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John Paul Cook

NoSQL, MUMPS, HL7, SNOMED, Meaningful Use and Electronic Medical Records

MUMPS is a NoSQL database and programming language that does not receive widespread attention. I searched for lists of the most important or most used NoSQL databases and MUMPS did not make the lists, although it should.

The Massachusetts General Hospital Utility Multi-Programming System, often referred to as just M, is a key-value database that was developed in 1966. MUMPS became the foundation for the Decentralized Hospital Computer Program (DHCP) developed at the U.S. Veterans Health Administration (VHA). Notice that I said developed at the VHA, not by the VHA. At one time there were direct orders prohibiting further development of this system and work continued in secret. Eventually, DHCP became VistA, which is one of the most widely used Electronic Medical Records (EMR) systems in the world.

VistA is not open source software, it is public domain software. That means that anybody can do anything to it, including making proprietary changes under no obligation to give the changes back to the public. Most VistA implementations use the SQL friendly Caché version of MUMPS from InterSystems, which you can download for free. Caché is also used by the dominant commercial EMR vendor, Epic Systems, as well as TD Ameritrade and the European Space Agency.

VistA does not include a gui. At VA Hospitals, the Computerized Patient Record System (CPRS) is a separate application that provides a minimalist gui on top of VistA. VistA supports the Health Level Seven (HL7) messaging standards used for healthcare informatics interoperability. It also supports SNOMED CT, a healthcare taxonomy supporting exchange of healthcare data. The VA has an ongoing project to enable VistA to support both ICD-10 and Meaningful Use. ICD codes are used to classify and categorize both medical diagnoses and inpatient procedures. Meaningful Use is part of the Patient Protection and Affordable Care Act (PPACA, otherwise known as Obamacare) and affects the reimbursement rates healthcare providers receive.

SNOMED CT, HL7, and ICD-10 are standards used around the world in healthcare. Meaningful Use is specific to the United States. I’ll be discussing all of these topics in greater detail in future blog posts.

Published Saturday, August 10, 2013 12:49 AM by John Paul Cook

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merrillaldrich said:

Hi John  - this is really interesting, and I had not thought of that system as a "nosql" system. OTOH, I have dealt with Cache, and it was, how can I put this, EXTRAORDINARILY problematic. I still get twitchy when I see the name. Maybe it was the version, perhaps new ones are better / simpler / more reliable.

August 12, 2013 6:22 PM

Ian Yates said:

Looking forward to the series :)

August 12, 2013 7:35 PM

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About John Paul Cook

John Paul Cook is a database and Azure specialist in Houston. He previously worked as a Data Platform Solution Architect in Microsoft's Houston office. Prior to joining Microsoft, he was a SQL Server MVP. He is experienced in SQL Server and Oracle database application design, development, and implementation. He has spoken at many conferences including Microsoft TechEd and the SQL PASS Summit. He has worked in oil and gas, financial, manufacturing, and healthcare industries. John is also a Registered Nurse currently studying to be a psychiatric nurse practitioner. Contributing author to SQL Server MVP Deep Dives and SQL Server MVP Deep Dives Volume 2. Connect on LinkedIn

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