I2EI1PUTERS Iii EiJICIF1E88. Gorry, GA: On the Mechanization of Clinical 92. Held, GD, MR Stonebraker, and E Wong: INGRES- ter's thesis, Vanderbilt University, 1979.

Judgment. Computer Applic in Health Care Delivery. ed. A relational data base system. AFIPS-NCC. 44:409-416, 96. Woodyard, M, and B Hamel: A Natural Language In-C Weller. Miami: Symposia Specialists, 1976. 1975. terface to a Clinical Data Base Management System.

89. Bleich, HL: The Computer as a Consultant. New Eng 93. Hamel, B, and JR Bourne: A Data Base Management Computers and Biomed Research. 14:41-62, 1981.J of Med. 284:141-147,1971. System for Clinical Records of Renal Failure. J of Clinical

90. Kernighan, BW, and DM Ritchie: The C Program- Engineering. 5:221-228, 1980.ming Language. Englewood Cliffs, New Jersey: Prentice- 94. Levitt, G, DH Stewart, and B Yormack: A prototypeHall Inc, 1978. system for interactive data analysis. AFIPS-NCC. 43:63-

91. Ritchie, DM, and K Thompson: The UNIX Time-Shar- 69,1974. This article is adapted from a paper in Applications ofing System. Communications of the ACM. 17:365-375, 95. Woodyard, M: MEDQUEL - Practical Natural Lan- Computers in Medicine, published in 1982 by IEEE/EMBS;1974. guage Comprehension in a Medical Environment. Mas- edited by M.D. Schwartz, Ph.D.

Solving problems quickly and easilyBy LEAH CATESEMB Staff Writer

ob Wickizer is a curious blend of Mid- Thus, the programmer is able "to see what main-frame companies.western grassroots convictions, ag- he or she is doing to the code, what the In its design, MUMPS meets the require-gressive young businessman and code is doing to them," Wickizer says. ments formulated by Barnett and Greenes

member of a technological avant-garde. He MUMPS is an example of an interpretive, in 1970 for effective hospital data baseis president of Mid-Continent Computer user-oriented language that resulted from management systems. Writing for Comput-Systems Inc., in Columbia, Missouri. The such work, says Wickizer. The user, with ers and Biomedical Research, Barnett andbusiness is a development house, special- the entry of MUMPS and its user-friendly Greenes include speed of output and pro-izing in the MUMPS (Massachusetts Utility features into the computer arena, became cessing and flexibility of permitted inputMulti Programming System) data base directly involved. "What that meant was data type among the requirements. A sys-management system. It is through the spe- that if you wanted to develop a program tem also must have a common data basecialty of his business that Wickizer comes you didn't have to go through the compile with multiple terminals so that a variety ofto his grassroots and avant-garde affilia- stage," Wickizer says. "Just skip it en- users have access to patient information.tions. tirely. Sit down, write your program and see The system must be easily changed to ac-MUMPS was important in Wickizer's pre- the results; it's executed as soon as you commodate new ways of looking at the

vious work, when he used the language for type it." data, and must have the potential for link-data processing in a CAT scanner project. As programmers and users alike began ing with other departments in the hospital.That work was in the late 1970s. Even now, seeing their computer work more directly, And as needs and technologies grow, theWickizer says, MUMPS is considered "a they began to experiment with applications system must be adaptable to a variety ofrelative newcomer to the computer scene." of user-oriented systems. One such appli- media, such as graphics, audio and videoThe language is in part the result of early cation was developing hospital information presentations.data base management systems devel- systems; MUMPS was developed at Massa- One of the most recent projects Wickiz-opment. chusetts General. With increased applica- er's development house is working on isThe data base management systems tion, says Wickizer, came a push for mak- called IRIS (Integrated Radiology Informa-

work was, according to Wickizer, not just ing MUMPS a standard ANSI (American tion System). Wickizer's description of theanother computer development project. National Standards Institute) language. system makes it seem ready-made to meetThe systems that resulted were no longer COBOL, FORTRAN and PL-1 had all been Barnett's requirements.compiled, but interpretive. established as standard languages. Their In IRIS, physicians dictate reports into aWith this development, Wickizer says, re- standardization was the result of moves by voice entry and response station - the VIS

searchers in the late 1960s faced "phenom- large vendor committees, according to or voice information system. Using a highenal philosophical differences." Essential- Wickizer. But MUMPS "was standardized speed data link, the voice information is re-ly, differences were between proponents of as a grassroots petition process. It's the layed to the TIS -the textual informationmain-frame centralized systems that rely only computer language to have gone system. This part of the system includeson the batch process of punching cards through that route." character and graphic display terminals,and compiling data and those who wanted And, he continues, because the push for and users can access other hospital infor-a system to provide more contact between MUMPS' ANSI standardization came from mation systems or the IARS (image ar-the user and the program as it is written, the grassroots level - the users them- chival and retrieval system) of the radiolo-With the development of the CRT (cathode selves -the language has the potential of gy department. The IARS then is linked toray tube), programmers began having more being much more responsive to needs than image display terminals in the radiologydirect contact with the computer program. the languages first developed by the larger department. And the model IRIS ultimately

40 EMB MAGAZINE JUNE 1982 0278-0054/82/0200-0040$00.750 19821EEE

COmPUTEFS hR [fEEJIEJIFlEIRIS NETWORK

DIGITAL NUCL ULTRARAD MED CT NMR SOUND

IMAGE Video DisksDISPLAY IARS

Figure 1: The IRIS network. The TERMINALS CHAR & GRAPHICuser dictates reports into a voice VOICE ENTRY DISPLAY TERMINALSinformation system (VIS); the & RESPONSE [_Wis7 TlI |voice signal then moves via high STATIONS H S ) Mass Storagespeed data link to the textual in HIGH SPEED

