6 ms·

MUMPS, the Archaic Health-Care Programming Language

33 points by vezzy-fnord 11y ago

woah 11y ago
> MUMPS concepts (directly) underly two of the largest contemporary NoSQL tools: GT.M and InterSystems Caché. Huh?
jacques_chester 11y ago
I feel like this journalist was struggling to understand the nature of different kinds of databases. > document-oriented databases (where different types of data are stored in one unified document instead of a bunch of tabular cells) There isn't one document, and typically documents aren't "unified" in the sense of having an enforced schema. > columnar databases (where data is laid out in key-valued arrays) Er, no. Where data is laid out in columns, to speed up aggregate and analytical operations. > (Confusingly, the NoSQL name corresponds to "not only SQL" rather than "no SQL.") Backronyms ahoy! > But the thing about abstraction in computer science, whether it's a high-level virtual machine-based programming language like Java or a bare-bones Unix shell, is that it always has a cost. So does hard-baking a single storage and access pattern, which is that you get it wrong and have catastrophically slow access and aggregation times. A relational database is a generalist, query optimisers are generally good at guessing how best to traverse a normalised schema and the last time people used "abstractions are too costly!" as a serious argument it was in the days of rewriting desktop apps in assembler.
vskarine 11y ago
MUMPS powers chunk of TD Ameritrade infrastructure. While sounds cool, this is just as scary as knowing that COBOL powers chunk of other banks infrastructures (Schwab, etc).
- qznc 11y ago
  > In 2006 and 2012, Computerworld surveys found that over 60% of organizations used COBOL (more than C++ and Visual Basic .NET) and that for half of those, COBOL was used for the majority of their internal software. https://en.wikipedia.org/wiki/COBOL#Legacy https://en.wikipedia.org/wiki/COBOL#Legacy Also, COBOL got a spec update in 2014. It is not really a dead language.
jrapdx3 11y ago
MUMPS is a subject I've tried to study before but confess I didn't get very far. For my purposes back in the 90's, PostgresQL was the best fit and it has worked out well. Meanwhile EHR systems have become a huge industry, but now having to catch up is hard. Learning about VistA is mind-boggling in its scope and complexity, and especially since it has been open-sourced for a long time. It's a point of curiosity that it's not been discussed more than a little here and there in the FOSS media. So I appreciate the informative article, as it gives me some starting points to explore this vast field. Might even give another stab at MUMPS, though it's a hill to climb. However some of the open-source projects that grew out of (or on top of) VistA offer some interesting ways of approaching it. One project with immediate appeal to me is EWD.js, which is a node.js javascript implementation of server and client via WebSockets, and a MUMPS DB backend. Should be interesting to try out. http://gradvs1.mgateway.com/download/EWDjs.pdf http://gradvs1.mgateway.com/download/EWDjs.pdf I could be wrong but it seems someone just starting out could find opportunities in the field of health care computing. Given the political thrust to have EHRs everywhere seems logical the field will grow. Above all, the need for security expertise in the EHR domain is enormous and will greatly expand in the next several years. The FOSS aspects might well create openings for innovators with creative products and ideas to reduce the cost burdens that high-priced EHRs have been contributing to health care systems.
rwmj 11y ago
I wrote MUMPS for a system called COSTAR (this was in 1989 or 1990). It was truly a terrible language. From what I've tried hard to forget: Everything is abbreviated, single letter functions everywhere. The database is a giant persistent hash table, accessed through programming language variables, with no schema, types or type checking (keep in mind this is used to store medical data). Everthing is global. There's virtually no structure in the language, I think they had subroutines but IIRC there were no named parameters. Existing programs were just unreadable spaghetti. Edit: Not Co-Star, but COSTAR: https://en.wikipedia.org/wiki/Computer_Stored_Ambulatory_Record https://en.wikipedia.org/wiki/Computer_Stored_Ambulatory_Rec...
- briandear 11y ago
  Yes, you can use just the first letter of a function name. It might as well support Morse Code for all the good that does in terms of readability. I wish I knew what MassGen was thinking when they thought that was a good idea. I shutter when I think of having to use that language for mission critical systems (or any system for that matter.)
