REVIEWER: John D. Halamka, CIO, Beth Israel Deaconess Center, CareGroup HealthCare System.
BACKGROUND: Boston-based CareGroup HealthCare System is an integrated delivery network that includes Beth Israel Deaconess Medical Center (BIDMC), Mount Auburn Hospital, New England Baptist Hospital, Deaconess-Glover Hospital and Deaconess-Nashoba Hospital, as well as 72 ambulatory care practices. With more than 13,000 employees and 2,000 medical staff, CareGroup and its members offer a broad spectrum of health services to residents of eastern Massachusetts.
PLATFORMS: The CareGroup IT infrastructure includes approximately 4,500 PC clients in multiple CareGroup member locations. The CACHE-based WebOMR is accessible through these internal PCs as well as on Web-accessible devices in any location. CACHE-based information is stored on an EMC Symmetric DMX platform.
PROBLEM SOLVED: Secure access to patient data over the Web has been available at BIDMC for years via a system known as CareWeb, which is built on InterSystems Corporation's CACHE post-relational database. In 2004, the decision was made to extend Web access to patient data for the 72 ambulatory care practices that are part of the CareGroup Network. There were several major challenges to overcome in developing and implementing this electronic health record (EHR) system. One is the complexity of medical information, which means data must be stored in multiple forms. In addition, the system must be extremely reliable, highly scalable to allow for organizational growth and also deliver fast response. CareGroup selected CACHE as the underlying database technology for its EHR system, which is called Web online medical record (WebOMR).
PRODUCT FUNCTIONALITY: The WebOMR team leveraged CACHE rapid application development facilities and advanced Web capabilities throughout the system development cycle. One example is CACHE Server Pages (CSPs), which consist of standard HTML or XML, so they can be created and modified using any text editor or off-the-shelf Web page creation tool. CSPs connect to the Web via any standard Web server, using fast APIs. Additionally, CACHE-based Web applications execute on the CACHE server, close to their data. This allows faster execution because all of the inter-process communication required to fetch or change data is eliminated. CACHE Web development capabilities made it possible to build prototypes very quickly. This facilitated our iterative development approach. Iterative prototyping was a key benefit throughout the development process. The CACHE multidimensional architecture is another key product capability because it supports management of a variety of data types.
STRENGTHS: In addition to advanced Web development features, the ability to deliver high performance and enterprise scalability are critical CACHE product strengths. CACHE also provides an extremely high level of application reliability.
WEAKNESSES: CACHE is a hierarchical database optimized for transactional performance. For aggregate data queries, such as population health analysis, we use separate OLAP tools via relational data marts which replicate selected CACHE data. We find that the speed and scalability of CACHE justifies the use of two databases - hierarchical for clinician-facing applications and relational for research and quality reporting.
SELECTION CRITERIA: Multiple database products were considered as candidates for the WebOMR system. Based on previous experience with CACHE as the foundation for multiple core clinical applications, the proven abilities of CACHE to support fast response, scale to handle varying transaction loads and support management of highly complex data were key factors in selecting this product.
DELIVERABLES: The primary deliverable of the CACHE-based WebOMR system is a Web-based EHR from which CareGroup is projecting significant care delivery benefits.
VENDOR SUPPORT: The level of support CareGroup has received from InterSystems over a working relationship of more than a decade has been at a consistently high level. The company has a worldwide response center (WRC) that provides 24x7 support for its products, and we've found the developers and systems engineers who staff the WRC to be extremely responsive and knowledgeable.
DOCUMENTATION: Caché documentation is comprehensive and useful.
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