do you feel that a Canadian, Japanese, or (god forbid!) French citizen/doctor/whoever should be able to get a copy of this for free also?
Re:US Gvt. develops a medical software system... (Score:2, Insightful)
That's incredibly faulty logic. The US gov't makes and builds and buys billions of dollars worth of stuff every day. That doesn't mean you're entitled to it.
Re:US Gvt. develops a medical software system... (Score:2)
But that doesn't mean that you shouldn't be.
Re:US Gvt. develops a medical software system... (Score:2)
You're right. I'd love my share fo time in an F-14 Tomcat that I helped pay for.
Backwards ! It was Developed by the Gov't First (Score:3, Informative)
Re:Backwards ! It was Developed by the Gov't First (Score:2)
If I'm not mistaken, MUMPS is not obsolete. I believe it's still massively used in the medical industry.
See this:
MUMPS - Massachusetts General Hospital Utility Multi-Programming System. A
database-oriented OS and the language that goes with it. Used originally for medical records. Only data type is the character string. Persistent associative arrays. Current versions for IBM RT and R6000, DSM (Digital Standard Mumps) for DEC, Datatree MUMPS for IBM PC, Unix MUMPS from PFCS . "MUMPS Language Standard"
How long will this last? (Score:4, Insightful)
Re:How long will this last? (Score:4, Informative)
In any case, they made an analysis tool call SOAP - Satellite Orbital Analysts Toolkit. Over time, it became VERY powerful - almost STK powerful.
But since it was developed on the govt's dime, STK had a shit fit. They sent letters to congress bitching that this outfit's tool was taking away their profits, since the govt. types didn't need to buy STK licenses any more in many cases.
I was always pissed about this a) because STK is the kitchen sink, the outhouse, the back yard, and the garage of satellite tools, and SOAP was great because it was a philips-head screwdriver, and often, all i wanted to do was screw in a screw - i didn't NEED anything more. b) STK's basic ppackage was "free" - but it didnt actually do jack shit, and to start working with it seriously was a $30k software outlay. c) we PAID for the SOAP software by paying the salaries of the guys that wrote it - so why should we get bitch slapped around for using it?
In the long run, it just ended up a constant feud, with the STK guys sending out nastygrams every few months, and we'd put boxes of STK on the wall and throw darts at it...
because i worked very close with the SOAP developers, and was sickened to think that TWO GUYS could make a better tool than the whole building full of people at STK. Bastard whiners.
Re:How long will this last? (Score:2)
STK = Satellite ToolKit, made by Analytical Graphics
Here is what an FFRDC is. [aero.org] I would actually love to work at Aerospace if it wasn't so fscking far away from me on the freeway... stupid SoCal.
Re:How long will this last? (Score:3, Insightful)
lobby congress to pass a bill banning Medicare from providing this software
Government produced information is public domain. Period.
sue the government under a 'no compete' clause
"no compete" clauses generally refer to provisions in a contract between two parties. What might that contract be in this case?
Re:How long will this last? (Score:2)
Re:How long will this last? (Score:2, Insightful)
The software itself, while quite expensive, is only part of the cost of having a medical software suite. There is also a lot of money in supporting and customizing the software and general support. The IT staff at a lot of hospitals and clinic groups don't tend to be that tech savvy. There
Conflict with "Windows Vista". (Score:2)
Opportunity (Score:3, Insightful)
Open Source? (Score:2)
Re:Open Source? (Score:2)
I suppose actually going to the site linked in the submission would be too hard? There you can read that it really is a F/OSS, GNU/Linux-based system.
Anonymous Source (Score:2)
Stuck in a rut (Score:4, Funny)
An open souce project that provides great value and fills a really important need that is hard to install and maintain.
Where have I heard that before?
Vista is written in mumps (Score:5, Informative)
MUMPS is line-oriented, like old-school BASIC
Evaluation is strictly left-to-right, so 3 + 4 * 5 Doesn't yield the result you think.
There are no local variables. Everything is global, except for "globals", which are persistent, and stored in a hierarchical file on disk.
Re:Vista is written in mumps (Score:2)
Anyone make a MUMPS automatic translator to a better language?
Re:Vista is written in mumps (Score:4, Informative)
Not being familiar with MUMPS, I looked it up and found the ever-popular hello world example: Aside from MUMPS and ADA, does the gub'ment use any non-wacky programming languages?
