Some History about MUMPS and InterSystems' Caché DBMS

Newer versions of the computer language MUMPS are used in a number of important healthcare computer systems including Sunquest, Epic, and Meditech (see: Persistence of the MUMPS Programming Language in Healthcare Applications). Here's an excerpt from comments posted on a federal technology blog called nextgov about MUMPS (see: What's So Wrong with MUMPS?):

I'm not talking about the disease -- although some folks treat it as such -- but the software that is the heart of the Veterans Health Information Systems and Technology Architecture, the electronic health record system at the Veterans Affairs Department. The big obstacle for MUMPS is the perception that no one except VA uses it, a simplistic view reinforced by Sen. Richard Burr, R-N.C., during a hearing on the future of VA information technology systems [recently]. At about the same time Burr was bashing MUMPS, the Coast Guard awarded a $14 million contract to Epic Systems Corp. for an electronic health record system based on MUMPS. That should be no surprise because Judy Faulkner, Epic's chief executive officer, founded the company in 1979 after working on MUMPS for VA. Faulkner has grown Epic into a giant in the heath care IT field, including a megabillion dollar contract with Kaiser Permanente, which has 8.6 million patients and 15,000 doctors. The company competes with Genera Electric Healthcare, which also based its software on MUMPS....So, why, of why, do VA and its chief information officer, Roger Baker, want to move off a MUMPS-based VistA, and why is the Defense Department considering Epic when they can tap into the stable and free system Faulkner based her company on?

You can't really discuss MUMPS these days without some mention of InterSystems. Here is some information about this latter company and its DBMS product, Caché, which is sold almost entirely indirectly through independent software vendors (ISVs) like Epic as an embedded component of their products (see: InterSystems: Best Kept Secret in the DBMS World)

InterSystems is a privately held software company...which has played a key role in the evolution of database technology. Mention of the company is, however, almost guaranteed to draw blank stares from cognoscenti in the industry. InterSystems began in 1978 as a provider of technology in support of MUMPS, an operating system that also acted as an interpretive language runtime environment originally developed for use by the Massachusetts General Hospital. The language was also called MUMPS, or M, and included a "global array facility," really a simple multidimensional DBMS. InterSystems developed a version of this facility that it originally called InterSystems MUMPS (ISM) to distinguish it from DSM (Digital Standard MUMPS), which was offered by Digital Equipment Corp. until InterSystems bought that version as well in 1994.....In 1997, InterSystems released Caché, a postrelational DBMS that used the M Technology storage engine but layered over it object-oriented services, an M Technology compatibility layer, and an ANSI standard SQL API. Since MUMPS and M Technology were originally used mainly by hospitals and healthcare IT service and software providers, the initial customer base for Caché was heavily oriented in the healthcare direction, although there was some interest from the financial community owing to its high performance.

I want to respond to the question raised in the nextgov note about why the VA's CIO is exploring the possibility of moving away from the MUMPS-based VistA EMR and to Epic. First of all, there is a large cost to the VA, I am sure well known to this VA executive, of maintaining a large staff of programmers to support VistA. Secondly, I am also sure that there is intense political pressure exerted on the VA by politicians from states such as Wisconsin, the home of Epic, to get out of the software business and purchase an EMR in the commercial software market.

I do take issue with the somewhat misleading statement above from nextgov: why is the Defense Department considering Epic when they can tap into the stable and free system [Epic CEO Judith] Faulkner based her company on?  While it's true that standard MUMPS was originally open-source and free, both Epic and InterSystems are profit-making enterprises and, as it is well known, the Epic EMR does not some cheap (see: Are You an Enterprise or Best-of-Breed CIO? Access to Cash May Make the Difference). Put another way, there does not seem to be a big MUMPS price break baked into the cost of an Epic EMR. Epic and InterMountain are providers of technology in support of MUMPS.

Comments

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[Dod Mumps User]

The primary reason that MUMPS based software is derided by people running the show in DOD and the VA is because the programming language itself is old. The other worry is that the programmers that do know MUMPS are old and the 'kids' aren't learning it at MIT these days.
I haven't heard any claims or slow transaction speed or other defect with the actual programming language.

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What is the excuse that they are giving for wanting to get away from the MUMPS software? Is there compatability problems. I am just curious what explanation are they giving for thier actions?