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In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to

In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.

nradov 1y ago
VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort. https://worldvista.org/ https://worldvista.org/
cyberax 1y ago
Vista is ancient, and it's written in MUMPS, an evil twin of COBOL.
- mattkrause 1y ago
  For context, many (most?) other EHRs are too, though they call it M now so it sounds less disease-ridden.
- vincent-manis 1y ago
  No, MUMPS (or M) is a remote descendant of JOSS, an interactive language of the 1950s. JOSS has all sorts of variants (DEC's FOCAL language of the 1960s was a dialect), but I think MUMPS is the only living one. MUMPS code is mostly unreadable, as the commands can be, and often are, abbreviated to the first letter. As a result, it looks a lot like line noise. Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes.
  - nradov 1y ago
    MUMPS was originally developed in the 1960s for use on minicomputers that had maybe 64KB RAM. At the time it was a lot more important to keep code size small, hence the single letter commands. Readability wasn't a concern then but it sure looks like a mess today.
    - vintermann 1y ago
      It's hard to imagine it's an improvement over just the raw assembly.
      - nradov 1y ago
        Imagine harder. It was an enormous improvement over assembly language. Not so much for the basic coding but for the portability and built-in persistent data structures. MUMPS has an excellent "NoSQL" database built in which is a pretty good fit for a lot of healthcare use cases.
  - cyberax 1y ago
    > Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes. Hence the "evil twin" comment :)

nradov 1y ago

VistA has some great functionality and end users generally like it, but unfortunately the underlying platform and developer tooling is hopelessly outdated. It's approaching a technical dead end and there's no practical way to keep it moving forward unless someone steps forward with the funding and resources for a major refactoring / rewrite engineering effort. https://worldvista.org/ https://worldvista.org/

cyberax 1y ago

Vista is ancient, and it's written in MUMPS, an evil twin of COBOL.

mattkrause 1y ago
For context, many (most?) other EHRs are too, though they call it M now so it sounds less disease-ridden.
vincent-manis 1y ago
No, MUMPS (or M) is a remote descendant of JOSS, an interactive language of the 1950s. JOSS has all sorts of variants (DEC's FOCAL language of the 1960s was a dialect), but I think MUMPS is the only living one. MUMPS code is mostly unreadable, as the commands can be, and often are, abbreviated to the first letter. As a result, it looks a lot like line noise. Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes.
- nradov 1y ago
  MUMPS was originally developed in the 1960s for use on minicomputers that had maybe 64KB RAM. At the time it was a lot more important to keep code size small, hence the single letter commands. Readability wasn't a concern then but it sure looks like a mess today.
  - vintermann 1y ago
    It's hard to imagine it's an improvement over just the raw assembly.
    - nradov 1y ago
      Imagine harder. It was an enormous improvement over assembly language. Not so much for the basic coding but for the portability and built-in persistent data structures. MUMPS has an excellent "NoSQL" database built in which is a pretty good fit for a lot of healthcare use cases.
- cyberax 1y ago
  > Regardless of its many warts, Cobol cannot be accused of being unreadable. Verbose, yes. Hence the "evil twin" comment :)