ADOPTING A CORPORATE PERSPECTIVE ON DATABASES - IMPROVING SUPPORT FORRESEARCH AND DECISION-MAKING

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.