  - acveilleux 11y ago
    They were thinking multi users on a few KB of RAM.
  - SloopJon 11y ago
    Keep in mind that MUMPS started around the same time as Unix (a little before, actually), so the same motivation for naming commands like cp, mv, and rm was likely at play in allowing abbreviations: interactive use on remote terminals.
- ajross 11y ago
  The whole development stack and runtime had to fit on a PDP-11/45. Contemporary assemblers and FORTRAN on comparable platforms were hardly better. COBOL required a much bigger machine. Pascal was still a slow toy from academia and C was in the future. Try not to judge quite so much.
ultimape 11y ago
My sister works for a place using Mumps. I read the manual she let me borrow and I decided I liked it better than the COBOL I was doing at the time. Then I cried myself to sleep. True story.
Yizahi 11y ago
Relevant WTF post: http://thedailywtf.com/articles/A_Case_of_the_MUMPS http://thedailywtf.com/articles/A_Case_of_the_MUMPS
- danielnixon 11y ago
  Follow-ups: http://thedailywtf.com/articles/MUMPS-Madness http://thedailywtf.com/articles/MUMPS-Madness http://thedailywtf.com/articles/Revenge-of-MUMPS-Madness http://thedailywtf.com/articles/Revenge-of-MUMPS-Madness!
- bshimmin 11y ago
  "OPERATORS: No precedence, executed left to right, parenthesize as desired. 2+3*10 yields 50." Wow. I mean... why?
  - acveilleux 11y ago
    Tiny little interpreter on early mini computers. You save RAM by not having to evaluate the whole expression.
briandear 11y ago
Kind of wild this article appears now. I just yesterday was talking with a potential partner when they suddenly dropped MUMPS connectivity into the requirements. My first thought was, "Oh sh--!" I have some basic MUMPs knowledge but I certainly don't want to have my business depending on it!
- ericcholis 11y ago
  Similar situation here, met with an associate who was trying to integrate with MUMPS.
  - rgaber 11y ago
    And this issue with this is?
cstross 11y ago
And for a different but convergent take on the same approach to this problem space, here's the Pick Operating System, which evolved for business applications on minicomputers in the 1960s, along similar lines (global hash table database, built-in language): https://en.wikipedia.org/wiki/Pick_operating_system https://en.wikipedia.org/wiki/Pick_operating_system MUMPS can thus be seen as a member of a (loose) family of 1960s era systems.
Novex 11y ago
So our saas web app backend is written predominantly in Cache Objectscript, which is one of the few remaining implementations of MUMPS. We use it on a day to day basis, which I guess makes me a MUMPS developer. As a programming language, it's a fairly standard procedural language. Cache introduces the ability for scoped java-like classes over the top of the standard procedural code and there's a SQL/ORM layer that at least allows a definition for the giant persistent hash table. That being said, a bunch of our code is in the legacy unscoped routines which is... interesting. The two real downsides are the complete lack of libraries for it (imagine having to allocate time to port DEFLATE as part of your developement scheduling) and the fact that 20 years of schemaless, unvalidated, tightly coupled data access leads to a boatload of weird bugs. Feel free to AMA.
- shaftoe 11y ago
  How well does Cache interoperate with other languages? Is it wrapped up in a library and consumed from another language that handles web requests/responses? Can you extend the Cache libraries by writing code in another language (even C) and importing it through a FFI?
  - Novex 11y ago
    There are bindings for most of the common languages to access Cache structures/functions (.Net, Java, Python, Perl, C/C++, Node.js) but not much the other way around. The only native to call out from Objectscript is via a low-level C interface. At the moment we're solving the problem by calling out to a set of Golang microservices from Cache over http. Cache itself actually has web support baked in, either via early-00's PHP style "echo directly down the pipe" or a newer MVC style framework they've built, but sadly stopped developing. Our product team made the choice to transition to their MVC style framework, another team built on ASP.Net so there are options.
  - SloopJon 11y ago
    Most clients interact with the database through a standard API like JDBC or REST, but there is an interface for calling functions written in C, and for getting into the database from C. It's kind of similar to Lua's C API. The Node.js binding is based on this interface.
