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Monday Morning Update 12/24/07

December 22, 2007 News 41 Comments

From Orthopod666: “Re: selling patient data. This is from an interview with the CEO of the AMGA regarding the AMGA/Anceta National Collaborative Data Warehouse, which provides groups with access to comparative healthcare data. ‘The revenue for the company (Anceta) will come from making the totally identified, HIPAA-compliant data available to third parties.’ If this is true, how can they possibly be HIPAA compliant?” Link. Other references to Anceta indicate that the data in the Collaborative Data Warehouse is de-identified, so I assume the reporter misquoted her source (her freelance articles elsewhere cover everything from beauty academies to LCD projectors to real estate, so she may have been in over her head, but surely the editor should have caught that goof).

From Former Medseek Employee: “Re: Medseek layoffs. Yes, it’s true. I was one of the chosen few who got the boot a week before Christmas. I believe there were 30+ employees shown the door. Cash flow was stated as the problem. Mike Drake is out too. The rumor mill has it that egineering folks are not happy in Jackson with losing their leader. Many are are ready to leave, which will only put Medseek in more dire straits.” Maybe you’ll get separation counseling from Chief Strategy Office Gale Wilson-Steele in the form of a free pass to her upcoming lecture called “Promote the Best, Improve the Rest: The Power of Positive Reinforcement.” Feeling better now?

From MedSlease: “Re: Medseek. Mr. HIStalk, you are a good judge of character and hit the nail on the head. Do you remember? Mr. Grehalva has been shaking the clients’ hands and working his free hand to pass out pink slips yesterday, five days before Christmas. There have been some very talented, seasoned people let go, including an older employee on medical leave whose wife is in intensive care with a brain hemorrhage. Merry Christmas, Medseek, and a Happy Lay Off. May 2008 bring you all that you deserve.” The reader is referring to this mention. Layoffs are part of corporate culture, unfortunately, and not entirely unsavory provided that: (1) companies don’t overhire and then correct their own excesses by downsizing; (2) the decision of who gets let go is made fairly; (3) executives share the pain by reducing their own compensation or benefits; (4) volunteers are first solicited to leave before axing those who don’t want to go; (5) separated employees are treated fairly and professionally without the usual security guard escort BS; (6) executives realize that layoffs are their failing, not those of the employees involved, and take appropriate actions to either improve their own skills or find better managers to replace them; (7) layoff decisions are a rare exception and not a routine management tool; (8) management is open about why the actions were taken and what they plan to do to avoid it in the future; (9) management doesn’t expect the shell-shocked survivors to cheerfully work extra hard to make up for the loss of downsized employees; and (10) employees aren’t singled out just because the company has at some point in the past decided to pay them higher salaries.

From Dr. Elias Kuando: “Re: Medseek. First Healthvision, now Medseek. It would seem that a lot of these size HIT vendors keep getting it wrong. Healthvision was expected. They lacked focus. But Medseek? This one surprised me. In my contacts with them as both a partner and a customer using their product, I always had the impression they had it right. That the CEO has left either by design or request speaks volumes about the company’s stability or instability. We have had discussions with Geonetric, but felt they were too small to be considered a serious player. The impression we got from their demo and functionality was that they aspired to be Medseek someday. Given this recent news, I would rethink that position.”

The SEC creates a Web-based tool that allows comparing executive compensation at 500 big companies, although the only healthcare IT one I could find was GE.

I decided not to send a Brev+IT today since not much is going on. Next week.

Listening: Catatonia, witty Welsh (and disbanded) chick singin’ alternative rock. Also: new Nightwish, icy, cinematic, and operatic Finn prog metal.

James Pennington, former CIO at Blue Ridge Healthcare (NC), joins JPS Health Network (TX) in the same role.

University of Miami’s heart clinic will use Active Ink‘s electronic forms software for patient check-in on tablet PCs.

Your federal tax dollars at work: bankrupt Bayonne Medical Center (NJ), soon to be sold off to a for-profit company, gets $487,000 for an EMR upgrade.

Philips hasn’t run out of acquisition money yet. The company announced Friday that it will buy sleep therapy products manufacturer Respironics for $5.1 billion in cash.

Merry Christmas (or its equivalent for whatever holiday you may be celebrating).

E-mail me.


Art Vandelay on Vendor Project Management

Many days, I feel like a boxing trainer looking at all kinds of boxers but not finding any with a solid one-two punch – a solid product with strong professional services. More and more, I have been focusing on the strength of the second punch – the vendor’s ability to provide technical assistance and manage a project. You have a real contender when you find one who can help with integration into our diverse environments.

The vendor’s ability to provide technical assistance includes application config., getting their product to work in our hardware environments and delivery of standard interfaces. As virtualization and monitoring ( e.g., response time, SNMP) become more prevalent, the vendors need to develop these skills. The challenges in the hardware environment are the lack of standards and number of varied products we all own. We now include information about these topics in our RFPs to set expectations with vendors.

