For as long as anyone can remember, the US Dept. of Veterans Affairs (VA) has managed patient data on VistA, their EHR system that was started in the 1970s. VistA consists of 180 different applications for clinical, financial, administrative and infrastructure functions in the VA. The Computerized Patient Record System (CPRS) represents the common clinical graphical user interface started in the 1990s.
The VA has released an RFI for companies interested in bidding on the process management of a migration from VistA to an ‘off-the-shelf’ application. The primary reason given for the change is that VistA has been customized into ‘130 unique instances making modernization and standardization efforts extremely complicated, expensive and time consuming’.
So basically, the VA is throwing in the towel on being a software developer (wisely in our view) and realizing that the architecture of VistA (MUMPS) may also not be the best development system to be on in a web 2.0 driven world. While some systems like Epic have stayed in the MUMPS universe, newer systems that utilize mobile devices are being developed in more modern languages and have a much bigger pool of programmers to choose from.
But whatever the cause for the VA’s decision, it is clear that the future for VistA will be dramatically different; unless the VA selects another MUMPS-based system like Epic, there will be a lot fewer MUMPS programming jobs. Like COBOL programmers of old, there are many that continue to carry the MUMPS torch including those that have implemented Open VistA, the open source version of VistA.
Given that open source software is free, one might asks why anyone would pay millions of dollars or even hundreds of millions for a system like Epic, which is also a MUMPS-based system. The answer is the same as why aren’t we all running our computers on Linux? Free is not really free, especially over the long run. And with the VA now set to abandon a software project that they have spent billions on for an ‘off the shelf’ platform, we can see that even they realize that free is not really free.