asmithmd1 11y ago
The hospital where my wife works just spent $1.2B (yes billion) on software written in MUMPS https://www.bostonglobe.com/business/2015/05/31/partners-launches-billion-electronic-health-records-system/oo4nJJW2rQyfWUWQlvydkK/story.html https://www.bostonglobe.com/business/2015/05/31/partners-lau... The company that provided the software is interesting: http://www.epic.com/ http://www.epic.com/ Based in a suburb of Madison Wisconsin, founded in the mid 1970's by a grad student who wrote some software for a local hospital. They grew organically by word of mouth never spending on sales or marketing. They landed Johns Hopkins as a client years ago and now Epic chooses which hospitals are allowed to "invest" in their software. They hire young grads right out of college who have never worked anywhere else - who find themselves trapped with completely non-transferable skills. It is like this company evolved in complete isolation from any outside influence on software development. Of course it is typical enterprise software developed by waterfall method that puts users last. My wife says the doctors are in open revolt. They have 1000's of open change requests - some critical to patient safety. For example the field to enter prescription instructions is only 64 characters. This is a hospital that administers chemotherapy so the instructions are more complicated than "take with food three times a day." The developer who got assigned that ticket had the nerve to suggest using abbreviations instead of making the change.
- amorphid 11y ago
  I never thought I'd suggest using a short URL on a prescription. (fake) bitly . com /grandapas-chemo-meds
- carbocation 11y ago
  What's entertaining is that MUMPS was developed at the Massachusetts General Hospital, which is now paying a third party over a billion dollars to use it in the form of Epic.
- bbgm 11y ago
  If you've used MyChart you've used EPIC. Both the hospital systems I've used here in the greater Seattle area use Epic for their EHR systems.
jwdunne 11y ago
Funny this crops up. I've had to quickly get to grips with a somewhat related subject: a human readable healthcare interchange format called HL7 v2 (v3 has, somewhat rightfully, replaced the custom format with XML). Here's an example: MSH|^~\&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|20060529090131-0500||ADT^A01^ADT_A01|01052901|P|2.5 EVN||200605290901||||200605290900 PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260 GOODWIN CREST DRIVE^^BIRMINGHAM^AL^35209^^M~NICKELL’S PICKLES^10000 W 100TH AVE^BIRMINGHAM^AL^35200^^O|||||||0105I30001^^^99DEF^AN PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||67890^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13579^ POTTER^SHERMAN^T^^^MD^0010^UAMC^L|||||||||||||||||||||||||||200605290900 OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F AL1|1||^ASPIRIN DG1|1||786.50^CHEST PAIN, UNSPECIFIED^I9|||A
- chris_wot 11y ago
  Please tell me that's not real data.
  - jwdunne 11y ago
    No, I pulled it from Wikipedia. I wouldn't ever share real data, especially since it's the transmission of STI testing results. Very telling about it's effectiveness though: you didn't spot "nickell's pickles" in there!
    - chris_wot 11y ago
      Oh, but I did :-) But given it's MUMPS, that could have been part of the file format...
- daigoba66 11y ago
  Who said that it is suppose to be human readable? HL7 v2 is actually fairly nice as a data structure. It's really easy to parse, compresses nicely, and is quite flexible in terms of schema. I'll grant you that the standard message schemas are terrible, but the data structure is elegant for what it needs to do.
Immortalin 11y ago
How does this compare to languages with built in databases such as prolog?
chris_wot 11y ago
Anyone who said that mumps was eradicated is kidding themselves.
emitchell 11y ago
Meditech runs on a variant of MUMPS: MAGIC (and its subsequent iterations). MAGIC was also developed by one of the researchers that made MUMPS. It's the only language I've come across that allows variable assignment during arithmetic.
ndonnellan 11y ago
And I still hear devs balk when I mention our (ehr) backend is written in perl. PERL!
raarts 11y ago
Earlier in life I ported MUMPS to the ATARI ST. I remember the syntax as being a little weird compared to all other languages I knew at the time. The persistence was a nice touch though, it allowed you work with data in a very intuitive manner.