Managing a project includes a flexible project plan and managing scope, issues and risks. Vendors need to leave appropriate “stubs” in the project plan where we can insert our tasks so that we have an integrated plan. This is always expected from our vendors answering RFPs.

Integration into our diverse environments involves more than just technology.  It is about people, processes and other vendors’ technology as well in order to drive real workflow changes. As the number of broad independent consulting firms dwindle, the opportunity for vendors to step into this space will grow. I have yet to see the “heavyweight” vendors really grab this concept and run with it, directly, or through channel partnerships with others. Right now, we operate as our own integrator as the vendors really aren’t looking outside the domain of their products.

Inga Talks to a Former Meditech Director

I had the opportunity to talk to a former Meditech director recently. He had some interesting commentary about the company, its culture, technology, and people. Here are a few interesting tidbits.

Product development

I would say that a very wise move made six or seven years ago was to consolidate all development efforts throughout the company into one organization. Prior to that development had sprouted up and was going on in all different parts of the company. But when the product efforts were consolidated under Bob Gale, the process of developing products matured to the extent that now there are some really good processes in place that have much less in the way of redundancy and reinventing the wheel many times over and also for more rapidly deploying resources to customers.

Orienting new employees to Meditech

The new employee orientation process is either two or three days and consolidates together a large group of people who all start at the same time. Everyone starts at the same time, and there is a certain bond that people have with that group that they started with. They get to know each other and I think that that method of bringing people on board is a good one in terms of not having to individually deal with so many people on common issues such as enrolling in health plans and understanding benefits and just general corporate culture pieces such as how you page people in buildings and so forth. And without that sort of centralized dissemination of the information you’d have all sorts of crazy things going on that would seem small but would make kind of a funny footprint over the whole organization.

Neil Pappalardo and whether he has a hands on or a delegating leadership style

Both – there are certain things he doesn’t get involved with day to day. He is very closely involved with the broad vision of where the company is going and the broad vision of the company’s financial direction but he is not one who would want to see every single detail of what is going on. He just wants to see if the broad vision is heading the way he has asked it to go. He has a very small number of people that report directly to him who would sort of fill him in whether or not we are moving in the direction he has asked for. He doesn’t have an office and sits out in the open in a workstation with other people. He goes right down in the cafeteria with everybody and just grabs his lunch. If you didn’t know who he was you wouldn’t know who he was (laughs) if you know what I mean. If someone didn’t point out that guy over there at that workstation is Neil, you would be likely to think that guy has been here awhile and looks a little older than everybody else. He has always made time for me.

Technology

The products are now developed in a much newer technology than MUMPS. The latest version of their products 6.0 client/server is written in a brand new technology developed by Meditech. Meditch develops the technology that is used to develop the applications and that has always been the case. MUMPS has not been used – I am not sure it was ever used to develop any Meditech products. A close cousin of that is named MIIS was the first language that any product developed by Meditch was written in. Over the years, that evolved into Magic, and Magic evolved into a Magic-based C/S. This newest technology is a brand new development environment that runs in Windows NT and but it also has ability to run in other environments as well because it relies minimally on the server side. They have applications that are used internally for administrative purposes that are running on Linux instead of NT just to give it a test and see how platform independent the technology can be. That is a newer product that is more of a staff scheduling kind of model that’s issued internally.

Why Meditech has been able to achieve such long-term success

Simply the fact the products do work. That is the key thing. It sounds almost like – why wouldn’t they work. You buy a car and expect to drive off the lot, not that they will have to tow it to your house and hopefully in a couple of months you can drive. I think because the products have been written to work together has been is a key to the success of their stability. They have never acquired other companies’ products and tried to put a portal or some kind of other face on top of that product and interface it behind the scenes. It’s true integration. The products were developed with the same technology under the same leadership and that really gives them true integration and not just the appearance of integration.

Meditech’s biggest challenges and opportunities going forward

I think continuing to retain good talent is going to be a critical piece for them. That is really what the company is built on. It’s human capital. You can be financially solid in many ways, but you have to be able to have the people who can carry out that vision and that plan. Another thing that will be a big challenge is getting customers moving forward on new technology. Magic is very solid and I know for a fact there is no plan to scale back or sunset Magic at all. Magic has been moving forward because there are so many clients on it. It would be very difficult from a logistical standpoint envision trying to get more than 1500 customers over to a brand new platform in a short amount of time. It would take a decade or more.

Whether Meditech will lose clients in the migration to newer technologies

I think the cost factor will be far too compelling to leave. And that people would benefit with staying with Meditech because it is only going to be a fraction of the cost to implement a newer technology then it would be to go out and license brand new software from a brand new vendor and do all the conversion. And who knows how much of the data would go with you and now more than ever be able to keep and maintain that data. Staying with Meditech would allow you to keep your historical data. They have migration plans in place that would allow customers a way to do that with minimal effort and maximum retention of historical data. That is an important thing I think to customers.

