Re: [PLUG] EPIC

On Sep 28, 2016 12:50 PM, "K.S. Bhaskar" <bhaskar@bhaskars.com> wrote:

If DaVita is using GT.M, I'm not aware of it - they are certainly not a paying support customer (we sell GT.M support on commercial terms).

But therein lies the rub with FOSS - one never knows where one's software is used, unless someone is a paying customer. For example, I am told that every cash register at the largest department store in Dublin, Ireland, runs a GT.M application, but I can't say for sure because they're not a paying customer. At one point, IMSS, the Mexican Social Security Administration (which provides care to employees of companies, and delivers about one third of the health care in the country) ran a modified VistA on GT.M at about 60 of their largest secondary and tertiary care hospitals. But since they're not a paying customer, I can't say for sure where things are today.

Regards
-- Bhaskar

On Wed, Sep 28, 2016 at 12:00 PM, Ken Smith <ruttsmith@gmail.com> wrote:
is fis-gtm what's running in the davita dialysis centers? I see that all of there units are Debian and looks like a ncurses based program running

On Sep 28, 2016 10:32 AM, "K.S. Bhaskar" <bhaskar@bhaskars.com> wrote:
Just a couple of bits' worth of my opinion, since I have been peripherally active in the EHR world (I manage FIS GT.M - http://fis-gtm.com / apt-get install fis-gtm on Debian/Ubuntu - which is widely used in electronic health records, including what is to the best of my knowledge the largest VistA deployment in the world - not the VA, who think taxpayer millions should be spent on a proprietary alternative; I also co-founded WorldVistA - http://worldvista.org - a 501(c)(3) non-profit with a goal of affordable healthcare IT worldwide, and served on the Board for a number of years).

GT.M is an implementation of MUMPS (Massachusetts General Hospital Utility Multiprogramming System), which was developed for use in healthcare, and remains widely used: two of the three major EHR systems, VistA and Epic, are MUMPS based, while the third (Cerner) is not. Of these, to the best of my knowledge, only Epic and VistA have had articles published in peer-reviewed medical journals demonstrating improvement in outcomes from the use of the EHR systems. [I am not a doctor; this is what doctor friends have told me.]

MUMPS is also widely used outside EHR systems, e.g., Quest and LabCorp are users. There are two major vendors of MUMPS, one proprietary (and which has exorcised the word MUMPS from its vocabulary, but is basically an implementation of MUMPS) and GT.M (we're not afraid of the name, and I used to hand out "got mumps?" caps). GT.M is also widely used outside healthcare, in banking (where it currently runs the three or four largest real-time core-banking systems in daily production use anywhere in the world) as well as many other applications.

Although MUMPS is a pretty simple procedural language, modern healthcare is an incredibly complex undertaking, and the complexity of EHR systems derives from the complexity of the healthcare processes that they need to support. Furthermore, the long life of these systems (some of them have their roots in the 1970s and 1980s), means that some of the code programmers work with was originally coded in a style that we would today consider archaic, and the style has evolved. You can't replace the code wholesale, just as you can't replace the streets of old cities wholesale even though many of them evolved around horse-drawn wagons rather than automobiles. So, if you go to sites like the daily wtf, you will see rants about MUMPS, about Epic, about VistA, and related software. These tend to come from programmers who don't appreciate that the complexity of the software flows from the complexity of the application domain.

I personally have mixed feelings about EHR software. Pre-EHR, my former primary care doctor used to look at me during office visits; post-EHR, she kept focussing on her laptop and made less eye contact (though I think the care I received was equally good). On the other hand, I was in the coronary ICU when my father came out of open-heart surgery some years ago, and as a software developer, I could truly appreciate how well the user interface of the Epic application matched the workflow of the nurse. The match to the application need was impressively seamless, despite being a Visual Basic thick client.

Feel free to send any questions / comments my way, either on- or off-list.

Regards
-- Bhaskar

On Wed, Sep 28, 2016 at 7:52 AM, Joe Rosato <rosatoj@gmail.com> wrote:
Thomas Jefferson University Hospital's just switched to it, where I work. The go live date was missed (isn't this always true?!) but will be active 'soon'. Picture a runner collapsed on the ground stretching their bloody arm forward to barely touch the finish line.

Joe

On Tue, Sep 27, 2016, 10:22 PM Ken Smith <ruttsmith@gmail.com> wrote:
I was just down at the VA today. I like going there, people are more layed back compared to other hospitals

On Sep 27, 2016 10:03 PM, "Ronaldo Nascimento" <sgtnasty@gmail.com> wrote:
We use VISTA/CPRS at my organization, not sure if its like EPIC, but I have been hearing alot more about it lately at the VA.

On Tue, Sep 27, 2016 at 6:17 PM, Charlie Li <ml+PLUG@vishwin.info> wrote:
On 27/09/16 18:04, Keith C. Perry wrote:
> What Doug Stewart said. I know very few people that "like" EPIC. Its
> tolerated because it has a long history in this area. I try to push
> smaller offices to consider GNU Health or other solutions but so far no
> one has been pressed to move. Feels like a lock-in syndrome and "the
> devil you know".
>
Or maybe they're worried about being not HIPAA-compliant in even the
slightest of ways, because you land and drown in shit creek when that
happens.

This reminds me why barely(?) anyone knows of any open source tax software…

--
Charlie Li
Can't think of a witty .sigline today…

(This email address is for mailing list use only;
replace local-part with vishwin for off-list communication)

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--
Ronaldo Nascimento =][=

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--
Joe

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