09 October 2003 - InterSystems, the largest provider of database software to the NHS, with nearly 5,000 NHS installations and over 170,000 concurrent online users, has revealed details of an Electronic Medical Records scalability test undertaken in collaboration with HP and EMIS.
InterSystems set out to provide answers to a key question facing suppliers to the NHS National Programme for IT, namely, how will database technology scale to provide the large Patient Record database envisaged by the Programme
Implemented on a pair of mid-range Alpha ES45 Servers running Open VMS version 7.3, and CACHÃ version 5, the test environment currently holds a total of 22 million individual medical records - almost half the population of England.
The database is derived from a Primary Care medical record schema deployed in the NHS today. The schema represents a lifelong patient history comprising repeat consultations, prescriptions, diagnoses and referrals. The database also holds other relevant data such as allergies, controlled drugs, immunisations and medical alerts.
The database currently contains details of over 280 million medical encounters, 365 million medication prescriptions and more than 425 million clinical investigations.
"CACHÃ runs the largest Acute Hospital systems in the NHS - so we understand the implications of deploying these systems to thousands of concurrent users," explains Phil Birchall, director of healthcare business development at InterSystems.
"At the same time, there are successful Primary Care solutions that deliver genuine clinical benefit at the point-of-care. The majority of a patient's lifetime healthcare activity is held within the Primary Care record, however this has previously only been available to the GP.
As there are over 30 million individual primary care records already stored in our database technology today, we thought it important to examine the implications of moving these records into a single centralised database."
The test system produces excellent query performance, even using relatively modest servers for an environment of this scale and scope. The system benchmarked in excess of 3 million completed Medical Encounters in an 8-hour working period - three times the NHS projected throughput for Primary Care in an individual LSP cluster. The unexpected discovery was the physical size of the database.
Birchall continues: "In this exercise we focused on transactional data rather than the storage of medical images or other binary data. We know from existing customers that the multidimensional database footprint of CACHÃ is much smaller than the relational equivalent, but we were delighted at how effectively CACHÃ was able to handle this challenge. The database contains over 1.5 billion rows of data, but uses only 300Gb of disk space."
CACHÃ has advanced data compression and sparse-array capabilities that make it possible to be so frugal with physical disk. Additionally, CACHÃ's high performance object-orientated capabilities allow developers to construct complex applications without the overhead normally associated with de-normalised data in relational databases.
Graham Frost, managing director, InterSystems Northern Europe, says: "Existing application providers to the NHS already understand the capabilities of InterSystems technology. They have first-hand experience of how it delivers performance and scalability while requiring meagre hardware resources. These factors are fundamental when delivering working solutions with public monies."
"This is an excellent use of our Healthcare Competency Centre in Reading UK," says Mark Gorham, VP of OpenVMS Systems at HP: "We all believed that it was important to invest the time and effort to prove that our technologies were ready to meet the challenges of delivering complex medical record systems of the scale demanded by the NHS National Programme for IT."
InterSystems technology is in use by hospitals, labs, clinics and GP practices throughout the NHS with an estimated 500,000 staff having access to InterSystems' databases. The top ten hospitals in the USA together with the Department of Defence and the Department of Veterans Affairs use InterSystems software for their healthcare solutions.
Kaiser Permanente, the largest private healthcare group in the world, recently chose a CACHÃ based solution from Epic Systems to deliver the largest US healthcare system ever to be developed outside of Federal Government. With 11,000 clinicians in 9 states and a health plan membership of 8.4 million people, the Kaiser implementation draws comparison with the challenge facing LSPs in the NHS National Programme.
"We want to do all we can to make the NHS IT Programme a complete success," says Graham Frost. "Therefore, we are sharing the details of this test with those organisations who might benefit from the experience that we have acquired from this effort and throughout our 25 years as a leader in the Global Healthcare market."