The biggest misconception about Meditech

That Meditech systems aren’t open. That is a long time fallacy that people have somewhere grasped onto. I think it is because it is not written in a language that they know, the assumption is it’s a closed system. The newer version, the 6.0 version of c/s, is even more open, even with data repository as one of the standard products that Meditech sells, which is a relational copy of their entire data set. That is about as open as you can get by today’s standards. And, even if you think about it, if the technology is different to write or to develop the product, it can be done in such a way that it will allow you to get at data you want to get at if you know the way to do it, and at the same time it can help protect your data from hackers and viruses and other malware that you want to keep away from the software. If you are running an application that is written in a technology that millions of people are familiar with, then millions of people would potentially know how to write something that would do harm, whereas with a Meditech environment you are not going to find that.

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Currently there are "41 comments" on this Article:

  1. Regarding Medseek, Healthvision et.al. We do our web development internally. Best decison we ever made. Too many outfits out there are not stable. Never even heard of geonetric?? It seems a lot of these HIT vendors are like the dot coms in the 90’s. I would wait for some time to pass and see who is still standing. I expect it will get worse before it gets better. My heart is out to all the Medseek employees terminated just days before Christmas. I dont see why they could not have kept them at the very least until the 2nd of January. Honestly, if removing 30 heads is so critical that you have to do it just days before Christmas you have some serious cash flow problems and that is just another reason to stay away.

  2. “The products are now developed in a much newer technology than MUMPS.”

    What a sad state of affairs we’re in that the first thing Former Meditech Director says about the technology is what it’s NOT based on. Magic is based on MIIS which is based on M. Unless there has been a total re-write of the software, there is still MUMPS at the heart of the beast. THIS IS NOT A BAD THING. However, I understand that the OLD=BAD crowd is large, and I am just one guy.

    I suppose this is why it’s impossible to find anything about MUMPS on the Intersystems site. Cache is “post-relational” right? Same kind of PR spin, different company. They all do it though, Epic, GE, Meditech….no MUMPS here! No siree!

    Feh.

  3. A few comments:

    1. Inbreeding
    In my mind, when I hear the words “homegrown” coming from MEDITECH, I process the word as “inbred.”

    Inbred OS, inbred DBMS, inbred programming language, etc.

    And I guess that’s what I dislike more than old technology: inbred technology. So I’m not saying OLD=BAD, I’m saying THREE GENERATIONS INBRED=BAD.

    Yes, I have used MAGIC, and yes I’ve seen C/S, and C/S fulfills Bob Martin’s adage: “you look at your old system, and you think ‘OH! This is terrible! I’m going to do a Grand Redesign and fix it!’ It takes a great deal of work and TEN FULL YEARS to finish the Grand Redesign, at which point someone looks at the new system and says ‘OH! This is Terrible! I’m going to do a Grand Redesign and …’ ad infinitum

    Bob Martin reference: http://www.developertesting.com/archives/month200609/20060912-SdbpCleanCodeByRobertMartin.html

    And remember, I’m just talking about the technology, NOT THE PEOPLE etc “be respectful” etc.

    2. “Openness” – Let’s try scoring this:

    OPEN as in Open Source:
    * not open source
    * not an open project (i.e. if you want to fix/change something, you cannot submit a patch)

    OPEN as in Open System:
    * as bad as the other vendors, no worse – probably NOT intentionally built to be difficult to integrate with, it just ended up that way. Business rules tied to the data entry form (i.e. not checking data coming over an interface in the same way as data entry). Most of your data stored in a Customer Defined Screen so you can’t make use of a “standard interface” (see #3 below). This same data stored in CDS’s is also why your “relational data repository product” is not as useful as it could be.

    Be careful when throwing around the “Open” word. Open for integration, or Open Source, or Open Source with community involvement?

    3. Standard interfaces – does anyone marvel at the fact that printers from dozens/hundreds of manufacturers all work on Windows? And you don’t have to pay a programmer to build you a custom printer driver every time? Is this an unfair metaphor (hint: it’s plenty fair)?

    4. MUMPS (and, largely generalizing, all its descendants) should not be used for complex systems, in the same way that FoxPro shouldn’t be used for complex systems, and in the same way that Excel shouldn’t be used for complex systems. I’ve said this before in the comments, MUMPS doesn’t scale for complexity well. We could get into “the MUMPS debate” again; that would be awesome.

  4. Art – please…don’t. Sarcasm doesn’t translate well on the internet.

    Programmer – Well, Epic for one. Everyone knows that Epic collapses under it’s own weight once you go over 100 beds. Same with VistA. Also, Cache and GT.M are exactly like FoxPro and Excel. Excellent comparison.

    Oops! There, now I’ve gone and used sarcasm. Hope nobody gets confused!

  5. “Well, Epic for one. Everyone knows that Epic collapses under it’s own weight once you go over 100 beds”

    Sorry, I should have indicated that I was really more interested in the “descendants” angle of p_anon’s post. The fact that MUMPS does not do certain things well does not mean that every language based on MUMPS has the same problems.