33 points by vezzy-fnord 11y ago

woah 11y ago

> MUMPS concepts (directly) underly two of the largest contemporary NoSQL tools: GT.M and InterSystems Caché. Huh?

I feel like this journalist was struggling to understand the nature of different kinds of databases. > document-oriented databases (where different types of data are stored in one unified document instead of a bunch of tabular cells) There isn't one document, and typically documents aren't "unified" in the sense of having an enforced schema. > columnar databases (where data is laid out in key-valued arrays) Er, no. Where data is laid out in columns, to speed up aggregate and analytical operations. > (Confusingly, the NoSQL name corresponds to "not only SQL" rather than "no SQL.") Backronyms ahoy! > But the thing about abstraction in computer science, whether it's a high-level virtual machine-based programming language like Java or a bare-bones Unix shell, is that it always has a cost. So does hard-baking a single storage and access pattern, which is that you get it wrong and have catastrophically slow access and aggregation times. A relational database is a generalist, query optimisers are generally good at guessing how best to traverse a normalised schema and the last time people used "abstractions are too costly!" as a serious argument it was in the days of rewriting desktop apps in assembler.

vskarine 11y ago

MUMPS powers chunk of TD Ameritrade infrastructure. While sounds cool, this is just as scary as knowing that COBOL powers chunk of other banks infrastructures (Schwab, etc).

qznc 11y ago
> In 2006 and 2012, Computerworld surveys found that over 60% of organizations used COBOL (more than C++ and Visual Basic .NET) and that for half of those, COBOL was used for the majority of their internal software. https://en.wikipedia.org/wiki/COBOL#Legacy https://en.wikipedia.org/wiki/COBOL#Legacy Also, COBOL got a spec update in 2014. It is not really a dead language.

jrapdx3 11y ago

MUMPS is a subject I've tried to study before but confess I didn't get very far. For my purposes back in the 90's, PostgresQL was the best fit and it has worked out well. Meanwhile EHR systems have become a huge industry, but now having to catch up is hard. Learning about VistA is mind-boggling in its scope and complexity, and especially since it has been open-sourced for a long time. It's a point of curiosity that it's not been discussed more than a little here and there in the FOSS media. So I appreciate the informative article, as it gives me some starting points to explore this vast field. Might even give another stab at MUMPS, though it's a hill to climb. However some of the open-source projects that grew out of (or on top of) VistA offer some interesting ways of approaching it. One project with immediate appeal to me is EWD.js, which is a node.js javascript implementation of server and client via WebSockets, and a MUMPS DB backend. Should be interesting to try out. http://gradvs1.mgateway.com/download/EWDjs.pdf http://gradvs1.mgateway.com/download/EWDjs.pdf I could be wrong but it seems someone just starting out could find opportunities in the field of health care computing. Given the political thrust to have EHRs everywhere seems logical the field will grow. Above all, the need for security expertise in the EHR domain is enormous and will greatly expand in the next several years. The FOSS aspects might well create openings for innovators with creative products and ideas to reduce the cost burdens that high-priced EHRs have been contributing to health care systems.

rwmj 11y ago

I wrote MUMPS for a system called COSTAR (this was in 1989 or 1990). It was truly a terrible language. From what I've tried hard to forget: Everything is abbreviated, single letter functions everywhere. The database is a giant persistent hash table, accessed through programming language variables, with no schema, types or type checking (keep in mind this is used to store medical data). Everthing is global. There's virtually no structure in the language, I think they had subroutines but IIRC there were no named parameters. Existing programs were just unreadable spaghetti. Edit: Not Co-Star, but COSTAR: https://en.wikipedia.org/wiki/Computer_Stored_Ambulatory_Record https://en.wikipedia.org/wiki/Computer_Stored_Ambulatory_Rec...

