To the Node.js Community: Healthcare needs your help!

This is a posting aimed at the growing community of Node.js developers.   I want to bring your attention to an industry that is crying out for your skills and expertise: healthcare.

It’s a little-known fact outside of Healthcare IT (and even sometimes within it!) that a significant number of the largest and most important applications that are used to run, manage and maintain healthcare throughout the world use a poorly-known and understood technology called Mumps.  Of these, probably the most interesting is VistA, a massive and very capable Electronic Healthcare Record (EHR), developed by the US Dept of Veterans Affairs (VA).  Not only is VistA used to manage the healthcare needs of over 8 million US veterans and their families across the USA, it’s also available as an Open Source EHR, and is increasingly being adopted by hospitals in the USA.  It’s also being deployed internationally, eg in Jordan and India, and a campaign in the UK is proposing its adoption there.  A recent research paper by Herbsleb, Muller-Birn and Towne provides a very comprrehensive background to VistA and its ecosystem of users and developers.  The VA have created a custodial agent named OSEHRA to oversee the governance of VistA within the Open Source arena.

Whilst this might all sound very impressive, there’s a problem: a ticking time-bomb that threatens this huge legacy of important software.  The problem is that the number of people who understand the Mumps technology is dwindling.  Within the VistA community, OSEHRA has been running initiatives to train new developers in Mumps as an attempt to address this situation, but retention rates are proving to be extremely low.  The bottom line is that the Mumps development community is losing more developers than it is gaining and the problem will inevitably become critical.

I’ve been fighting a rear-guard action to try to reconcile this situation for some time.  I believe the solution is in the hands of you, the Node.js community.

Mumps is an interesting technology.  I’d summarise it as a remarkably powerful NoSQL database technology, let down by an old-fashioned and much maligned language.   Replace that language with Javascript and you have something very interesting.  Do that replacement in such a way that the old legacy Mumps data and logic is accessible from Javascript, and there’s an opportunity for that legacy of Mumps-based healthcare code and data to be maintained and supported in the future by the Node.js community.

To that end, I’ve recently written three part series of articles that lay out a strategy for the future of Mumps (Part 1, Part 2, Part 3).  It’s what I’m hoping is the first salvo: a first step to engage the minds of the Node.js community and draw their attention to what is, to the Mumps community a growing risk and danger, but which, to the Node.js community, can be seen as a huge opportunity.

I don’t pretend that it will be easy: VistA alone is a huge, sprawling application.  The Mumps code within it is far from pretty or easy to understand, but I believe we now have at least the beginnings of a way to begin encapsulating and abstracting that old logic and moving it into a modern era using Node.js and Javascript.

I’d therefore invite Javascript developers from the Node.js community to take a look at my postings and begin considering if and how this problem can be tackled.  There’s probably no more important or worthy sector of IT than healthcare, and in my opinion, you, the Javascript and Node.js development community have the tools, the skills and, indeed, the responsibility to rise to the challenge of solving this critical problem.  Let me, the Mumps development community and OSEHRA know what you think.








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