"This stuff isn't hard if you know your way around a computer" This is true. What's hard is finding recent grads willing to suck it up and work with 40 year old technology. If you want to submit claims to Medicare directly, you have to do it via ZMODEM on a direct dial 56k line. ATZ...ATDT PHONENUMBER...I do it every day. As for development. Do you know a lot of MUMPS programmers? Do you know a lot of programmers who know what MUMPS even is? This is what 90% of the currently used EMRs use as a backend/DB. VistA, EPIC, Centricity, Meditech...all of these vendor packages use M, and there have always been jobs for people with MUMPS skills. At least there has for the 15 years I've been doing it. With the influx of Government monay, the need will only increase. But try finding classroom instruction in MUMPS - it doesn't exist. You sound really confident though, so you are probably right.

"having the expertise required in a single language to land a good job"

If, first and foremost, you are concerned about landing a programming job, it helps to know what industry you're looking to enter. Healthcare and Electronic Medical Records are hot topics right now with a lot of money, private and public, backing it. IT adoption in Healthcare is seen as a panacea for all that ails, and while I may not agree with that directly, there is certainly a lack of trained programmers willing to work in the field. Most EMRs are decades old and use MUMPS as the back end.

http://en.wikipedia.org/wiki/MUMPS

It's quirky, "old" and not OO, but if it's a JOB you want, there's worse things out there than helping deliver better care through M programming.

Well, Enemy Territory:QW runs lickity split on my machine while Oblivion crawls. And Oblivion is older. So my fingers are also crossed that this means Bethesda starts putting out game that are better optimized.

Questions 4 and 5 assume a specific type of relational database. I've met plenty of competent programmers who wouldn't have ready answers for those questions. That said, if a candidate can't BS through these successfully, they'll have a difficult time navigating standard office politics, not just programming your DB.

"They probably did, in the same slipshod fashion they consructed their steaming pile of MUMPS."

I can't wait for a real company to come along that writes an EMR in Java/Oracle. They will obviously provide better training because of the technology they use.

"At least Epic is using strongly typed data fields, like chars, strings, integers, floats, and doubles." And it's all getting stored as a string because Epic runs on Cache, which is MUMPS. In fact 99% of Epic is still coded to the 1995 standard. They maintain that the code base is not dependent on Cahce and is M-implementation independent. I admit that from a practical standpoint this is BS...Intersystems basically owns that arena. GT.M is an option but good luck getting Hyperspace to work with it.

"The language is truly unlike anything most modern programmers are accustomed to." So the solution is to throw out 30 years of hard work because nobody cares to learn it? Where is the "modern" replacement? It doesn't exist because of the monumental effort required to create an EMR. I fail to see how getting new programmers accustomed to the technology is a problem when ISC provides Cache Object Script. Write your code with COS and you never have to use dot syntax again. Curly braces all the way.

Coding "MUMPS over Cache" provides hooks to any kind of UI you'd care to create. VistA doesn't have a very attractive UI (anyone know what CPRS is written in?), but MUMPS implementations have moved past the old roll and scroll in the past decade. Epic uses a Windows client written in VB, but is moving to .NET and a browser based UI ala IDX. VistA could do the same.

Interoperability is handled by HL7 http://en.wikipedia.org/wiki/HL7 interfaces.

"But really with all the crap, legacy systems held together presently by silly string...you really almost need to start OVER."

Many hospitals are starting over. They're scraping their old, cobbled together systems (seperate Lab, Physician Practice, HIS vendors) and going with a single vendor. Epic, Cerner and the like have seen a lot of interest in going with single vendor installs.

Hi-o! Over here! In the corner...in the big empty room...How come nobody ever wants to play with me?

Seriously, any decent programmer can pick up the basics of MUMPS in a weekend. There are plenty of compelling reasons to do so. Developing VistA is both patriotic (helping US vets!) and globally humanistic (Open source helps 3rd world countries deploy better medical technology!). Not to mention the massive amount of money currently floating around to help develop and deploy EMRs.

As for projects which cover the same ground as VistA...where are they? The 2 biggest commercial players in EMRs - EPIC for large hospitals and Meditech for smaller, community hospitals - are both M-type platforms. There are NO other competitors written in other languages because building a hospital automation system is really complicated and takes decades to mature. Yes there are 100x more Java programmers out there, but we'll never see a commercially successful EMR written in Java because there is 0 business need for one now.

My name obviously implies bias, but the reason that many of the Medical record systems out there now - VistA, EPIC, GE/IDX, Amtrim for labs ect. - are based on MUMPS is because of its string handling capabilities. Much of a medical record is transcribed notes, character strings which need to be manipulated and stored. MUMPS was designed to do this from the start, which is why it's the right tool for the job. Take that DailyWTF with a very large pinch of salt. The source for VistA is already available though a FOIA request, and GT.M (the MUMPS platform it runs on) is open source. Run the whole shebang on Linux and presto-changeo, Open Source EMR. This is what Medsphere is doing, selling services and support as the core business. http://en.wikipedia.org/wiki/MUMPS

I agree with everything you said except - Re: laptop popularity - I have no problem playing 2 or 3 year old games on my laptop. Mind you, these are games that I buy at a discount, but they are still A+ titles (just old). I probably just made your point for you but, I've been drinking... "Linux for the PC" - Yep...2009...the year of Linux on the desktop. Indeedy.

The "DDR as exercise" argument is still lost on me. I mean, if "real exercise" is a tedious waste of time, then how does DDR make it better? Beacuse you're dancing/playing a game? Then why not actually dance? I mean with real people and/or with live music (thereby supporting local music and possibly hooking up)? I have the same problem with the esspress-o machines. They have them @ my gym (Sound Mind & Body in Seattle) and the first thing I thought of when I saw them was "How can I hack this?". I thought that because these thing are serve me better as Intellectual Exercise than as real physical exercise. I go to the gym to pedal a stationary bike because it's raining out and I can't ride my "real" bike. I sit at home playing Quake Wars because I'm done exercising and want to take a break from reality. Taking a break from reality (gaming) is mutually exclusive from exercise (reality). I could say the same thing about sport and drinking, except you nerds would just throw Rugby in my face. Damn you nerds!!!!