I’ve seen Java described as “the new COBOL” on some websites. I’m unsure if that’s fair to COBOL.

We can live with MUMPS programming for the same reason billions of dollars are moved around by COBOL every day: it works.

Or even comments from you would do.

From wiki

The VistA system is public domain software, available through the Freedom Of Information Act directly from the VA website,[11] or through a growing network of distributors. The VistA Software Alliance is a non-profit trade organization that both promotes the widespread adoption of versions of VistA for a variety of provider environments.

VistA is a collection of about 100 integrated software modules.

VistA was developed using the M or MUMPS language/database. The VA currently runs a majority of VistA systems on the proprietary InterSystems Cach

What worked well about the VHA VistA system was a) it was developed via a prototypical opensource process, with b) substantial, ongoing input from its users.

I also understood that Vista was based on an old programming language that has it’s problems even for FLOSS people?

The Victorian Government is committed to the Cerner Corporation system as used by Childrens Hospital of Pittsburgh – see below. It’s already running about 3 – 5 years late and over budget to buggery.

Things did not go so smoothly at Childrens Hospital of Pittsburgh, which installed a computerized health system in 2002. Rather than a godsend, the new system turned out to be a disaster, largely because it made it harder for the doctors and nurses to do their jobs in emergency situations. The computer interface, for example, forced doctors to click a mouse ten times to make a simple order. Even when everything worked, a process that once took seconds now took minutesan enormous difference in an emergency-room environment. The slowdown meant that two doctors were needed to attend to a child in extremis, one to deliver care and the other to work the computer. Nurses also spent less time with patients and more time staring at computer screens. In an emergency, they couldnt just grab a medication from a nearby dispensary as beforenow they had to follow the cumbersome protocols demanded by the computer system. According to a study conducted by the hospital and published in the journal Pediatrics, mortality rates for one vulnerable patient populationthose brought by emergency transport from other facilitiesmore than doubled, from 2.8 percent before the installation to almost 6.6 percent afterward.

Quite the reverse – as you yourself point out, the risk of failure with big centralised projects is very high. And once in they tend to be extremely inflexible, stifling all innovation.

It looks like the stimulus packages in the US and here are not really geared to improving services for citizens, but keeping select businesses happy.

There are two ways citizens can benefit from a nationwide health record system:
* Epidemiologists can discover patterns easier
* Health professionals know the history of the individual patient

However, the big problem is setting up the appropriate access controls, and ensuring currency of information. This was all defined by the OMG Healthcare Domain Task Force years ago, in the Clinical Observation Access Service, and, in a wider context (but not finalized), the Healthcare Services Specification Project.

Key among the requirements is unambiguous authentication and authorization of consumers of clinical data. By itself, nationwide authentication and authorization systems can provide huge benefits to all types of activities, not just those related to clinical observations, but I’m still to see anything here or in the US (I may have missed it) that pushes such essential infrastructure.

Has anyone else seen initiatives that put the basics in before the medical stuff which depends on the basics?