Posts from the “Health IT” Category

The Massachusetts General Hospital Utility Programming System (known a MUMPS, or simply M) is both a language and a database management system. First standardized by ANSI in 1977, it is actually quite a bit older, with roots extending into the 1960s. Since that time, it has become an ISO standard (with the most recent version being ISO/IEC 11756:1999). As a database management system, it is remarkably ahead of its time, being a type of NoSQL database (technically, a key/value store with hierarchical keys). From a health IT perspective, it is important because many important systems such as VistA and Epic are written in MUMPS or related languages (such as Caché ObjectScript from InterSystems). Unfortunately, classical MUMPS has not evolved significantly since the MUMPS Development…

Categories: Health IT, Software Engineering

Tagged: features, iso, language, m, mumps, standard

Microservices for Health IT?

Greg Woodhouse

Posted on October 2, 2016

Hospitals and doctors offices are busy places. When computer systems are used in the delivery of patient care, any unreliability or lapse in availability is a serious problem. There are always backup procedures (such as paper records), but they are just that: a backup. Looking at it a different way, the electronic health record (EHR) must never be a hindrance to the health care professional. In a recent post, I discussed how systems that are time consuming or difficult to use can cause problems rather than solve them. But if a system is unavailable when it is needed, or if it fails to work correctly, it is most certainly getting in the practitioner’s way! Worse, unreliability can lead to errors, and can be a…

Categories: Health IT

Tagged: ehr, microservice, OOD, OOP, SOA

We Need to do Better

Greg Woodhouse

Posted on September 24, 2016

I recently had a physician tell me, point blank, “EHRs are a failure”. He went on to add that [physicians] spend way too much time entering data. That, in itself, isn’t new. The difference is that paperwork has turned into keyboard work, and a lot more of it has to be done in real time, during the patient visit. In 1995, the AMA reported that physician satisfaction with EHR systems had plummeted from 61% to 34% over 5 years. Watching this doctor work, it is not hard to see why: the work was obviously time consuming and awkward, and the computer system didn’t even provide the information he needed. I’m not proposing that we go back to the hypothetical “good old days” when everything was…

Categories: Health IT

Tagged: agile, collaboration, customer, ehr, satisfaction, survey, ui, ux

The Structure of FHIR Resources

Greg Woodhouse

Posted on September 19, 2016

Let’s begin by reviewing some basic facts about Fast Health Interoperability Resources (FHIR). A FHIR resource is a representation of one of the objects managed by Electronic Health Record (EHR) systems. The word “object” shouldn’t be taken too literally, though. A FHIR resource may represent a person, as is the case with Patient and Provider, an event such as an Encounter, or something more abstract, such as BodySite.But FHIR resources are not merely concepts. A resource will contain a number of properties (such as demographics for a patient) and relationships with other resources. Resources may be divided into a number of categories: Clinical Identification Workflow Financial Conformance Infrastructure Of these, the first four groups are of the most direct interests to clinicians. The others…

Categories: Health IT

Tagged: fhir, hl7, standard, structure

Open Source and Open Standards

Greg Woodhouse

Posted on September 17, 2016

It would be a rare person who has not encountered the concept of open source software, if not actually used it in some context or another. Open source has become an important approach to software development and management today, but what is it? In simple terms, it is software developed under a licensing model that provides users that agree to the license associated with it various rights. Typically, those rights will include the freedom to use, copy or modify the source code with certain restrictions. Those restrictions may include an obligation to make any changes to the software available under the same terms as the original license, though this is not required by all open source licenses. Some licenses may restrict commercial use of…

Categories: Health IT, Software Engineering

Tagged: DrugBank, open source, open standards, standards

Using Python to Format FHIR Resources

Greg Woodhouse

Posted on September 9, 2016

I don’t know about you, but I find it frustrating to try and get complex JSON or d right when trying to build it “by hand”. There are just too many things that can go wrong: forgotten commas, unbalanced brackets, and so forth. Fortunately, JSON (we’ll focus on JSON here) is a fundamentally simple format. Objects consist of key/value pairs where the keys are always strings, and the values are one of: a string a number the special values true, false or null another object an array consisting of items of any of these types (including this one) This translates very naturally into Python, where dictionaries and lists are basic data types. To illustrate, let’s take a relatively simple FHIR resource, a condition: { “resourceType”:…

