Adopting a corporate perspective on databases. Improving support for research and decision making

Area of Science:

• Health Informatics
• Health Services Research
• Database Management Systems

Background:

• The Veterans Health Administration (VHA) manages complex health care information systems to serve diverse user needs.
• Traditional centralized databases present challenges in accommodating varied user perspectives (clinicians, researchers, administrators).

Purpose of the Study:

• To describe the VHA's approach to developing and managing large-scale health care information systems.
• To highlight the evolution from a distributed database (DHCP) to an event-driven system (EDR) for improved data reporting and management.

Main Methods:

• Utilized a decentralized, multisite distributed data system (DHCP) with decoupled hospital databases.
• Developed a newer system (EDR) employing multiple, highly coupled databases for workload data aggregation.
• Implemented automatic data subset posting from DHCP to EDR for various management levels.

Main Results:

• The DHCP's centralized policy fostered data coherence, while decentralized management ensured local relevance.
• The EDR system effectively aggregates workload data across facility, regional, and national levels.
• Adopting a corporate perspective for EDR development yielded substantial database improvements with minimal legacy system impact.

Conclusions:

• VHA's strategic database development, balancing centralization and decentralization, effectively meets diverse user needs.
• The Event Driven Reporting system represents a successful integration of a corporate perspective for enhanced health data management.
• This approach demonstrates cost-effective database improvements with modest disruption to existing infrastructure.