REVIEWER: Steve Flammini, director of application development for Partners HealthCare.

BACKGROUND: Partners HealthCare System, Inc. is a multibillion dollar healthcare network based in Boston which includes Massachusetts General Hospital, Brigham and Women's Hospital, Northshore Medical Center, Faulkner Hospital, Newton-Wellesley Hospital, Spaulding Rehabilitation Hospital, McLean Hospital and Partners Community Healthcare, Inc. (PCHI), a network of more than one thousand primary care physicians located throughout Massachusetts.

PLATFORMS: Caché-based data is stored on an EMC Symmetrix Enterprise Storage platform. The Caché server platform (both database servers and application servers) runs on Intel-based Compaq Proliant hardware, running Windows NT operating system.

PROBLEM SOLVED: Since its formation in 1994, Partners HealthCare has grown to encompass multiple large healthcare institutions to serve a physician population of more than 4,000, approximately 25 percent of whom are the PCHI primary care physicians. Our clinical database strategy calls for leveraging the Web to extend application reach throughout the state as well as throughout the institutions included in our network. InterSystems Caché provides the appropriate mix of scalability, performance, reliability and cost- effectiveness which are key to enabling a massive multi-entity organization to successfully execute this strategy.

PRODUCT FUNCTIONALITY: While our environment includes multiple database products, Caché is a cornerstone of the overall clinical database infrastructure and is the software environment of choice for core clinical applications. This is characterized by massive data volumes, a high level of information complexity and the need to maintain high performance and reliability while handling very large numbers of information requests. Currently more than 300GB, the Caché- based Clinical Data Repository (CDR) is expected to continue to grow substantially for the foreseeable future. Via a secure intranet and a CDR Viewer (CDRV) application, physicians can now easily access information, dramatically improving the timeliness of information delivery while simultaneously reducing the cost.

STRENGTHS: Caché is optimized to enable high-performance transaction processing and deliver the massive scalability needed for large enterprises and especially critical for Web-based applications. The product's Distributed Caché Protocol significantly reduces network traffic, which means faster transaction processing and makes it possible to scale up to serve many thousands of users without sacrificing performance. The Caché post-relational architecture, which includes a multidimensional database, is well suited to handling highly complex clinical applications in a much more flexible way than is typical of two-dimensional relational technology. Also key is the overall reliability of Caché in a 24x7 environment. Caché is a potent and agile Web services platform and XML server.

WEAKNESSES: Caché does not currently support real-time analytical processing. However, InterSystems plans to introduce some real-time analytic capabilities with the next major release of Caché.

SELECTION CRITERIA: In addition to the performance and scalability requirements previously addressed, we required database technology that could be managed very easily while supporting high availability. Caché is outstanding in this area. Additionally, the preference was for a database that makes it possible to implement data models in a manner that reflects how the data naturally occurs. Real-world clinical data is inherently very hierarchical and extremely complex. With Caché, we implement post-relational data models that fit the clinical domain in a much more appropriate way than is feasible with the relational approach. Additionally, we are increasingly requiring strong XML capabilities, and Caché is a very good XML server.

DELIVERABLES: For the CDRV application, Caché delivers easy, secure access to clinical data to a base of thousands of information users across a wide geography. Caché is the database foundation for hundreds of applications running on our technology infrastructure.

VENDOR SUPPORT: We have a close working partnership with InterSystems. Interaction with InterSystems' engineering and support organizations is ongoing, and they get high marks for response.

DOCUMENTATION: Application development and system management documentation are delivered to the desktop as HTML documents. The literature itself is quite rich and includes code samples as well as a programming tutorial for newcomers.

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