briandear 11y ago
Yes, you can use just the first letter of a function name. It might as well support Morse Code for all the good that does in terms of readability. I wish I knew what MassGen was thinking when they thought that was a good idea. I shutter when I think of having to use that language for mission critical systems (or any system for that matter.)
- acveilleux 11y ago
  They were thinking multi users on a few KB of RAM.
- SloopJon 11y ago
  Keep in mind that MUMPS started around the same time as Unix (a little before, actually), so the same motivation for naming commands like cp, mv, and rm was likely at play in allowing abbreviations: interactive use on remote terminals.
ajross 11y ago
The whole development stack and runtime had to fit on a PDP-11/45. Contemporary assemblers and FORTRAN on comparable platforms were hardly better. COBOL required a much bigger machine. Pascal was still a slow toy from academia and C was in the future. Try not to judge quite so much.

ultimape 11y ago

My sister works for a place using Mumps. I read the manual she let me borrow and I decided I liked it better than the COBOL I was doing at the time. Then I cried myself to sleep. True story.

Yizahi 11y ago

Relevant WTF post: http://thedailywtf.com/articles/A_Case_of_the_MUMPS http://thedailywtf.com/articles/A_Case_of_the_MUMPS

danielnixon 11y ago
Follow-ups: http://thedailywtf.com/articles/MUMPS-Madness http://thedailywtf.com/articles/MUMPS-Madness http://thedailywtf.com/articles/Revenge-of-MUMPS-Madness http://thedailywtf.com/articles/Revenge-of-MUMPS-Madness!
bshimmin 11y ago
"OPERATORS: No precedence, executed left to right, parenthesize as desired. 2+3*10 yields 50." Wow. I mean... why?
- acveilleux 11y ago
  Tiny little interpreter on early mini computers. You save RAM by not having to evaluate the whole expression.

briandear 11y ago

Kind of wild this article appears now. I just yesterday was talking with a potential partner when they suddenly dropped MUMPS connectivity into the requirements. My first thought was, "Oh sh--!" I have some basic MUMPs knowledge but I certainly don't want to have my business depending on it!

ericcholis 11y ago
Similar situation here, met with an associate who was trying to integrate with MUMPS.
- rgaber 11y ago
  And this issue with this is?

cstross 11y ago

And for a different but convergent take on the same approach to this problem space, here's the Pick Operating System, which evolved for business applications on minicomputers in the 1960s, along similar lines (global hash table database, built-in language): https://en.wikipedia.org/wiki/Pick_operating_system https://en.wikipedia.org/wiki/Pick_operating_system MUMPS can thus be seen as a member of a (loose) family of 1960s era systems.

Novex 11y ago

So our saas web app backend is written predominantly in Cache Objectscript, which is one of the few remaining implementations of MUMPS. We use it on a day to day basis, which I guess makes me a MUMPS developer. As a programming language, it's a fairly standard procedural language. Cache introduces the ability for scoped java-like classes over the top of the standard procedural code and there's a SQL/ORM layer that at least allows a definition for the giant persistent hash table. That being said, a bunch of our code is in the legacy unscoped routines which is... interesting. The two real downsides are the complete lack of libraries for it (imagine having to allocate time to port DEFLATE as part of your developement scheduling) and the fact that 20 years of schemaless, unvalidated, tightly coupled data access leads to a boatload of weird bugs. Feel free to AMA.

shaftoe 11y ago
How well does Cache interoperate with other languages? Is it wrapped up in a library and consumed from another language that handles web requests/responses? Can you extend the Cache libraries by writing code in another language (even C) and importing it through a FFI?
- Novex 11y ago
  There are bindings for most of the common languages to access Cache structures/functions (.Net, Java, Python, Perl, C/C++, Node.js) but not much the other way around. The only native to call out from Objectscript is via a low-level C interface. At the moment we're solving the problem by calling out to a set of Golang microservices from Cache over http. Cache itself actually has web support baked in, either via early-00's PHP style "echo directly down the pipe" or a newer MVC style framework they've built, but sadly stopped developing. Our product team made the choice to transition to their MVC style framework, another team built on ASP.Net so there are options.
- SloopJon 11y ago
  Most clients interact with the database through a standard API like JDBC or REST, but there is an interface for calling functions written in C, and for getting into the database from C. It's kind of similar to Lua's C API. The Node.js binding is based on this interface.

