If anyone's interested in learning about healthcare IT, just ask!

Replies to This Discussion

Permalink Reply by David Morris on July 13, 2009 at 12:25pm

I know this is a very open ended question but where do I begin? I would like to build my career in Healthcare IT, but my first steps out of college landed me in networking with a government contractor. I am trying to determine what skills I need to develop in order to make the move and get back on track. Any help would be greatly appreciated.

Permalink Reply by Branden Tanga on July 15, 2009 at 6:31am

It really depends on where you would like to be in healthcare IT. I'm not familiar with other industries, so I don't know how the complexities of healthcare compare to other industries, but healthcare IT jobs tend to break down into these categories:

* programmer - self explanatory
* application specialist - someone who is an expert at using a healthcare application, can be a highly technical position if the application is complex, but oftentimes is not a programmer themselves.
* clinical specialist - someone who has direct knowledge of healthcare. Commonly a nurse or doctor. Oftentimes the clinical and application specialist are the same person.
* Networking - same as other industries, but oftentimes the networking person is also responsible for maintaining the spiderweb of network connections between all the different applications at a particular site.

As far as how to get your hands dirty and learn? Unfortunately, most healthcare applications are closed source and extremely protective of their IP. By and large, the most wide spread open source EHR (electronic health record) are the variants of VistA (capitalized A on purpose), which is the EHR that is used by the U.S. Dept of Veterans Affairs in all of their inpatient facilities across the nation.

I would recommend you join the google group hardhats, they are the technical forum for VistA enthusiasts.
http://groups.google.com/group/Hardhats?pli=1

Due to its history of being an internal application in the VA, you pretty much needed to be a VistA expert already in order to install or use it. However, the hardhats community has made great strides lately in packaging a ready to run flavor of VistA in an installable format (not sure if it's point and click, but it's way easier than it used to be). On the hardhats list, the latest installer is named astronaut.

If you are a a programmer, be prepared to have your eyeballs pop out of their sockets when you examine VistA source code. It works, and is algorithmically correct, but Mumps (the language VistA is written in) let's you take syntactic shortcuts that are not available in newer languages. If you google around for the most unreadable code in production use, it tends to be VistA code written in Mumps. I can read VistA code no problem, I'm not sure if I should be happy or sad about that. Note: I am very fond of Mumps, particularly GT.M (flavor of Mumps). What I am not fond of is the VA coding standard.

Since VistA is freely available (albeit hard to work with), many, many other closed source EHR's out there are actually based on VistA (though none of them will admit it). If you see a job posting for a Mumps programmer in healthcare, it's VistA or VistA related.

I have a special place in my heart for VistA, it's where I got my start in healthcare IT. It was a difficult struggle to get up to speed, but when you come out on the other end, you'll find that your skills are in high demand.


David Morris said:

I know this is a very open ended question but where do I begin? I would like to build my career in Healthcare IT, but my first steps out of college landed me in networking with a government contractor. I am trying to determine what skills I need to develop in order to make the move and get back on track. Any help would be greatly appreciated.

Permalink Reply by Branden Tanga on July 15, 2009 at 6:34am

I also see on your techhui page that you're friends with Curtis Kropar. He has also worked in the healthcare industry, programming in Mumps for VistA. He may have additional insight as to where you might want to look to get a leg up in the industry.


David Morris said:

I know this is a very open ended question but where do I begin? I would like to build my career in Healthcare IT, but my first steps out of college landed me in networking with a government contractor. I am trying to determine what skills I need to develop in order to make the move and get back on track. Any help would be greatly appreciated.

Permalink Reply by Ken Berkun on July 15, 2009 at 11:13am

Whoa, MUMPS is still in use? Cool!

Permalink Reply by Branden Tanga on July 15, 2009 at 6:18pm

Yups, its still in heavy use in the healthcare and financial industry. If there's a black box at the far back end of the server room that does the actual heavy processing, it's probably a MUMPS box. Although in finance it might be cobol or a few other languages as well.