Re:Vista is written in mumps (Score:3, Informative)
Re:Vista is written in mumps (Score:3, Funny)
Well, that makes sense - it certainly is pathological. [wikipedia.org]
Re:Vista is written in mumps (Score:2, Insightful)
I don't much like Ada myself, but
Re:Vista is written in mumps (Score:3, Informative)
f p=2,3:2 s q=1 x "f f=3:2 q:f*f>p!'q s q=p#f" w:q p,?$x\8+1*8
[part of Keith Lynch's
including code to format it neatly into columns--DPBS]
(from ftp://rtfm.mit.edu/pub/usenet/comp.lang.mumps/M_T e chnology_and_MUMPS_Language_FAQ,_Part_1_2 [mit.edu]
)
line noise?
Perl's got nothing on mumps.
Re:Vista is written in mumps (Score:2)
Re:Vista is written in mumps (Score:2)
No WONDER it keeps getting delayed!
Re:Vista is written in mumps (Score:2)
You forgot the only thing that makes MUMPS worth programming in: the array structure. Arrays are string indexed and are stored as B trees, making it easy to create your own DB structures. It can be faster than SQL DBs in applications with enough data and dimensions, hence its creation and use at hospitals (the first M is for Massachusetts general hospital) and its use in the financial sector. See the article for more stuff if you're interested (including links to open sour
Local variables (Score:3, Informative)
Of course there are local variables-- that's what the N directive is all about. It's local within the scope of the in which it was declared.
INFORMATIVE??????? WTF (Score:2)
This will be illegal in a few years (Score:3, Insightful)
Furthermore, The Industry will make sure that if the government does make any of its own software, it must either not release it or charge more than industry does for similar solutions.
At least that's how I see The Industry spending it's lobbying dollars.
Re:This will be illegal in a few years (Score:2)
Wheres the tarball? (Score:3, Insightful)
Seriously, is this REALLY open source?
If my tax dollars paid for it's development, I want source...
(Visualizing nice canned preconfigured Linux or Mac boxes for Doctors offices///healthcare facilities)
Re:Wheres the tarball? (Score:4, Informative)
And, you can indeed have all of the source you want. But, unless you're prepared to read and modify source code that looks like:
you probably won't be able to do much with the code.
It's written in (M)umps, an old, old, heirarchial database developed for (surprise) hospital use by the Massachusetts General Hospital [wikipedia.org]. The V.A. began developing this system in the early to mid-80's and some of the originals (like George Timson) are still involved the last I heard. They've added a relational database layer (complete with reporting system) on top of the M layer, and have implemented pretty much everything a hospital would need (from prescriptions to e-mail to patient encounter information and so on) in this language.
Right about the time Delphi 1 came out, the V.A. decided they needed to get into the GUI game and created a component that could be used from Delphi to transmit data to and from a V.A. database via TCP stream. This is the basis of the graphical system that an earlier poster mentioned.
Since then, there's been a lot of incredibly cool work done by programmers in the V.A. with this system. I worked as a programmer for the Topeka V.A.M.C. when they did the GUI patient medication admistration system, which caused the incidence of patient medication errors to drop through the floor (I didn't do much of the work on it, but went Cowboy Action Shooting on the weekends with the guy that did).
For all of the abuse that a lot of government employees take on /., pretty much every programmer I ever met or worked with in the V.A. was bright, dedicated, professional, and knew their business.
Anyway, if you're truly serious about downloading this, you need to go to Intersystems [intersystems.com] and download a copy of Cache for either Windows or Linux, and then go to Hardhats [sourceforge.net] and download the the database. Back when I was still working with it, they had an actual Cache database file that you could download that was already pretty much preconfigured. Since it's been almost 4 years since I've done any VistA work, I'm not sure what the current state of the system is.
And for those of you saying that the commercial software companies aren't going to stand for this competition: the V.A. would periodically evaluate SQL-based databases to see if they could meet the needs of the V.A. Every test I'd ever heard of said that there was no software out there that could meet the needs of the V.A. and, even if they could find software that met their needs, the conversion from one system to another would be nightmarish (to say the least).
Re:Wheres the tarball? (Score:2)
More to the point, it's freely available via *Sourceforge*! (As if the guy you're responding to has the slightest need for a hundred megs of MUMPS code, let alone plans to audit the thing before opening his Mandrake-based hospital.)
Comment removed (Score:4, Informative)
hl7 (Score:2)
It does (Score:2)
A complete open source VistA stack (Score:5, Informative)
Vista isn't actually open source in the normal way (Score:5, Informative)
I did some investigation into it a few months back as one of my customers is a small rural hospital who is shelling out a large sum of money to both IBM and a small software vendor for their management software/hardware.
