Can somebody look at Medscribbler

Hi,

A few days ago, medscribbler decided to do an Open Source release. The release appears legit. They have the sourcecode available from the sourceforge medscribbler svn repository. The license is clearly labeled as GPL v3.

Sadly, I do not have the time to download this and see if it is worthwhile. However, theoretically, it should be a tablet-oriented EHR interface system that could be quite valuable code.

Not so found of the .NET server, but the tablet-side code could be important.

Can somebody download this and do a write-up? Let me know.

-FT

A geek in the ER

Recently someone turned me on to a post by data expert Joe Bugajski entitled the Data Model that Nearly Killed Me.

The article is marvelously written, and meticiously detailed. He actually has a chart where he chronicals his pain level, repeated histories, medications and location.

I am always impressed by the level of analysis that the average geek can bring to a healthcare IT situation.

The problem is that while Joe is familiar with Data Models, he is not familiar with Healthcare IT. I can tell you that none of his recommendations are actually practical. Mostly because they are top-down oriented, which is the right way to view a data model, but the wrong way to think about Health IT.

Joe has not yet familiar with the under-water portion of the iceburg that he has run into. I have been trying to fix the problems he is experiencing for years and I can assure you, they are much harder than even he thinks. However, most of the problems are not technical, but political in nature.

Joes take makes a good read.

-FT

MUMPS is modern

NextGov has an article that implies that the VA and DOD should compile MUMPS code to Java code.

Before we get into this discussion I would like to point out the fundamental flaw with implying that MUMPS is not a modern system. People who say things like this are usually ignorant, arrogant, biased or a healthy mix of all three. MUMPS engines have evolved and improved just like other systems that were developed in the same time frame. No one would consider calling C, (which powers the iPhone as Objective C) SQL, (which underlies ORACLE, and MySQL) or Unix (which is the design paradigm for Linux) antiquated. Unless you can detail exactly what ‘modern things’ MUMPS cannot do you have no business calling it old or implying that it is not modern.

Doing so merely serves to show that you are purveyor of second-hand technical knowledge. If you do not like MUMPS and have some legitimate reasons to avoid it, please take a page from David Uhlmans playbook:

I do not in any way want to offer
a general commentary on why some people want to use MUMPS or don’t
want to, or X language is better than Y, I am not looking to instigate
a flame war or really say that what we are doing is a better or worse
approach from a technical standpoint than anything else. It is the
right approach for us.

There are good reasons to get away from MUMPS, and there are good reasons to stay with MUMPS. Please do not use propaganda to make it seem like it is obvious in either direction.

Now… on to the idea of compiling MUMPS:

That is a seriously problematic idea. But it is hardly original at this stage. This is similar to the strategy that ClearHealth Inc. is following with WebVistA. ClearHealth has described the WebVistA technology strategy here and discussed it briefly on Hardhats. However, the basic strategy that I have taken away from talking directly to David Uhlman is that they compile MUMPS to C code, and then the C code to PHP modules, which they then use to build a web interface to VistA.

This much better than the idea of compiling to Java, because:

  • It works now. Not after 2 years and millions of dollars.
  • It jumps all the way to a web-environment.

But there is one basic problems with any ‘compile MUMPS’ technical strategy.

It is not clear where or how you edit the code.

If you edit in MUMPS then, you are not really getting away from MUMPS at all. Further the compile times for ‘all of VistA’  take days or weeks. That does not work for the write, compile, test, debug, write… software development method. But the C code that results is essentially just a pre-cursor to machine code. You might as well just modify the assembly code directly. You cannot really edit at the PHP level, because you are dealing with binaries at that point. But it is even more problematic that you could code modifications in MUMPS -and- C, but what would that mean? In short, this seems like a recipe for unmaintainable code.

Be assured, ‘migrating’ or ‘converting’ from MUMPS to anything will result in a lose of meaning. The Java compile methods that are mentioned in the NextGov article are just as problematic as the ones ClearHealth is using with WebVistA, and for the same reasons.

This does not mean that the compilation method will not work. But it does mean that we should be dubious about any strategy that suggests this method until they have been proven to work. At least David Uhlman is basically saying, ‘hey look, this seems to be working for me, let me get the kinks out and I will show you’, rather than the arrogant position of: MUMPS is not modern, I have done this in the lab, please give me many millions of dollars and several years and I will be able to change this all to unreadable and unmaintanable Java. Please. It is hard to imagine how little I think of this idea. If this happens to be an idea that you support…. I hereby fart in your general direction.

-FT

Medsphere bus

This is simply the -best- publicity stunt that any FOSS EHR vendor has done yet.

Last year Cerner decided not to return to the HIMSS show-room floor. Instead they decided to subversively bring in thier massive traveling booth. This is a converted semi truck that obviously cost a small fortune. It is obvious that the pricetag on this thing has got to be into the hundreds of thousands, if not millions. Anyone who has been to the showroom floor at HIMSS can quickly recognize that this is merely another chapter in the book of excess that is the proprietary EHR vendor community. This kind of spending speaks to one thing: massive profit margins sustained by vendor lock-in.

Medsphere heard about this, and decided to pull a little stunt. They found an old VW bus and turned into a symbol of their company and to a great extent our community as a whole! They spent a modest sum refurbishing their bus, which was already a symbol of everyman freedom! Then they drove it to HIMSS and tried to find a place that they could show thier bus next to the Cerner bus.