Here's a link to a press release from my favorite flavor of MUMPS, GT.M
http://www.fidelityinfoservices.com/fnfis/newsroom/20041108b.htm

An excerpt:
"Profile is deployed in more than 350 financial institutions in 18 countries, providing excellent scalability and cost-of-ownership benefits. The KTB implementation is the first production Profile system on a SUN platform and the world’s largest real-time implementation in a single configuration, with over 14 million accounts and 10 thousand workstations. " -- Profile is Fidelity Information Services RDBMS layer which sits on top of GT.M

In the healthcare industry, MUMPS is used in VistA, which is the Electronic Health Record used by the U.S. Dept of Veterans Affairs, as well as in CHCS, which is the inpatient EHR used by the Department of Defense. Both of these organizations (DoD and VA) constitute the 2 largest healthcare providers in the nation. VistA, and by extension MUMPS, is also used by several countries as their state run EHR. One example is IMSS in Mexico, which is their state healthcare organization. IMSS covers about half the population of Mexico (approx 45 million out of 100 million), and they use VistA as one of their 2 Hospital Information Systems.

So, MUMPS is everywhere, but no one knows it.


Ken Berkun said:

Whoa, MUMPS is still in use? Cool!

Permalink Reply by Ken Berkun on July 15, 2009 at 7:13pm

When I was at U.C. Davis in the mid 70's my favorite professor was Dr. Dick Walters who taught information systems in the medical school. He was heavily involved in the standardization of MUMPS. He used it to teach us about the standardization process, which is pretty interesting, but painful. I wrote a few simple MUMPS programs but have never had call for it since. But the way it uses sparse arrays and especially the way you can use strings as indexes into arrays is pretty neat. Thanks for bringing back memories.


Branden Tanga said:

Yups, its still in heavy use in the healthcare and financial industry. If there's a black box at the far back end of the server room that does the actual heavy processing, it's probably a MUMPS box. Although in finance it might be cobol or a few other languages as well.

Here's a link to a press release from my favorite flavor of MUMPS, GT.M
http://www.fidelityinfoservices.com/fnfis/newsroom/20041108b.htm

An excerpt:
"Profile is deployed in more than 350 financial institutions in 18 countries, providing excellent scalability and cost-of-ownership benefits. The KTB implementation is the first production Profile system on a SUN platform and the world’s largest real-time implementation in a single configuration, with over 14 million accounts and 10 thousand workstations. " -- Profile is Fidelity Information Services RDBMS layer which sits on top of GT.M

In the healthcare industry, MUMPS is used in VistA, which is the Electronic Health Record used by the U.S. Dept of Veterans Affairs, as well as in CHCS, which is the inpatient EHR used by the Department of Defense. Both of these organizations (DoD and VA) constitute the 2 largest healthcare providers in the nation. VistA, and by extension MUMPS, is also used by several countries as their state run EHR. One example is IMSS in Mexico, which is their state healthcare organization. IMSS covers about half the population of Mexico (approx 45 million out of 100 million), and they use VistA as one of their 2 Hospital Information Systems.

So, MUMPS is everywhere, but no one knows it.


Ken Berkun said:

Whoa, MUMPS is still in use? Cool!

Permalink Reply by Curtis J. Kropar on July 16, 2009 at 12:29am

HI GUYS !

Hey Branden ! I have not seen you around in a while. I just stumbled across this page tonight. Thanks for the mention / referral by the way.

Yes, I have a bit of a working with healthcare. Have done it on and off for about 10 years.
Worked with the VA in Cleveland very early in my career, way back in '86. Was an original programmer for VistA for a while. More recently doing medical research programming in Indianapolis and then back at the VA here in Hawaii.

Branden is right, Vista uses MUMPS code. Although what makes it so incredibly difficult to read is that VistA is built using a combination of MUMPS and VA-Fileman. (also written in mumps) combining the two, there is basically no standardized program flow. Entry points can come from anywhere, exits points are sometimes based purposely on error trapping.

