Open Epic/FHIR Resources

[Christian Caldwell]

Greetings Group -

I was listening to the Community Meeting back in 2024, and there was some discussion about Epic, their API, and how it works with GT.M (Blow my mind, amazing conversation). Someone mentioned that Epic didn't share their API, and I wanted to know if the group has ever come across these:

https://open.epic.com/

https://fhir.epic.com/

I came across these during my research into Epic and their community connect program for the mental health programs my nonprofit helps support here in Colorado. You can even set up for an epic account, aka Hyperspace access, to help develop and integrate apps with it for free (I have one to play around with here and there). I heard there was work on the lung screening app and on working with Epic for Mount Sinai, which is super cool.

I also thought about the links above and wanted to share them with the group. On the call, there were talks about the future of Vista. Vista has great potential, and Cerner will fail for the VA. Maybe WorldVista and Epic join forces and save the day for the VA :) lol. The group could get ahead of it just by saying.

I do have a good relationship with most of the members of the Colorado congressional delegation, and my Rep, Jason Crow, is a Vet. I’m sure he’s heard of this Cerner project and its concerns, but wanted to share the resource. Has World Vista ever considered testifying before Congress? Based on the 2024 session, you guys and gals have some amazing insight into why Vista works for the VA, and it shows in why only maybe 10 sites have moved to it. Anywho, I hope to join the group at the Community Meeting this year, as I'm super excited to meet everyone.

Christian

[Nancy Anthracite]

Back when they were condidering moving to Cerner I walked the halls of the Congressional Offices endlessly, dropped off written information and I seldom was even allowed to talk to anyone.  Testifying is by invitation and there was certainly no chance of me getting invited considering it was tough to talk to a staff person who often didn't even know what VistA is.  I did some indication that the written material I provided was read, but you can see what good it did.

At the time, I was also trying to raise awareness of privacy invasion in patient medical information being promoted by the federal government. I got even less traction for that.

--

Nancy Anthracite

[Dave G]

I use epic daily. Their fhir  open and market place.

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[Dave G]

Years ago someone testified circa 09-11

[K.S. Bhaskar]

My representative (Chrissy Houlahan - PA-06) is a vet, and some years ago (when the VA did a competition-free selection of Cerner as part of Jared Kushner's Government modernization program circa 2017) I spoke on a video-call with someone on her staff about VistA. I didn't hear anything further.

Regards

- Bhaskar

[Christian Caldwell]

Ahh, Hah... I always wondered how Cerner won the bid over Epic. That explains it right there: Kushner/Trump backdoored that deal for Larry Ellison, as they are close friends. It makes sense why things were somewhat paused during the Biden administration and are now revamping. 

[Dave G]

Technically general dynamics won the bid.

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[Christian Caldwell]

Did they win the bid for all three rollouts of Cerner IHS, DOD, and VA?

[OldMster]

It was definitely a back door deal, but to be fair Oracle didn't buy Cerner until a few years after the deal was done.

[Christian Caldwell]

Good point. I just read up and saw that Oracle bought them in 2021, but I'm sure that deal had been in the works for a while. I just find it interesting how it all played out. Were there any good reasons they didn't go with Epic? Any articles or anything on it? I would have figured Epic would have been the clear choice, given that Judith was an original member of the Vista development team. I always suspected that Meditech and Epic borrowed code from the Vista project. Plus, they are MUMPS-based, whereas Cerner is Oracle DB; I figured it would have been an easier migration. Also, Epic has a track record of implementing large-scale EHR projects. I am a Kaiser member and have followed their implementation of Epic since I was in middle school. I know Kaiser started out rocky, but in the end I think they have really done well with Epic and have made some cool innovations. A lot of people don't know this, but Kaiser uses Epic and Cerner; they use Millennium for lab operations. 

[Benjamin Irwin]

One of the problems with choosing EPIC is that it is MUMPS based.  One of the reason that the VA stated for moving away from VistA was that is was written using such an "old and obsolete" language as MUMPS.

[Christian Caldwell]

MUMPS can't be that old and obsolete, as most of the nation's health care systems run on it and will continue to do so for years to come. Epic, Meditech, and even UnitedHealth and Cigna still rely on MUMPS for various applications. I'm trying to convince my cousin, a cybersecurity professor at a local university in Colorado, that we still need to teach COBOL, MUMPS, and FORTRAN. Many critical systems still run on these languages, and we face a significant shortage of workers to support them. I know firsthand from my day job, as my company provides 3rd-party support for JDE, Oracle, and SAP, and we support some pretty old versions of those platforms. It's becoming increasingly difficult to retain a workforce for these tasks without investing in developing new talent.  

[Benjamin Irwin]

I agree with you Christian.  I came to MUMPS a little late in 1988, but have been working with computers sense paper tape was common.  FORTRAN was my official college computer language.

[Christian Caldwell]

It surprises me that, with all the Epic implementations over the years, we haven't been able to build a thriving, scalable MUMPs programming community. 

[K.S. Bhaskar]

This is just my opinion, but I think there are at least a few reasons. In decreasing order of impact:

1. A large MUMPS vendor announced in 1995 that they were no longer going to participate in the standards effort or comply with the standard.
2. VistA may well be the largest widely-used application actually coded in MUMPS. A large banking application with which I used to be associated was coded in a lightweight object-oriented (sort of) scripting language that was compiled into MUMPS for execution. I suspect other widely-used MUMPS applications have adopted a similar approach. Of course, there are likely MUMPS applications which are purely written and used within a company.
3. For a large enterprise-scale application, the complexity of the software matches the complexity of the underlying enterprise, i.e., the complexity is in the software, rather than in the language. In the VistA world, there are specialists in lab, pharmacy, etc.

There are likely others, but these are the ones I can think of. Caveat: I am a MUMPS newbie, having been associated with it only since 1995.

Regards

- Bhaskar

[Christian Caldwell]

1. A large MUMPS vendor announced in 1995 that they were no longer going to participate in the standards effort or comply with the standard.

1. 1. Wasn't this InterSys that went this route? I read that DSM folded under them. 

1. VistA may well be the largest widely-used application actually coded in MUMPS. A large banking application with which I used to be associated was coded in a lightweight object-oriented (sort of) scripting language that was compiled into MUMPS for execution. I suspect other widely-used MUMPS applications have adopted a similar approach. Of course, there are likely MUMPS applications which are purely written and used within a company.

1. 1. Agree with that statement, Epic's core DB Chronicles is MUMPS, but Hyperspace, which is the primary interface, is built on Electron.js 

1. For a large enterprise-scale application, the complexity of the software matches the complexity of the underlying enterprise, i.e., the complexity is in the software, rather than in the language. In the VistA world, there are specialists in lab, pharmacy, etc

1. 1. Agreed. As I've explored Vista and RPMS, I can see the complexity and customization that went into building them to fit the specific needs of the VA and IHS. Although Epic and Vista have something similar at heart, as I learned from a webinar with Judith and a senator. She talked about how she built Epic with the patient at the center, and I think that's one thing Vista/RPMS does well. 

[Christian Caldwell]

There are likely others, but these are the ones I can think of. Caveat: I am a MUMPS newbie, having been associated with it only since 1995.

Please don't be modest; many of you on this mailing list are the godmothers and godfathers of MUMPS, which is why Epic and others follow this list.

On Friday, January 30, 2026 at 3:01:08 PM UTC-7 K.S. Bhaskar wrote:

[ivaldes]

I like to think of myself as more a MUMPS bastard child having done unspeakable acts with MUMPS like a full QRDA reporting engine.