  6. I was very careful with my words, and I will continue to be careful.

    1. MUMPS does not scale well for complexity. As for examples, I gave a good general example (business logic embedded in the data entry forms), and if I root around/search the L list, I could post some specific bad code written in whatever MEDITECH variant of MUMPS that is allegedly not MUMPS. I can pull out examples, but I don’t think anyone wants to compare code in two languages.

    I said this the last time we went around: MUMPS (and several other technologies/platforms invented since) encourages “tight coupling” in such a way that when you have a large (i.e. complex) system, your programmers start running over each other/themselves.

    For a language-and-platform-agnostic alternative to this “smart UI” architecture, check out Domain Driven Design, it’s admittedly at the “new software engineering fad” status right now, but the concepts are solid. I don’t think you can adopt Domain Driven Design if you’re using MUMPS; if you can, by all means do so.

    There are videos presentations and podcasts and whatnot if you’d like an introduction, just google for Domain Driven Design Eric Evans.

    2. I didn’t make any mention of scaling for sheer size, intentionally. MEDITECH MAGIC has a problem scaling, but so does every system in the world, including all the new systems built on all the hot hot new technology. I don’t have any complaints about this “size” aspect of scalability.

    3. If there are a few “takeaways” from all my comments here, I’d like them to be:

    * MUMPS is a bad platform for complex systems (e.g. CIS/HIS)

    * Hey, MEDITECH, you don’t need to go implementing literally everything yourself. Feel free to adopt open source. This strategy works for industry peons like IBM, who build products on top of Java (Not Invented Here!) and Linux (Not Invented Here!). Also stop using MUMPS (or MEDITECH NIH equivalent of MUMPS) for new development, for reasons stated above.

  7. “I was very careful with my words, and I will continue to be careful”

    You certainly are. In fact, you are being so careful that you’re really not saying anything at all. It appears that you’re just trying to smear MEDITECH with the shortcomings of MUMPS, when MT applications are not being written in MUMPS.

  8. I’ve posted a longer message over on the forum.

    http://www.histalk.com/forum/showthread.php?p=270#post270

    I’ve pointed out specific MAGIC problems, but like I said in the post, some are incidental and would occur in any system. You’ll also be happy to know (if you’re working for MEDITECH) that I think that the worst thing is that most other vendors have the same architecture, unchanged since the days when hardware cost more than software.

    And I’m only picking on MAGIC because I used it most. Had I been primarily a McKesson (or whatever) customer, I’m sure they would be “feeling the love” instead of MEDITECH.

  9. “I’ve pointed out specific MAGIC problems, but like I said in the post, some are incidental and would occur in any system”

    Not some, every. Every language has issues that make it good for doing some things, and not so good for doing other things.

    In any case, if you want to complain about Meditech, you go right ahead. Just don’t say that Meditech applications are coded in MUMPS, because that simply is not true.

  10. MumpsMan – no sarcasm intended. This is a valuable discussion that is usually spread among many threads within individual postings as opposed to being in one contiguous thread. Call me crazy but following the discussion and learning more about this often controversial topic is “fun” to me.

  11. What is good architecture ? My paycheck is not at all connected to architectures and architecture understanding and I would be curious to know what exactly is it ?
    Is there a governing body out there who gets a final word on WHAT exactly defines a good architecture.
    In 2006 what was considered good architecture by many , in 2007 lo behold you get to hear a totally different story.
    Each technical architect I meet, has some own theory to add about his/her idea of architecture, good architecture, bad architecture. And what finally works in the end is what I call the Workable architecture, problem solving architecture. When you solve a set of problem, you at times do choose after your best efforts to adjust with some’ what you term’ live along’ problems.
    In this moving taget game, for today I would add what solves the problem for the guy who is paying the money, is workable architecture.
    Product Architectures need to solve dual problems, namely 1. Vendor Profit 2.Client needs. What goes out to clients, is usually an optimum solution mix of these two problems.
    In consulting markets we usually solve only one problems namely client needs.We get billed on daily basis, and that is our set of problem. Hence the consulting guys usually have a different understanding of architectures as they solve different set of problems.
    I know in my setup cache and mumps solve old (1960-70s) mission critical business problems, Java takes care of our network applications computing needs very well.And When we need to impress clients with GUI we cannot think of a better solution than .net/Microsoft.
    As newer technologies are cheaper, we have had at multiple times various team trying to run mission critical systems out of cheaper Linux, .net, windows, R on rails technology. And I beleive we will continue to see investment in these kind of test migration efforts till we hit the golden profitable eye. And by then I can extrapolate, architecture would have taken on a totally different meaning and dimension.
    let the fun continue……
    to a great 2008

  12. A few responses:

    1. I’ve spent 0 years programming for MEDITECH.

    2. MEDITECH applications, the ones I’ve seen (MAGIC extensively, C/S from afar) look like MUMPS. We can have a argument discussing the semantics of “what is MUMPS” and that would be awesome as well. The quick definition for me is: if it has all the same weaknesses as MUMPS, then it might as well be MUMPS. MAGIC and C/S, as far as I’ve seen, look like MUMPS. If you want a full list of weaknesses, look at the Wikipedia discussion page to which I linked in my forum post–whoever wrote that did a much better job than I could have.