I have to say thought that MUMPS, in my opinion, even though it is a approaching being a 50 year old language.... is one of the most powerful languages you can get your hands on. Even back in 67 when it was designed, it had built in data redundancy, build in distributed data, Y2K compliant, multi user, multi process, and several other heavy hitting features. Plus... the speed is BIZZAARREE!!!!! Another point Branden made about it being used in the financial industry. It is actually becoming one of the industries new standards. (what was old is new again) The pure throughput of the language allows it to execute so fast, large processing centers are starting to take notice to this. This "little" online stock company called Ameritrade, dropped their relational databases and switched over to mumps. Because their transactions are guaranteed, the relational databases were too slow. They found the speed of mumps and converted to it, dumping the relational databases. And with the GT.M version, you can do SQL statements against the MUMPS database now too. So you can build web applications more easily.

There is not a month that goes by that I don't get some type of near 6 figure recruiting offer from someone asking about MUMPS. Most of the hardcore MUMPS programmers I know make at least 65 k a year.

I have actually been considering converting our online databases over to use MUMPS as the database.

Back to the subject though....Career options.

1) consider doing some research on MUMPS. Flavor 1) GT.M Flavor 2) Caché M' (intersystems)

http://en.wikipedia.org/wiki/MUMPS
http://www.hardhats.org/links/Mlinks.html

2) A big issues in healthcare, and Branden will likely back me up on this, is the security of data and HIPAA compliance. Data security itself is possible its own career path in the healthcare field. Basically, making sure that only the people that NEED to see the patients data get to see the patients data. Lots of time is devoted to the security aspect. Making sure that a sessions/screens automatically time out of there is no activity. Making sure that all data is copied into backup files before and after you make changes, creating a full audit trail of what was done with the patients record. On, and on, and on... I see almost every day someone trying to develop some type of doctors office program where they are using something like MS-Access as the database. You can even see offers on craigslist and other places for doctors wanting to hire programmers to make a program for them. Most of these programs will not end up being HIPAA compliant and can end up getting the developers and doctors some big fines. MS-Access is not considered a secured database. Here are some references.
http://databases.about.com/od/security/a/hipaa.htm
http://www.systemsolutions.ws/index.php?id=204 (a fairly good explanation)

3) Data Migration. Moving data securely between two or more databases. This is done for insurance payments, reimbursements, data mining, data warehousing, etc. Being able to move healthcare data has to be done through secure methods as well. You cant just make ASCII text files and dump them over an open connection. Man... been so long I cant remember the protocol names..........


anyway,
Sorry, not trying to steal the show there Branden !
Hey You have to stop in sometime and see what we are working on !

Permalink Reply by David Morris on July 16, 2009 at 1:51am

Thanks for all the info. It has definitely given me some starting points for research and practice. I honestly haven't even heard of MUMPS.

As my current experience is in networking, I am hoping to use that to open the door perhaps a general networking job or network security. Ultimately, I want to gain a solid understanding of the programming and/or applications side of things as well. It seems that the deeper I go into the IT field the more I realize that I know nothing. =o). That is precisely why I need to get out of my current role which is basically shaping up to be that of a Cisco/Microsoft drone.

I know that there are a lot of applications that seem to be in high demand, but I'm not entirely clear on the skills/knowlege required. I've been hearing a lot about EPIC and PACS. I'm also trying to gain a greater understanding of how HIPAA is applied in practice.

Permalink Reply by Curtis J. Kropar on July 16, 2009 at 2:35am

If your interested... I would invite you to spend some time with us at Hawaiian Hope. That web based data management tools we designed that the homeless shelters use to manage all of their day to day operations......... Because of the type of data that is being managed, we have implemented pretty much full HIPAA compliance into our software. I would be happy to show you some of those things and show you what we are working and moving towards on future updates.
David Morris said:

Thanks for all the info. It has definitely given me some starting points for research and practice. I honestly haven't even heard of MUMPS.

As my current experience is in networking, I am hoping to use that to open the door perhaps a general networking job or network security. Ultimately, I want to gain a solid understanding of the programming and/or applications side of things as well. It seems that the deeper I go into the IT field the more I realize that I know nothing. =o). That is precisely why I need to get out of my current role which is basically shaping up to be that of a Cisco/Microsoft drone.

I know that there are a lot of applications that seem to be in high demand, but I'm not entirely clear on the skills/knowlege required. I've been hearing a lot about EPIC and PACS. I'm also trying to gain a greater understanding of how HIPAA is applied in practice.