A Physician's Workstation as an Application of Object-Oriented Database Technology in Healthcare

We describe solutions to practical database problems encountered during the implementation of a prototype Physician's Workstation (PWS) at Hewlett-Packard Laboratories: (i) the integration of legacy data repositories using an object-oriented database management system; and (ii) the development of a clinical information model which logically encapsulates potentially heterogeneous underlying data sources, and presents a unified view of relevant patient information to the application layer. This model is a first step towards an Electronic Medical Record (EMR), In addition, we show how the system has been architected to yield substantial performance gains by applying smart caching and data staging techniques, as well as how these techniques can be used to improve availability of data. The prototype is at present being evaluated in a clinical setting at the Veterans Administration's Medical Center in Palo Alto (PA-VAMC), where we have integrated their legacy Decentralized Hospital Computer Program (DHCP). The integration approach described is equally suited to the integration of other legacy systems. The PA-VAMC prototype provides access to over 30,000 patients, of which 5,500 are cached in PWS.