    3. As far as architectures go, I don’t claim to know everything. If there’s one thing I’d like to point out, it’s that a lot of MUMPS (and MUMPS-alike) folk don’t seem to think there are better alternatives to MUMPS. Which is a perception I am fighting strongly.

    4. I realize now that I probably shouldn’t have used the word “inbred” above, oops 🙂 My bad guys, I apologize for that.

  13. “1. I’ve spent 0 years programming for MEDITECH.”

    “MAGIC and C/S, as far as I’ve seen, look like MUMPS.”

    Given your ZERO years programming at Meditech, when did you get a chance to look at how Magic and C/S Magic work?

    “If there’s one thing I’d like to point out, it’s that a lot of MUMPS (and MUMPS-alike) folk don’t seem to think there are better alternatives to MUMPS. Which is a perception I am fighting strongly.”

    Actually, I think you’ll find that any programmer who really knows what they are doing will tell you that the language they are using really does not matter that much.

  14. “if it has all the same weaknesses as MUMPS, then it might as well be MUMPS”

    So far you have listed exactly ZERO weaknesses that MUMPS and Magic have in common.

  15. I was expecting you to attack my credentials; which is fine, they’re relatively weak.

    I’ve listed a bunch of reasons why I thinks MUMPS and MUMPS-alikes are a bad platform. And then I linked to the Wikipedia article on MUMPS which I think sums up everything I want to say, only better than I could have said it. For hopefully final reference, see here: http://en.wikipedia.org/w/index.php?title=MUMPS&oldid=39516284#Criticisms_of_the_MUMPS_Language – if you don’t want to read it, they have headings/subheadings so you can skim.

    As I said somewhere else, I don’t have to be a super-expert to call this one. It’s like the Hawaii-Georgia game right now–I might be wrong, but I’m strongly betting that Georgia is going to win this one, based off of what I’ve seen. Apply to MUMPS-alikes: I haven’t seen it all, but from what I’ve seen…

    So no, I’m not a platform expert; it’s just that this one is easy to call.

    .

    And yes, I’ve heard the “good programmers program well in any language” quote. This sounds like you’re conceding, excellent.

  16. “I was expecting you to attack my credentials; which is fine, they’re relatively weak”

    Relatively weak is being kind.

    “I’ve listed a bunch of reasons why I thinks MUMPS and MUMPS-alikes are a bad platform”

    No, you haven’t. You keep saying that MUMPS is a bad platform, but you have listed ZERO reasons why Magic is a bad platform, or what Magic and MUMPS have in common that makes Magic so bad.

    “if you don’t want to read it, they have headings/subheadings so you can skim”

    I already skimmed it, and it had nothing to do with Magic.

    “I don’t have to be a super-expert to call this one”

    No, but you do need to have a clue, and you have none.

    “And yes, I’ve heard the “good programmers program well in any language” quote. This sounds like you’re conceding, excellent.”

    I’m doing nothing of the kind. Unless you can list some specific shortcomings of a language, which you have not, or know something about the language, which you clearly do not, then it makes no difference to you what language Meditech uses.

  17. It’s true I don’t have access to the source code repository for all the HIS/CIS systems ever written, but I HAVE seen tidbits here and there about the hot new MEDITECH programming environment. Witness here:

    http://comstock-software.com/blogs/cds/2007/09/meditech-fs.html

    Let’s get specific based off of the limited code snippet:

    Still using MUMPS-like syntax:
    * Terse variable names. There is no excuse for this in 2008 when we’re provided GBs of RAM and TBs of storage.
    * Space used as a control structure (this was listed in the MUMPS criticism page)
    * MUMPS syntax, unfamiliar to many of us, and (if it’s not MUMPS) not supported by a training/learning/3rd-party ecosystem present in mainstream languages/platforms.

    If you would like, I can further tie the generic criticisms of MUMPS specifically to either MAGIC or the limited bits I’ve seen of FOCUS (FS/FOCUS? sp?). I don’t want to further beat up on MAGIC because it was brilliant when it was written (1960s), but I can if you’d like.

    The point is: nothing has changed. It’s 2008 and the code snippet I referenced looks as terse and unmaintainable as everything I’ve seen in MAGIC. If FOCUS is anything like C/S (and by extension MAGIC), nothing will change, again.

    I would like to focus on the “business logic enmeshed in the UI layer” issue if you’d like to work on a big specific criticism. If so, let me know and I’ll post on the forum and hopefully organize it better than this mishmash.

  18. You don’t like the syntax?

    SOUND THE ALARMS!!!

    You must be kidding.

