ICS 499 - BMXNET, the next step

Purpose:

The purpose of this proposal is to gain minimal insight into electronic health record systems (EHR), and to explore the possibilities of developing an open source component to enable greater extensibility and interoperability for development platforms.

Introduction:

The Indian Health Service (IHS) is an organization under the U.S. Department of Health & Human Services (HHS) that provides health care services for American Indians and Alaskan Natives through federal IHS, tribal, urban-operated facilities and programs. The scope of its health care services have expanded into over 500 health care facilities composed of hospitals, health centers, school health centers, health stations, satellite clinics, and Alaskan village clinics. IHS and the U.S. Department of Veteran Affairs (VA) are long time collaborators in the tradition of health information and technology advance sharing. In 1984, IHS picked up on the VA's very own "VistA" medical health information software (not to be confused with Windows Vista) and renamed their version of the system to "Resource and Patient Management System" (RPMS). RPMS is one of the most notable and successful adaptations of VistA health information systems. RPMS is a decentralized, conglomerate application composed of 60 plus applications fitted to work independently or in unison. The software modules can be broken up into three main categories: 1) Practice management applications that consist of patient registration, billing, scheduling, etc., 2) Clinical applications that directly support health care planning, delivery, management, and research, and 3) Infrastructure applications that consists of the management, development and communication tools of RPMS. Our main focus will be on the infrastructure of RPMS by utilizing the tools associated with it, including VA's Kernel package manager system, and the all important VA's FileMan as RPMS's database management system.

Problem: 
Currently hospitals and clinics pay millions (in Hawaii $20-50 million) just to implement a commercial enterprise medical health record software. What can we do to reduce the cost and increase support for our hospital clients? Also, developing GUI tools for medical health record systems require prior knowledge of old languages like MUMPS or clunky looking GUI's for reporting patient data built in Delphi. How can we increase the support and ease the pain for future developers planning to write Electronic Health Record systems (EHR) but have to adapt to decades of tradition?

Solution and Goal:

Amongst the various tools and applications written for RPMS, there is one with the sole purpose to communicate to a level of .Net supportive applications. This component is called BMXNET. BMXNET is a .Net specialty tool that provides disconnected row set technology for linking .Net applications with RPMS. This built in library gives the ability to communicate with RPMS by simple query statements (SQL data definition language) to access patient records and returns them in a familiar .Net data structure. So with that fact in mind, why don't we build a component that utilizes BMXNET to support multiple runtime engines such as Mono and Java. By doing this we will improve the interoperability of development platforms and give developers a greater range of environments to develop GUIs for EHR systems. Simply, no more looking at dirty, old 60's code written MUMPS. Let's eliminate the thousand lines of code that you know can be done better in another language more comfortable to you as a developer and meets todays expectations of Object Oriented Programming. This will also save hospitals millions in costs for purchasing the EHR software (plus tech support) and hopefully create a more aware community of open source developers for bettering the health care industry.

The next step:

In the past week, I've had the chance to dive into two documents regarding the setup and running of BMXNet. These user, technical/developer guides can be found directly from IHS's home site here. The user guide helps first time developers new to BMXNET get started in using the classes of ADO.NET and integrate them with BMXNET (now .NET 2.0 framework supportive) technologies, while the technical guide gives the infrastructure of BMXNET. I will begin within the next few days by rolling out a test/development server for installs of RPMS and GT.M's compiler for the standard M (MUMPS) language. Hopefully by then I'll be able to communicate from a .NET application (written in C#) to RPMS via BMXNET. The next steps will be to figure out a way to translate these exchangeable commands to be consumed by another runtime engine besides C# and the .NET environment platform (the conversion and eventual goal). At this point, Mono seems to be the easiest but we can't rule out that its fully .NET compatible since it merely provides a portal for Windows .NET applications to be ran in Linux.