Podcast Summary: Asianometry – "The Curious Database Powering America's Hospitals"

Host: Jon Y
Date: November 20, 2025

Episode Overview

In this episode, Jon Y explores the fascinating history, technical features, and persistent influence of MUMPS (Massachusetts General Hospital Utility Multiprogramming System), the hybrid programming language and database that underpins much of the American healthcare system's digital infrastructure. Jon follows MUMPS from its chaotic origins in hospital wards to its widespread, and somewhat unlikely, adoption across industries and continents.

Key Discussion Points & Insights

1. Chaotic Beginnings: Hospitals and Information Overload

• Context: Massachusetts General Hospital (MGH), founded in 1811 and affiliated with Harvard, was an early adopter of computer science aimed at solving inefficiencies in hospital communication.
• Challenge: In the 1960s, doctors managed dozens of patients daily, relying on complex paper-based processes involving vast support staff, leading to frequent communication errors and rising costs.
  • "[A] 1974 study done at the Kaiser Permanente Healthcare System...found that 25 to 40% of healthcare costs then stemmed from information processing." [02:33]

2. Early Computing Efforts & Project Stumbles

• IBM and BBN Enters: In 1962, MGH contracted with Bolt, Baranek and Newman (BBN) to develop a total information system, spearheaded by MIT professor Jordan Baruch, leveraging "timesharing"—multiple users accessing a central computer simultaneously.
• Initial Failure: After two years and $1.5M/year with little hospital buy-in, the project languished; staff could not adapt to laborious, assembly-language powered systems.

3. Dr. Octo Barnett & The Laboratory of Computer Science

• Leadership Shift: NIH recommended that MGH take the lead. Dr. Barnett, with his cardiology background, took charge and recruited recent MIT graduates Neil Pappalardo and Kurt Marble (despite their limited computer experience).
• Pushed to Innovate: Pappalardo suggested building a new programming language; initially threatened with firing, he and Marble did so in secret.
  • "Barnett told him that a hospital lab should not be doing that, and two to three times even threatened to fire him if he did it. So naturally, Pappalardo and Marble went ahead and did it anyway." [12:00]

4. Birth of MUMPS: Features and Innovations

• Integrated by Necessity: Built in 18KB of memory on a PDP7 minicomputer, MUMPS fused system, database, and language tight for maximum efficiency.
• Hierarchical Database: MUMPS organizes data in parent-child “trees” (hierarchical model), optimizing for up-to-date, keyword-searchable, narrative-focused medical records.
• Global Arrays: Data stored in “global arrays” (identified by a caret "^"), which blurred the distinction between disk and memory, enabling instant data availability.
  • "In mumps, these coordinates are formatted as an up arrow or caret followed by something like a patient ID and then a list of subscript values..." [23:15]

5. Open Source Spirit and Dialect Proliferation

• Early Openness: Tapes freely circulated, like early Unix; user groups grew up organically.
• Babel Problem: By 1972, at least seven incompatible dialects of MUMPS existed—abbreviated, symbol-heavy, and often extended in idiosyncratic ways.

6. Toward Standardization: ANSI and Avoiding "Unix Wars"

• Government Steps In: With $5M invested and compatibility issues looming, the U.S. launched a formal standardization effort.
• MUMPS Development Committee: Formed in 1973 by government and industry, it set syntax/language standards, culminating in ANSI recognition in 1977.
  • "A mumps avengers made up of industry and hospital users was assembled...and with that, in 1977 the mumps standard was labeled an American national standard, averting a Unix wars type scenario." [36:08]

7. Surprising Global and Cross-Industry Adoption

• Beyond Healthcare:
  • Swiss Parliament crisis system
  • Netherlands patent tracking
  • UK Royal Mint equipment control
  • British Stock Exchange
  • Soviet fishing fleet management

8. MUMPS in the U.S. Veterans Health Administration (VHA)

• VHA Embraces MUMPS: Frustrated by COBOL, rogue groups inside the VHA used MUMPS for speedy, physician-driven dev, eventually winning head-to-head trials.
• Decentralized Innovation: The result was VISTA (Veterans Health Information Systems and Technology Architecture), a network of 180 subsystems and one of the largest health databases in the world.
  • "By the 1980s, VISTA covered 169 medical facilities, 180,000 medical staff and over 8 million veterans, all without relying on a single vendor." [48:12]

9. Legacy, Rebranding, and Longevity

• Attempts to Rebrand: The community tried to shed the MUMPS name, rebranding it as “M Language” for broader appeal.
• Mixed Perceptions:
  • "There's a lot of hate thrown at mumps. They call it an archaic dinosaur, a joke language that is hard to read and deserves to be replaced with something more modern." [56:55]
• Persistence: Despite criticisms, MUMPS endures because it is fast, deeply integrated, highly reliable, and has built-in scarcity of skilled programmers—making it surprisingly resilient.

Notable Quotes & Memorable Moments

• On Chaotic Hospital Workflows:
  "Treatment was chaotic and communication errors were common, and the costs of such were rising." [01:33]

• On MUMPS’ Core Database Feature:
  "The core Mump's function from the very beginning, however, was the database, and it was tuned for the medical environment's stringent demands." [19:56]

• On Programmers' Extensions:
  "Programmers complicated this yet further with their own extensions, often prefixed with the Z letter." [33:18]

• On the VHA and MUMPS Revival:
  "They made surprising progress and eventually in 1981, the head of the national association of Veterans Administration Physicians...arranged a bake off with the Kobol team that the mumps team won." [44:05]

• On Enduring Legacy and Criticism:
  "Though one can easily argue that mumps quirks and skill shortages can be its own form of job security. But mumps is well suited for what it does..." [59:50]

Timestamps for Major Segments

• 00:00–03:00 — Historical context: why hospital information processing was so hard
• 03:01–13:30 — Early computer projects, BBN and Jordan Baruch
• 13:31–23:30 — Dr. Barnett joins, MUMPS origin story, and technical innovations
• 23:31–32:00 — Database design and implementation details
• 32:01–36:30 — Open source culture, dialect proliferation, and push for standardization
• 36:31–45:00 — ANSI standardization and diffusion worldwide
• 45:01–54:00 — MUMPS in the VHA, the VISTA project, and its vast reach
• 54:01–End — Perceptions, rebranding, and MUMPS’ continued relevance

Tone & Style

Jon Y’s narrative is wry, knowledgeable, and dotted with tongue-in-cheek asides about technical misadventures and the quirky persistence of aging technologies in critical infrastructure. The episode leans into both the technical nitty-gritty and larger historical ironies, painting MUMPS as both a workhorse and underdog of modern computing.

This summary captures the winding journey of MUMPS from 1960s hospital chaos to continued relevance today, spotlighting the people, design decisions, technical features, and cultural impacts that have made it an enduring—if odd—pillar of American (and global) healthcare IT.