Re: Database design.

[Drsolly <drsollyp () drsolly com>]

On Tue, 6 Jun 2006, Brian Loe wrote:

> VISTA doesn't do much in the way of a national health care records system.
>
> Drsolly doesn't appear to be representing the project very well, or
> simply doesn't understand it. A comment like, "My GP doesn't have any
> xrays or MRI scans of me" is born of...what, exactly?
>
> A NATIONAL health care database isn't going to be worried about just
> your general practitioner - but also your hospital visits,
> specialists, pharmacies and prescriptions, etc.. I work in the health
> care industry, meaning my company does health care related processing
> (you figure out which of those mentioned it is) and we deal in
> terabytes of data A DAY - and we're only the 2nd or 3rd largest
> processor of such information!
>
> On top of those records add every x-ray you've ever had in your life,
> or any other medical "picture" (have any kids?). Now days hospitals
> send MRI scans and more "live" to other hospitals for other physicians
> to review - those are saved. Not only are those saved but in the US,
> due to HIPAA regulations, there's a pile of documentation that must
> also go with it.
>
> Unlike VISTA (which has versions for VA hospitals and a version for
> doctor's offices), a national database would need to be robust enough
> not just store all of this data but also report on it (we have three
> independent systems containing the same data for different functions
> that must be performed on it by pharmacies, doctors, patients and
> insurance companies). We have several billions wrapped up in our
> hardware/software - not to mention recurring expenses for maintenance
> and upgrades (which you should expect a lot of them) and we STILL get
> throttled on busy days (like the first of the month). AND WE ONLY
> HANDLE ONE ASPECT OF THE HEALTH CARE DATA WORLD!
>
> A NATIONAL health care records system may actually prove to cost MORE
> than 40 billion and it won't be built in a day, meaning you should
> expect that you'll be servicing the system as you build it up. I'd
> make a guess and say you'll need a terabyte per person of space, to
> start. You may need space for each doctors office, pharmacy and
> hospital as well. Whatever insurance system you have may have needs as
> well (national health care, though, in the UK, right?)...

We don't store all that data. I had a leg x-ray several years ago, and I 
really don't think that the record of it was kept. Nor was there any 
reason to - the situation they were checking up for (blood clot), wasn't 
there. I also had a foot x-ray about 30 years ago. Again, the condition 
they were checking for (fallen arch) wasn't there. I cannot believe that 
this got filed. 

The problem with spending humungous amounts of money on a platinum-plated 
IT system such as you suggest, is that you don't have that money for 
spending on nurses and hospitals. My feeling is that your design is 
overkill, and will wind up losing more lives than it saves, because the 
money that could be spent on medicine, would be spent on programmers and 
computer systems. Just the storage you're suggesting, one terabyte per 
person, at $500 for a terabyte storage, would cost 30 billion dollars.

Certainly I can see that from the point of view of a vested interest in 
the medical IT profession, someone would think that this money is well 
spent. But I think that more lives are saved by medical attention, 
together with a much simpler (and cheaper) computer system.

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