DATA LIN Kformation system (TIS), which T

leads to the image archival and re- IARS: Image Archival and Retrieval Systemtrieval system (IARS). The latter is TIS: Text Information Systemlinked to image display terminals VIS: Voice Information System OHIS

OHIS: Other Hospital Information Systemand, ultimately, to a video diskstorage system.

will have a video disk storage system. with a conventional batch process. By willingness to experiment with programs.Wickizer admits that IRIS is the excep- 1971, the system had been modified to in- Stephen L. Johnson, of the University of

tion rather than the rule even in the rela- clude capabilities for physicians to directly California-Davis, describes the charactertively young field of data base manage- dictate reports into the system. After ex- strings used by MUMPS as being closer toment systems. And not all the elements in pansion to Truman Memorial Veterans Hos- the user's own thought processes. John-the ideal IRIS have yet been used together pital in Columbia, MARS became a proto- son, in a MUG Quarterly article, writes,at any facility. A radiology department in an type for MARS II. "People tend to think in terms of strings,Albany, New York, hospital is the closest Prototyping is an advantage associated and so it's only natural to carry that pointto using the entire network. In that system with distribute data processing and net- of view into programs." In other languages,the video component is lacking, and the working systems, according to Stephen L. Johnson continues, the programmer maylinkage with the image retrieval system still Veazie, of Veazie and Company in Chicago. have to declare different variables for num-is weak. From his vantage point on the cut- Veazie writes in Hospitals magazine that bers, characters and other elements, whichting edge, Wickizer predicts that, though prototyping "involves more direct user par- is "a process that can fragment one'sIRIS is a stranger to data base manage- ticipation in the development cycle." Such thought processes and thereby mask thement systems applied use, "next year user involvement is one of Wickizer's favor- problem to be solved - it is difficult to seethere'll be half a dozen; in five years, hun- ite themes when he talks about computer theforestforthetrees."dreds." development in general, and MUMPS in A major time-saver found in MUMPS isAn example of the most up-to-date particular. Before the 1960s and the advent what Thomas Munnecke calls the "invisi-

MUMPS application is MARS and MARS of user-oriented systems, Wickizer says ble" features. Munnecke, of Metasystems11. Basically, MARS is the text information computing was an "extremely conservative in Riverside, California, contrasts BASICsystem and the image retrieval system por- field." People tended to think that "once and MUMPS in a MUG Quarterly article. Intion of IRIS. It was developed to meet the you start putting stuff into the computer, MUMPS he says, "much of the housekeep-needs of the radiology department at the it's like casting something in concrete." ing-type syntax has been automated andUniversity of Missouri Medical Center in Wickizer thinks Such notions inhibit pro- does not appear in the MUMPS high-levelColumbia. MARS II is the commercial ver- grammers from taking risks. And, he says, code." This feature means that the pro-sion of MARS I, which was designed to pro- if risks aren't taken, the programmers and grammer spends far less time performingvide "timely a.vailability of the written re- users lose out on valuable flexibility and the housekeeping tasks of a program, suchport of the radiologists' opinion." That is creativity. New ways of processing are not as defining subscript ranges and datahow Wickizer and Gwilyn Lodwick describe considered - new ways that might in- types in the array. Such chores instead arethe initial purpose of MARS, in an update crease productivity while saving time and carried out by processes embedded in thereport written for M\/UG Quarterly. From its costs. Wickizer and others list features of MUMPS code, Munnecke notes.beginnings in 1964, MARS went through a MUMPS that bring the user and program- Another time-saving feature is the abbre-series of developmental stages that started mer closer together, with a consequent viated code system. With this feature, the

EIMB MAAGAZINE JUNE 1982 41

EOMPiPUTERS Ill,ME.. _.1Eprogrammer need only write the first initial lyzer to document the program, the user The tank may well be more powerful, but aof a code command - not the entire com- may be faced with an array that looks more driver can handle a Ferrari with gracefulmand. Wickizer says that with this feature, intimidating than a more conventional pro- ease.the MUMPS user will have only one page of gram, such as Pascal, Johnson concludes. And Wickizer believes that such ease iscode to every 10 or even 20 pages of code Johnson points out other difficulties what will sell MUMPS. As computers losefrom other systems. And, at the overall sys- MUMPS proponents face in their push to their mystique for laypeople, consumerstem level, he gives the example of a CO- make the system more popular. Because will begin to see themselves able to solveBOL program that would employ 10 users MUMPS was developed in a hospital, it is their own programming problems. Theand would need 1 million characters. A geared toward smaller systems. As a con- mystique will fade rapidly as more peoplecomparable MUMPS program would ac- sequence, initial development was done use microcomputers in their own homes,commodate 16 users who would need only with slower, smaller machines in mind. and begin realizing that what the large cen-95,000 characters, Wickizer says. This imposed limitations on both memory tral system can't do at the office, "my kidThe abbreviated code is not entirely an and speed of the system. And today, other can do at home on his Apple."

advantage, though. Johnson points out systems offer MUMPS competition in And that's why Wickizer touts the user-that "the compactness of MUMPS code those areas. oriented features of MUMPS. After all, saysmakes it difficult to sight read. It's almost Wickizer, though he admits that storage Wickizer, a user "doesn't care whether it'sas if, for the beginning programmer in capacity and speed are seen as problems, measles or MUMPS" - he just wants aMUMPS, the worse a line of code looks the remains undaunted. He says that compari- problem solved as quickly and easily asmore likely it is to be correct." Unless a son of MUMPS and older systems are like possible.programmer has an automated code ana- "comparing a Ferrari to a Sherman tank."

42 EMB MAGAZINE JUNE 1982