InterSystems Demonstrates Scalability of Primary Care Systems

Database systems supplier InterSystems, has announced that it has carried out successful scalability tests of its CACHÉ database product in collaboration with primary care clinical systems supplier EMIS to demonstrate how primary care electronic records can be scaled to a national-scale system with a small hardware footprint.

The scalability tests were based on demonstrating how its CACHÉ database technology can be applied to scale up primary care systems to provide the extremely large national electronic patient record database, ‘NHS Spine’, envisaged by the National Programme for IT (NPfIT).

The test database, built in a test environment at the HP Healthcare Competency Centre, Reading, has been scaled to hold 22 million individual medical records. In total the database currently contains details of over 280 million medical encounters, 365 million medication prescriptions and more than 425 million clinical investigations.

The electronic records and database built for the scalability tests were derived from a primary care medical records schema widely used in the NHS, which represents a lifelong patient history comprising repeating consultations, prescriptions, diagnoses and referrals. It also holds other relevant data such as allergies, controlled drugs, immunizations and medical alerts.

"CACHÉ runs the largest acute hospital systems in the NHS – so we understand the implications of deploying these systems to thousands of concurrent users," explains Phil Birchall, Director of Healthcare Business Development at InterSystems.

But he added that in addition to acute systems there are already successful primary care systems that deliver real clinical benefit at the point of care. InterSystems says it already holds over 30 million individual primary care records stored in its database technology

Mr Birchall explained that a key objective of the scalability tests was to examine the implications of moving primary care records into a centralised database. “The majority of a patient’s lifetime healthcare activity is held within the primary care record, however this has previously only been available to the GP.”

He told E-Health Insider that primary care systems tend to get overlooked as they are small and not generally seen as enterprise-scale applications. “But what we have shown is that general practice clinical systems can have an important role to play in the national programme, they actually have the most contact with patients.”

Mr Birchall continued: “We have shown how technology can be scaled to join up these systems to a single system in which more than half of the population’s existing electronic medical records can be stored.”

The test system has also demonstrated how query performance can be delivered, even using relatively modest servers for an environment of this scale and scope. The system benchmarked in excess of 3 million completed medical encounters in an 8-hour working period – three times the NHS projected throughput for primary care in an individual LSP cluster.

Thanks to the data compression technology used by CACHÉ, the physical size of the database developed was extremely small. Despite containing over 1.5 billion rows of data, it uses only 300Gb of disk space.

Birchall explained "In this exercise we focused on transactional data rather than the storage of medical images or other binary data. We know from existing customers that the multidimensional database footprint of CACHÉ is much smaller than the relational equivalent,

In addition to NHS customers, Intersystem’s CACHÉ database technology is also used in top ten hospitals in the USA, and the Department of Veterans Affairs uses InterSystems software for their healthcare solutions. Kaiser Permanente, the largest private healthcare group in the world, recently chose a CACHÉ based solution from Epic Systems to deliver the largest US healthcare system ever to be developed outside of Federal Government.

The test database was implemented at the HP Healthcare Competency Centre, Reading, UK, on a pair of mid-range Alpha ES45 Servers running Open VMS version 7.3, and CACHÉ Version 5.