JAMIA reported in this research article that Physician’s preferred the Free/Open Source based order entry system in the Veterans Administration VistA software versus a commercial one: ‘…Overall, house staff were dissatisfied with the commercial system, giving it an overall mean score of 3.67 (95 percent confidence interval [95%CI], 3.37-3.97). In contrast, the CPRS had a mean score of 7.21 (95% CI, 7.00-7.43), indicating that house staff were satisfied with the system…’ While this data is compelling, it is worth pointing out that Free/Open Source Software does not pre-clude or exclude commercial companies from selling installation, support, training and documentation for it. They just don’t ask you to give up your rights in doing so.
The MUMPS programming language, also known as M, was specifically designed for use in healthcare and has a long history. It is the basis for the Veterans Administration VistA software as well as many other commercial healthcare applications. Because of its unique properties, it is used in banking as well. Open source bindings to CORBA exist (see below) and a complete open source M compiler, GT.M, is available on Sourceforge. There is much activity surrounding M in healthcare, perhaps more now that there is a Free/Open Source M compiler available. Read on for links to books and resources for programming in M
KS Bhaskar, recent recipient of the 2002 Linux Medical News Software achievement award writes: ‘A good book for M programming is: Walters, Richard F. M Programming: A Comprehensive Guide. Digital
Press, 1997. ISBN: 1555581676. In the US, Amazon lists it for $39.95 and claims to be able to ship it in 24 hours. An advanced online reference is Ed de Moel’s MUMPS By Example http://jacquardsystems.com/Examples, but don’t look to it as a tutorial.’
Alexander Caldwell of tk_family_practice writes: ‘The documents that come with GT.M from source forge are very good for installing it and getting an overview of how the database works, and how a system administrator would maintain it, but without something like this you won’t get far past just getting it installed: http://www.geocities.com/SiliconValley/7041/mwm999/mwm.html
start with the MWM001 link and look for the “teach you, teach me” link…
KS Bhaskar further writes: ‘There is plenty of M expertise Down Under, and there is even an
implementation of M developed in Australia that just went open source
(http://mumps.sourceforge.net)…Open source nuts and bolts for connecting to VistA with CORBA exist: esiobjects.sourceforge.net and while a binding to VistA has not been released yet, perhaps one will emerge in 2003…’
The Veterans Administration maintaines this page which contains a monograph on the VistA clinical computing software: ‘…A collection of monographs has been developed as an introduction to VHA developed software that comprises a large part of our integrated hospital information systems..’ Thanks to Peter Groen for this link. This is also the first new entry in the newly created ‘VistA’ subject category.
Updated at 1700: Almost missed the real story further down that the American Academy of Family Physician’s is considering open source. American Medical News has an article which may sound all too familiar. It is one Doctor’s saga with 3 different electronic medical record software, concluding that: “The most expensive was the worst and by far the cheapest was the best,” but it still didn’t work for her. It is a good read, if nothing else to note the money and time wasted, the arrogance of a closed-source vendor and the passing mentions of shoddy OS software: ‘”The problem with Dr. Orchard is that she was very computer illiterate,” said Richard Low, MD, Infor-Med’s CEO. Thousands of doctors are “highly satisfied” with his software because it helps them save time and work more efficiently; but to reap those benefits they had to learn to use the Praxis EMR software. “She refused to learn,” Dr. Low said…’ Thanks to Gary Kantor for this link.
I am trying to put together a Special Intrest group for the Health Information Systems Society www.himss.org. I currently have about 9 people intrested in signing a charter. HIMSS requires 25 signatures on the charter to establish the group. I need help in the form of commitment to sign the charter, write the charter and get this group rolling. I believe Open Source has reached a ritical mass of interest in healthcare and this forum will be beinficial within HIMSS.
If you are interested contact me at pat_at_alricthemad.com (replace the _at_ with @)
I hope to have a table at the SIG open house during the Annual HIMSS conference and perhaps meet in San Diego.
Martin Fink is a manager at Hewlett-Packard and the author of The Business and Economics of Linux and Open Source. Which is reviewed here: ‘The Business and Economics of Linux and Open Source is written for executives whose companies produce software and for IT managers who must choose and/or deploy this software within their companies…’ Fink gave an excellent presentation at the recent Open Source Health Care Alliance (OSHCA) meeting in Los Angeles. Thanks to Adrian Midgley for this link.
Typing skills and age of a clinician may not be barriers to computer use in medicine. Lack of computer experience or desire to use a computer might be. So says some not-so-new studies here and here. ‘…Several factors that we had predicted would be barriers to an electronic medical record, such as clinician reluctance to type or perform data entry, have not proved to be significant problems…’