M. Meistrell et C. Schlehuber, ADOPTING A CORPORATE PERSPECTIVE ON DATABASES - IMPROVING SUPPORT FORRESEARCH AND DECISION-MAKING, Medical care, 34(3), 1996, pp. 91-102
The Veterans Health Administration (VHA) is at the forefront of design
ing and managing health care information systems that accommodate the
needs of clinicians, researchers, and administrators at all levels. Ra
ther than using one single-site, centralized corporate database, VHA h
as constructed several large databases with different configurations t
o meet the needs of users with different perspectives. The largest VHA
database is the Decentralized Hospital Computer Program (DHCP), a mul
tisite, distributed data system that uses decoupled hospital databases
. The centralization of DHCP policy has promoted data coherence, where
as the decentralization of DHCP management has permitted system develo
pment to be done with maximum relevance to the users' local practices.
A more recently developed VHA data system, the Event Driven Reporting
system (EDR), uses multiple, highly coupled databases to provide work
load data at facility, regional, and national levels. The EDR automati
cally posts a subset of DHCP data to national database tables every 24
hours, thus providing timely, verifiable data to local and national V
HA management. The development of the EDR illustrates how adoption of
a corporate perspective can offer significant database improvements at
reasonable cost and with modest impact on the legacy system.