    If you’re a user you don’t have to know the syntax.

    Do you have any real issues?

  19. “Let’s get specific based off of the limited code snippet”

    By the way, the idea that you think you can make assumptions about a language based on a snippet of code like that is laughable.

  20. So in summary:

    1. I have listed a great deal of specific and general claims against MUMPS-style architectures and platforms. See above, we’re ringing in a grand total of 24 comments at this point. The best counterargument I’ve heard thus far is “platform doesn’t matter.” Which is fine; that’s valid. I’ll just say: platform DEFINITELY matters.

    Platform matters because of the “why” test–when you ask “why?” enough times, you eventually get to the root problem. I’m sure you’ve heard of this “why” test. “Why did we experience downtime?” “Because the system got hung.” “Why?” “Because the queues locked up permanently.” “Why?”

    Do you know the answer to that last “Why?” Hint: it starts with M and (optionally) ends with UMPS.

    “Why are our interfaces buggy?”

    “Why can’t our systems adopt our “unique like a snowflake CDM” into their standard CDM?” (I know “a standard template” is something I’ve wanted)

    “Why is it so difficult/impossible to troubleshoot some problems?”

    “Why am I told so often things are ‘impossible’?”

    “Why is the pace of development slow?”

    “Why is system integration between two well-established, large systems so difficult and require so much customization?” (this is not just MUMPS’ fault, but … that’s another long post)

    2. I will leave it to the reader to determine whether I have any authority to be making claims, or whether my claims are valid at all. It’s clear we disagree on this point, and I don’t think we’re making headway anymore.

    3. If there’s one thing you come away with, just try not to take for granted that “this is just the way things are.” They don’t have to be.

    I won’t be replying further, but I subscribe to the comments RSS feed so I’ll see replies.

  21. #1 – The Why test.

    “Why are our interfaces buggy?” – Ask your vendor, this sounds like poor programming. Check Cloverleaf?

    “Why can’t our systems adopt our “unique like a snowflake CDM” into their standard CDM?” – again, an issue with the vendor, not the language/DB

    “Why is it so difficult/impossible to troubleshoot some problems?” – Lack of training? D ^%ER – proper error logging is key.

    “Why am I told so often things are ‘impossible’?” – You aren’t working with the right people. Nothing is “impossible” with M, but many things are cost prohibitive. “Impossible” just means that the knowledgeable people aren’t willing to invest time in educating you as to the challenges.

    “Why is the pace of development slow?” – Of the ISO standard? Read the wikipedia entry. The MDC disbanded. If you mean of the application, again that is a gripe between you and the vendor, and has nothing to do with MUMPS.

    “Why is system integration between two well-established, large systems so difficult and require so much customization?” (this is not just MUMPS’ fault, but … that’s another long post) – None of these Whys? are attributable to MUMPS. Why even include this?

    As for #2, yes – the reader should make their own determination of your authority to make claims regarding M.

    http://en.wikipedia.org/wiki/Fear%2C_uncertainty_and_doubt

    #3 – “This is the way things are…” You are correct. Things don’t have to be this way. Start your own EMR company and build your product in Java on top of SQL or Oracle and join the 20th century. Or take your fight to the source and convince vendors to re-write thousands of lines of legacy code for no ROI. In the meantime, the rest of the HIS world will continue to work with and improve upon M-based applications.

  22. 1. “Do you know the answer to that last “Why?” Hint: it starts with M and (optionally) ends with UMPS.”

    “Why is it so difficult/impossible to troubleshoot some problems?”

    “Why am I told so often things are ‘impossible’?”

    “Why is the pace of development slow?”

    Unless you’re using a Meditech system, then it ends with “agic”. If you’re using some other kind of system, it begins with a different letter and ends with a different group of letters. None of those problems have anything to do with the language, and Magic is not the only language that produces code with bugs. They all do.

    ” 2. I will leave it to the reader to determine whether I have any authority to be making claims”

    Indeed, I think we have clearly established that you have no idea what you are talking about.

    “3. If there’s one thing you come away with, just try not to take for granted that “this is just the way things are.” They don’t have to be.”

    Sorry, but the only thing I took from this is that consulting standards must be pretty low if you’re able to find employment.

  23. “Why is the pace of development slow?”

    p_anon, the problem isn’t just that you’re wrong when you make the claim that things like this are due to the language an application is programmed in, the problem is that your claim is obviously wrong even to a newbie, and yet you keep repeating it. It causes one to wonder what your real agenda is here.

  24. It’s been very interesting to watch the banter spawned as a result of the notes summarized by Inga following an informal chat she and I had in December.

    It is amazing to see how many “critics” have added their two cents that aren’t worth a penny. Do you REALLY know what’s going on at MEDITECH? Do you know what the philosophy of the company is moving forward into the future? If you ask the right people in the company they’ll tell you. It would probably be worthwhile to ask and be informed rather than make bombastic statements such as those that speculate that MUMPS equates with Magic and Magic with C/S and, even more absurdly, that Focus somehow equates with Magic? If that’s what you “think” you’re just flat out wrong in your assumption, and that is all it is, an assumption.