asmithmd1 11y ago

The hospital where my wife works just spent $1.2B (yes billion) on software written in MUMPS https://www.bostonglobe.com/business/2015/05/31/partners-launches-billion-electronic-health-records-system/oo4nJJW2rQyfWUWQlvydkK/story.html https://www.bostonglobe.com/business/2015/05/31/partners-lau... The company that provided the software is interesting: http://www.epic.com/ http://www.epic.com/ Based in a suburb of Madison Wisconsin, founded in the mid 1970's by a grad student who wrote some software for a local hospital. They grew organically by word of mouth never spending on sales or marketing. They landed Johns Hopkins as a client years ago and now Epic chooses which hospitals are allowed to "invest" in their software. They hire young grads right out of college who have never worked anywhere else - who find themselves trapped with completely non-transferable skills. It is like this company evolved in complete isolation from any outside influence on software development. Of course it is typical enterprise software developed by waterfall method that puts users last. My wife says the doctors are in open revolt. They have 1000's of open change requests - some critical to patient safety. For example the field to enter prescription instructions is only 64 characters. This is a hospital that administers chemotherapy so the instructions are more complicated than "take with food three times a day." The developer who got assigned that ticket had the nerve to suggest using abbreviations instead of making the change.

amorphid 11y ago
I never thought I'd suggest using a short URL on a prescription. (fake) bitly . com /grandapas-chemo-meds
carbocation 11y ago
What's entertaining is that MUMPS was developed at the Massachusetts General Hospital, which is now paying a third party over a billion dollars to use it in the form of Epic.
bbgm 11y ago
If you've used MyChart you've used EPIC. Both the hospital systems I've used here in the greater Seattle area use Epic for their EHR systems.

jwdunne 11y ago

Funny this crops up. I've had to quickly get to grips with a somewhat related subject: a human readable healthcare interchange format called HL7 v2 (v3 has, somewhat rightfully, replaced the custom format with XML). Here's an example: MSH|^~\&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|20060529090131-0500||ADT^A01^ADT_A01|01052901|P|2.5 EVN||200605290901||||200605290900 PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260 GOODWIN CREST DRIVE^^BIRMINGHAM^AL^35209^^M~NICKELL’S PICKLES^10000 W 100TH AVE^BIRMINGHAM^AL^35200^^O|||||||0105I30001^^^99DEF^AN PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||67890^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13579^ POTTER^SHERMAN^T^^^MD^0010^UAMC^L|||||||||||||||||||||||||||200605290900 OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F AL1|1||^ASPIRIN DG1|1||786.50^CHEST PAIN, UNSPECIFIED^I9|||A

chris_wot 11y ago
Please tell me that's not real data.
- jwdunne 11y ago
  No, I pulled it from Wikipedia. I wouldn't ever share real data, especially since it's the transmission of STI testing results. Very telling about it's effectiveness though: you didn't spot "nickell's pickles" in there!
  - chris_wot 11y ago
    Oh, but I did :-) But given it's MUMPS, that could have been part of the file format...
daigoba66 11y ago
Who said that it is suppose to be human readable? HL7 v2 is actually fairly nice as a data structure. It's really easy to parse, compresses nicely, and is quite flexible in terms of schema. I'll grant you that the standard message schemas are terrible, but the data structure is elegant for what it needs to do.

Immortalin 11y ago

How does this compare to languages with built in databases such as prolog?

chris_wot 11y ago

Anyone who said that mumps was eradicated is kidding themselves.

emitchell 11y ago

Meditech runs on a variant of MUMPS: MAGIC (and its subsequent iterations). MAGIC was also developed by one of the researchers that made MUMPS. It's the only language I've come across that allows variable assignment during arithmetic.

ndonnellan 11y ago

And I still hear devs balk when I mention our (ehr) backend is written in perl. PERL!

raarts 11y ago

Earlier in life I ported MUMPS to the ATARI ST. I remember the syntax as being a little weird compared to all other languages I knew at the time. The persistence was a nice touch though, it allowed you work with data in a very intuitive manner.