Categories: Health IT, Tutorial

Tagged: fhir, hl7, JSON, python

Syntactic vs. Semantic Interoperability

Greg Woodhouse

Posted on September 5, 2016

Achieving a satisfactory level of integration between different electronic health record (EHR) systems and related products (such as PACS systems) is difficult. In practice, a level of integration we might call syntactic interoperability is achievable through the use of standards such as HL7 v2, CDA, FHIR, or DICOM. But on one level, these are standards for data representation and interchange. It is true that these standards define logical models such as HL7 v2 messages and segments, the RIM in HL7 v3, or resources in FHIR, and these models do help in creating a common vocabulary. But experience has shown that every system interface requires a lot of development effort, and can involve conundrums that are hard to solve (if not downright impossible). Why is…

Categories: Electronic Health Record, Health IT

Tagged: data, ehr, interoperability, OWL, RDF, semantic web

Is My Database Relational? Should it Be?

Greg Woodhouse

Posted on September 2, 2016

This article started out as a talk, Is FileMan Relational? that I’ve given on a few occasions at MUMPS and VistA conferences. File Manager (or just FileMan) is a MUMPS application that provides another level of abstraction and a set utilities that comes close to being a database management system built on top of MUMPS. In fact, I often compare the relationship between FileMan and MUMPS to the storage engines in MySQL. Without going into too much detail, I ask to what degree FileMan follows Dr. E. F. Codd’s famous twelve rules, and conclude that it compares favorably with popular relational database management systems. This meant to be counterintuitive, and a bit provocative, because the basic abstraction in FileMan (the file) has a hierarchical…

Categories: Health IT

Tagged: database, mathematics, mumps, rdbms, relational, theory

Requirements for an Electronic Health Record

Greg Woodhouse

Posted on September 2, 2016

We have discussed the importance of shared vocabularies in electronic health record systems and interoperability, but this is not enough. In order to successfully build interfaces between EHR systems, we need to understand them in functional terms, and we need to understand how those requirements are realized in actual systems. Unfortunately, different products have been developed to meet different business goals, and often have different priorities.a Fortunately, healthcare has a long history, and there are familiar procedures that are more or less standard. Examples include admitting a patient, writing a prescription or a lab order, entering progress notes, patient education, and so forth. To be successful, an EHR system will need to be as familiar and useable as possible. It can succeed best by…

Categories: Health IT

Tagged: ehr, ehr-s, requirements, standards

Representing JSON objects in MUMPS

Greg Woodhouse

Posted on August 30, 2016

Author’s note: Since publishing this, I’ve learned that the array representation was first proposed in a joint paper by George James and Rob Tweed, A Universal NoSQL Engine, Using a Tried and Tested Technology. Given the ubiquity of MUMPS in Health IT, and the increasing use of JSON as a data format, there is a need for a simple way of converting between the two formats. But before presenting such a mapping, let us briefly review the two formats. In MUMPS, arrays are key/value pairs in which keys may be organized hierarchically. Not only are ROOT(1)=”abc” ROOT(2)=”def” and ROOT(“abc”)=”def” legal arrays, but so is ROOT(“abc”)=”d” ROOT(“abc”,0,12)=”ef” ROOT(4,”def”)=1.1 There are a few things to notice here. For one thing, numbers and arrays may be freely…

Categories: Health IT

Tagged: JSON, mumps, vista

Information Technology in HealthCare

Posts from the “Health IT” Category

Desiderata for a Future MUMPS

Greg Woodhouse

Posted on October 14, 2016

Microservices for Health IT?

Greg Woodhouse

Posted on October 2, 2016

We Need to do Better

Greg Woodhouse

Posted on September 24, 2016

The Structure of FHIR Resources

Greg Woodhouse

Posted on September 19, 2016

Open Source and Open Standards

Greg Woodhouse

Posted on September 17, 2016

Using Python to Format FHIR Resources

Greg Woodhouse

Posted on September 9, 2016

Syntactic vs. Semantic Interoperability

Greg Woodhouse

Posted on September 5, 2016

Is My Database Relational? Should it Be?

Greg Woodhouse

Posted on September 2, 2016

Requirements for an Electronic Health Record

Greg Woodhouse

Posted on September 2, 2016

Representing JSON objects in MUMPS

Greg Woodhouse

Posted on August 30, 2016