    To those who believe that I must be an in-bred, blind follower who is incapable of making objective statements about a company I workED for for two decades are, again, just flat out wrong.

    I continue to work in the HIT industry as a vendor neutral consultant. If anything, my stated impressions about MEDITECH have only been solidified further now following even greater exposure to other vendors.

    Even while working at MEDITECH I was regarded as an open minded thinker who constantly looked at what others in the market were doing so that I could find a way to ensure that what I was doing for MEDITECH exceeded what the competition was doing.

    A professional with blinders on would not have been the president of the Association of Support Professionals and a vice-president of the HDI.

    If anything, my participation in these organizations opened the eyes of the others who were members. They couldn’t believe how dramatic the gap was between what MEDITECH did to support its customers compared to what any of the other vendors who were members did.

    In fact, what we did in the area of supporting customers stood out to the point that it was cited as a positive case study in a report titled “Designed for Supportability” which was authored by two prominent management scholars from Boston and London.

    My agenda? Show me the goods! I’m certainly not blind, yet I am objective and I am educated. If I see a deal out there that matches the dependability and value that MEDITECH offers, I’ll be the first one to acknowledge it.

  25. “Focus somehow equates with Magic? If that’s what you “think” you’re just flat out wrong in your assumption”
    Your statement above is 100% incorrect.

  26. Not trying to speak for Anonymous, but if Einstein himself came up to me and told me he’d invented a perpetual motion machine I’d still be skeptical…

    I’ll be the first to admit that I know nothing about Focus, but the MUMPS – MIIS – Magic genealogy is well documented. For BostonHITman to suggest otherwise damages his creditability. If Meditech decided to do a complete re-write of the Magic product, why re-invent the wheel (as is being suggested) with a home-grown product? What would be the business decision driving this? If Meditech is married to the speed and power of a MUMPS-like platform, why not go with Cache and let Intersystems do the heavy lifting? If not, why not go with a “real” language and DB like p_anon is suggesting?

    Could it be that Focus migration requires some backwards compatibility with the MIIS derivatives? This seems to me to be a logical assumption, and the simplest explanation for continuing to develop an in-house language/DB.

    I’m not try to attack anyone here, I’m just really genuinely curious. I’ve long since moved on from my Meditech support days, but I like to be able to speak intelligently to the historical nature of M and it’s “family tree” – no matter how extended. I’d like to add that in the interest of full disclosure that I am also a Meditech “fan”. and think that it is a great system.

  27. “Not trying to speak for Anonymous, but if Einstein himself came up to me and told me he’d invented a perpetual motion machine I’d still be skeptical…”

    Einstein would have a lot to gain by inventing a perpetual motion machine. What does Meditech have to gain from telling people they’re replacing an old language they invented with a new language they invented if it’s not true? Or even if it is true? If there’e nothing gained either way, I don’t see why there is any reason to doubt it.

  28. Mumps Man, I take offense at your intonation that my statements related to the entirely new Focus technology somehow damage my credibility. Truth be told, your statements that continue to link any new technology MEDITECH develops back to MUMPS only serve to damage your credibility assomeone qualified to comment on this subject. at all.

    Let’s just agree to disagree: I am right and you are completely wrong. The future will prove the accuracy of my statements and the folly of those you’ve made.

    Clearly, you must know that this is a forum which can be searched and will be here for quite some time. If you’d like to dispute what I’ve written, just keep in mind that the archives will be here in the future to document your misguided statements.

    By writing what you’ve written already you’ have already damaged your own credibility because your statements are now here for posterity. It’s up to you to decide whether you’d like to add more uninformed prognostications that will only serve to dig yourself in deeper.

    (See: http://en.wikiquote.org/wiki/Bill_Gates)

    You claim to be a MEDITECH fan. If this is true, take the advice from my most recent post and ask them what they’re up to. They’re proud of their newest technologies and they won’t be shy about the reasons why.

    Remember, the actual name of the company is not MEDITECH but “Medical Information Technology, Inc.” They are committed to developing technologies best suited to the needs of the healthcare market. Can you name another company that does that in addition to writing all of the software they market? I think you’d be hard pressed to find a company that just writes all of their own software themselves., never mind having the vision to do it using a technology that they designed specifically to meet the unique needs of healthcare organizations.

    If you consider how long it takes to re-write an entire Healthcare Information System that is truly integrated you would have to be short-sighted to use the technology “du jour”. The over-the-counter development tools of today will be obsolete or extinct before a complete HCIS re-write by the same vendor is completed. MEDITECH knows this because they are the only vendor that’s done it.