The biggest knock on Vista is that its written in MUMPS [wikipedia.org], a rather obscure programming language dating to the late 60's. It's a really interesting language, but altogether it's something of a pain to deal with, and the only two open source implementations of it are the Sanchez GT/M stuff that WorldVista uses (which I'm not even sure *IS* open source, the licensing isn't very clear on it, further, alot of it is written in assembler which means its effectively non-portable), and another MUMPS->C translator developed by a guy at the University of Northern Iowa. http://math-cs.cns.uni.edu/~okane/cgi-bin/newpres
Re:Vista isn't actually open source in the normal (Score:2)
> its written in MUMPS, a rather
> obscure programming language
Wow, so true. From gtm_V5.0-000/_RSEL.m:
Re:Vista isn't actually open source in the normal (Score:3, Insightful)
There is very little of GT.M that is written in assembler, but since GT.M is a compiler, the code generator is the real obstacle to portability. The assembler bits are mostly there to do things like manipulate stack frames, which a run time system needs to do.
Feel free to contact me at ks dot bhaskar at fnf dot com if you have any questions on this.
Very specialized components (Score:2)
Re:Very specialized components (Score:2)
Bad news for my company ... (maybe) (Score:5, Interesting)
Some clients seem to like it because it gives you seamless operation through your entire organization, and others don't like it because it's a huge monolithic piece of software, and represents TONS of vendor lock-in.
I wish the execs up top here would realize that in this day in age, open standards like XML and now open source applications like this pose a huge threat to their business model, whose only strong point is that you get a highly integrated system (we're like the Microsoft of healthcare IT, basically).
Oh well. I'm just one lowly developer. What can I do about it? I'd like to see my company succeed, but I worry that they're way too stuck in the 20th-century "lock them in", "monolithic application", "integration over interopability", "the only standard is a defacto one" -mindset.
SourceForge must be hating this article... (Score:5, Informative)
Re:SourceForge must be hating this article... (Score:3, Informative)
> The "o" and "r" directories have 23K files
> each in them. Bizarre.
Not really odd at all, a quick look told me that the o directory contains the object files derived from compiling the source files in the r directory (.m aka mumps or M database files)
Mumps is what vista is based on which is a database system that is available for free or commercially see http://www.mcenter.com/ [mcenter.com] for links to the free (go to link for m development committee)
Re:SourceForge must be hating this article... (Score:2)
Yup, it's a bunch of binaries: I guess it just looks a little odd... I'd expect to see them broken out into a directory hierarchy that mirrors a package or module structure. But perhaps M doesn't have a concept of such a thing?
linuxmednews.com (Score:4, Informative)
My submission was worse. (Score:2, Informative)
The NYT seems a little breathless IMHO, with how wonderful Medicare is to be giving software away. VistA was IIRC _always_ public domain, as it was written under contract to the VA, and also IIRC the VA (and the USG) has the copyright.
VistA renamed from DHCP (Score:2)
Heheh.
Wow (Score:4, Informative)
At the time, the idea was that companies would take the FOIA release (which had everything except encryption routines) and create their own release they would sell to hospitals.
I remember getting some bloodwork a few months ago and seeing a computer screen with the familiar login screen for a MUMPS system.
Open Source Voting Code? (Score:2)
Lotsa medical FOSS out there... (Score:2, Informative)
Debian-med has a fairly big list -- http://www.debian.org/devel/debian-med/ [debian.org]
Euspirit http://www.euspirit.org/ [euspirit.org] had a huge list... but the site seems to have evaporated.
I wrote a lengthy article about that FOSS in medicine-- it can be found here: http://www.utmj.org/issues/82.3/Technology_Rev [utmj.org]
Re: (Score:2)
Vista? (Score:2)
Re:The goverment is so good at everything else (Score:2)
Just because something comes from the feds does not make it
Re:Great, that $25,000 can chip away at... (Score:2)
Re:Great, that $25,000 can chip away at... (Score:5, Insightful)
See the following link for more info:
http://www.makethemaccountable.com/myth/RisingCos
Re:all your medical records are belong to us (Score:2)
Much, if not all, of your medical info is stored in databases already.
Re:Someone Code A Replacement (Score:2)
As an example, (M)umps is an intrepreted language. It is not at all uncommon to find application code stuffed into a variable, and then find that the variable gets executed in a completely different