The pictures that result are a fitting visual analogy between the basic mindset and philosophy of the FOSS commercial EHR community and the proprietary EHR vendors.

Enough preface… have a look!!

A lesson in visual philosophy
A lesson in visual philosophy

My wife attends the University of Houston.

Normally, I reserve this space for discussing Health IT matters, but in this case I must make an exception. UH is one of the most frustrating institutions I know of. I believe, that UH has one of the most ineffective Information Infrastructures I have ever seen. So I am devoting a new topic in my blog to discussing my frustrations with it. My wife (Laura) and I have been having multiple, serious frustrations for some time, and each time I imagine that I should write something about it. But I do not want to start yet another blog, so I am going to use a category of this blog for now.  Perhaps I will use RSS etc to turn this into a separate blog. If you are interested in my Health IT posts… please skip this.

Today vnet.uh.edu is down. Vnet is the portal for students to receive course materials from their professors. Why? As best I can tell, it is down because it is test-time. The university education website is down… when it is needed most. It is probably down because it is being flooded with users. It is being flooded with users since so many students have a test tomorrow.

In short, vnet is exactly the sort of tool that breaks when you need it most.

There is little that vnet does, that Moodle does not do. Moodle, because it runs on Linux, can happily sit in the cloud at Amazon or Rackspace, which means that it can scale (in an automated fashion) to the point that entire countries could hit the website at the same time.

But instead it is being hosted either by the school or by vnet. In either case, it breaks constantly. According to this video vnet “leverages open source”. However, the vnet website has no mention of downloads, community or license. That usually means that the application is 100% proprietary. Further, it is easy enough to conclude that VNET was primarily developed by UH.

I am sure that VNET has some features that Moodle does not. But instead of adding to Moodle, and using a known-good platform, UH has decided to use a platform that they built themselves.

Now my wife cannot get to her documents. And I am sitting here pressing “refresh” in the hopes that I will be able to get onto the site, so that my wife can pass her Genetics class.

-FT

Customizing Windows

At work, I often have to use a Windows machine. Despite my opinions regarding FOSS software, Windows is a fact of corporate life. Often, I cannot even dual boot. *sigh*

However, when I do have to use Windows, I do not like to go far without my *nix power tools. Here is a list of tools and tweaks that I use to make my Windows experience tolerable.

FOSS tools

gvim – the windows install lets you “edit with vim” from the right click, perfection.

winscp – because ftp uses plaintext

putty – does everything with terminals, telnet, ssh, everything…

emacs – is a little harder to install than vim, but if you use it, you use it.

wireshark – why even bother debugging a network without it?

proprietary tools

Google Toolbar – indispensable if you use gmail

Google Desktop – save time searching your own computer

Adobe Flash Player – because Youtube is just not the same without it

Adobe Reader – because you need to use pdf’s

lifehacker apps

I will update this post as I find things that are totally irreplaceable. However, there alot of ways to improve the Windows user experience, besides making it more like *nix. The best place that I have found for new and different ideas for Windows productivity tools is the LifeHacker: Featured Windows Download category.

Enjoy,

-FT

Health IT (HIT) in Houston

Houston has the largest medical center in the world. I am starting a new networking group in Houston called HIT in Houston

I plan to discuss current events, and Health IT trends as they apply to Houston, T.X. Soon I hope to begin holding monthly meetings through meetup.com and I already have a Linked In Group for HIT in Houston.
If you would like to be included, you can contact me through this site.

-FT

Meeting Dr. Winn at e-MDs

I just had a great meeting with Dr. Winn over at eMds this week. Dr. Winn and I have been in discussions for months regarding how e-MDs might be able to leverage Free and Open Source software. I cannot discuss much until the proverbial ducks are in the proverbial rows, however, I can tell you that Dr. Winn is planning some very very big things with regards to FOSS releases. Thats all I can say for now… but you can assume that I was there for a very good reason.

sign_handshake_fredtrotter_and_drwinn

Along with meeting the whos-who of e-MDs, I took a tour of the e-MDs facility. This place was huge! They had really cool training rooms and other resources to host clients. All in all, they are obviously a first-class software company. (admittedly proprietary, but then no one is perfect.)

The trip concluded with a visit to the best corporate toy I have ever seen. e-MDs has a working moving replica of Robby the Robot, from Forbidden Planet. The replica moves and is controlled via an MP3-player. They have a sound track of funny sayings about e-MDs recorded in a robotic voice that they have the Robot “say” as it moves around, blinks and chirps.

fred_robby_and_drwinnn

Sum it all up

I have been running Postnuke as my blog engine for as long as I can remember. I have received complaints from a fellow blogger that it is difficult to track what I am doing via a single RSS feed. Now I need to blog something that requires a picture. To accomodate the new requirements I am moving to WordPress, which is better focused as a blog engine. Rather than “migrating” my old postnuke posts, I will sum them up here.

  • Please take a look at the Byrons Gallery which I think is really excellent.
  • I would also like to point to a most important post over at my cousins blog which honors my brother. Thanks, Angus, it meant alot to those of us in Texas who have not been able to see the stone yet.
  • I have been interviewed about FreeB and medical billing by LinuxMedNews.
  • I once had a trailer, but I managed to turn it over. Pics of my Home Wreck
  • Byron Trotters Memorial Page, probably more moving than anything is the Guestbook.

Thats it. Thats the relevant content from a blog that I have had for two years. I have been a bad blogger…

-FT