    I think one only has to look at the long-term success that MEDITECH has had to recognize that they KNOW WHAT THEY ARE DOING. Would you, or anyone, contend that they’re anything but a phenomenal success as a business? It’s not by accident. As a company they are as stable as the rock of Gibraltar. If I were a CIO making a decision about which vendor to implement or upgrade with I’d sleep a lot better at night knowing that I’ve selected an organization that has the largest market share, has been around the longest, has the highest customer retention rate, has no debt and is highly profitable even though their products and services are priced at or below market norms.

    Think about it…

  29. “What does Meditech have to gain from telling people they’re replacing an old language they invented with a new language they invented if it’s not true?”

    Contracts signed by people like p_anon. Who, sadly, there are quite a few of in decision making positions. Like I said beofore, mention MUMPS and people run screaming for no other reason than it’s “old technology”. MEDITECH is revising it’s PR history (just like Intersystems), in an attempt to purge M from it because that is what’s going to make them more money.

  30. BostonHITman said “It would probably be worthwhile to ask and be informed rather than make bombastic statements such as those that speculate that MUMPS equates with Magic”

    I said “the MUMPS – MIIS – Magic genealogy is well documented. For BostonHITman to suggest otherwise damages his creditability.”

    http://en.wikipedia.org/wiki/Meditech
    http://www.referenceforbusiness.com/history2/10/Medical-Information-Technology-Inc.html

    (For some reason this corporate timeline is no longer on the main Meditech site:)

    http://web.archive.org/web/20001109094100/www.meditech.com/Main/AboutUs.htm

    (Just scroll to the right…)

    Anyway in a later post you siad “Mumps Man, I take offense at your intonation that my statements related to the entirely new Focus technology somehow damage my credibility.” Ok so NOW you may be talking about Focus, but I am only speaking about your statements that “MUMPS equates with Magic”. I freely admit (and did so earlier) that I know nothing about Focus and am just looking for some clearer historical perspective on MUMPS at MEDITECH.

    Either way you’re right about people being able to search teh intrawebs (see above)…technology is amazing like that. I’m sure that I’ll rue the day that I made heated personal attacks, spewing outlandish FUD and avoiding specifics in a lame attempt to cover my lack of technical knowledge. One of us is going to come off as irrational and lacking substance. Re-reading these posts I think that person is clearly me. Sorry for wasting everyones time.

  31. “but the MUMPS – MIIS – Magic genealogy is well documented. For BostonHITman to suggest otherwise damages his creditability”

    No one has denied the MUMPS – MIIS – Magic genealogy. What he, and I, have said is that they’re not the same language.

    By the way, there is no compatibility between Magic and FS.

  32. Thanks for clearing this up. I must have mis-interpreted the “speculate that MUMPS equates with Magic” statement. Sometimes it’s hard to understand tone or inflection on the internet.

    As for the language incompatibility, does this mean that Magic and FS will still store data in a similar way? IE can I layer the new app code on top of my old array without changing the data structure?

    Sorry if I’m talking GT.M/Cache talk, it’s what I am most familiar with.

  33. “As for the language incompatibility, does this mean that Magic and FS will still store data in a similar way? IE can I layer the new app code on top of my old array without changing the data structure?”

    I’m not entirely sure what you are talking about, but I’m pretty confident the answer is no.

  34. wow – this was fun to read – I know its two years later – but i just had to post from the perspective of someone who has worked in information systems outside of healthcare and just joined the meditech world in 2008.

    ‘tightly coupled’ and ‘loosely coupled’ is the big deal here. everything else is dull details. It is why meditech has a retention rate and overpriced software. the rest of the IS world has moved on to better architectures. Even the biggest dogs are starting to realize that enterprise integrated systems are not the way to go. but for most hospitals, moving on is cost prohibitive unless you bring in programming talent that is still expensive and a high risk due to the difficulty of measuring talent in the interview process.

    people are smearing meditech because when they realize this, they feel like they are being taken advantage of… and they are.

    In general – quit standing on your floating ice patch defending the water. in another 10 years all systems will evolve to a master data system architecture with a SOA layer, a data dictionary, and business rules management with a generic front-end. Its inevitable, and much cheaper.

    in the meantime – I have to spend hours figuring out how to code in meditech so I can make an interface that would normally cost $10,000 plus maintenance… (a two hour affair in any present day coding architecture) then after that I have to build an NPR report that will do the cost containment report because I couldn’t get anyone on the phone at meditech that new how to get their standard report to work correctly. In the mean time, I have to try to look through source code so I can find functions in this ‘open’ language… because when I asked meditech for info on programming – they said ‘get a job at meditech’. pretty smug, no?

    and if you think i am going to spend millions of dollars moving to 6.0 — with no migration plan — and integration costs that include consulting bills because I can’t pull folks off the floor to build… well i think you can see how absurd that is.

    Just my two cents, two years late. I hope you all open your minds a bit and realize that if we don’t demand change, we will continue to be locked into mediocrity. We need to join together to continue the progress of architectures that increase efficiencies, ROI, and security… or at least bring in the latest Information System best practices from other fields… not spending hours defending last decade’s technology.







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