REDMOND, Wash., November 23, 1998 — When patients enter a hospital or medical office, the last thing they want to know is that their medical records are among millions of others stored somewhere in a warehouse of file boxes.
Patients want assurance that individual medical records are indeed individual, secure and easy for the doctor or clinician to understand. In the modern health care environment this is not always possible. Frequently, health records are stored in multiple computer systems occupying acres of physical space.
Enter TeraCLIN. TeraCLIN is a powerful prototype database management system recently developed by Microsoft and Data General Corp., a major supplier of health care information systems hardware. TeraCLIN is designed to demonstrate the scalability, performance and reliability of SQL Server 7.0, ActiveX for Health Care modules and the Windows NT platform within Data General hardware.
The prototype database, using Microsoft SQL Server 7.0, holds more than a terabyte (a thousand gigabytes) of text, dictated voice and digital imaging data such as CAT scans and MRIs, all housed within Data General’s CLARiiON full Fibre Channel disk array storage, managed by multi-processor AViiON AV 8600 Cluster-in-a-Box servers.
Like Microsoft’s prototype TerraServer satellite photo project, TeraCLIN is not designed to be a line of business application for Microsoft. Instead, it is intended to position SQL Server 7.0 on the Windows NT Platform as a viable price/performance alternative to UNIX-based systems.
TeraCLIN marks one of the first efforts to develop a prototype clinical data warehouse of a terabyte of atomic data-the amount of data typically generated by a high-volume health care provider in multiple locations. By housing this volume of data and delivering it in a format that can be easily analyzed by non-technical health care workers, TeraCLIN makes it possible for medical clinicians to obtain access to patient data all in one place. The result for the patient is a more efficient and complete diagnosis.
“The biggest advantage of TeraCLIN is the ability to allow clinicians not trained in information systems technology to access data,” says Paul Smolke, Microsoft’s managed care industry manager. “It used to be that data was delivered in a raw form that had to be analyzed by a technical specialist. Now, any health care worker can get answers to queries in plain English.”
The resulting benefit is “a more comprehensive examination of medical records for each individual patient and less risk,” says David Flawn, vice president for NT marketing at Data General, which demonstrated TeraCLIN at COMDEX/Fall ’98 last week. For the patient, he adds, “it means a more efficient and complete diagnosis.”
Accessing real data with real English within the Windows interface provides a layer of cost-effectiveness that is key for HBO & Company, (HBOC), says Rusty Lewis, the company’s chief technology executive. Lewis, whose company is the largest developer of medical information systems in the United States, previewed TeraCLIN at a Microsoft HealthCare Users Group (MS-HUG) conference last month.
Price/performance is a primary consideration for HBOC’s end users – as are reliability and security – and the TeraCLIN prototype is designed to provide assurances on all ends. A key factor in its efficiency is that the application was created within just four days, using Microsoft’s ActiveX for Health Care modules, scaled to new proportions to structure the massive database.”
“What Data General and Microsoft have proven with the TeraCLIN project is that SQL Server 7 does indeed have the enterprise scalability on the proper level of server and storage technology that is required in the health care market,” says HBOC’s Lewis.
To understand scalability, consider the many levels of a database of records. A simple Microsoft Access database may contain a list of names and addresses, accessible by a single user. An online, electronic commerce version of SQL Server may be taxed bythousands of information requests within an hour, as millions of visitors to a catalog Web site inquire into the available sizes of a colorful shirt, a top-selling book or a compact disc. Now, imagine the scope of a database that can tell a doctor, health care worker or clinician the state of a patient’s health, in his or her doctor’s voice – complete with graphics illustrating the patient’s condition.
The TeraCLIN database is the equivalent of 500 million pages of text or approximately 40,000 four-drawer filing cabinets of information. It stores two years of information for 6 million patients, medical records for 300 medical facilities and the records and updates of 5,000 physicians. It contains information on 4,581 variable diagnoses, 40 types of lab tests, 652 different medications, 300 insurance companies and 710 billable services offered by health care organizations.
High-end medical imaging systems and separate huge transactional databases to house medical records currently exist on expensive minicomputer systems. However, TeraCLIN’s combination of text, dictated voice and digital imaging data puts together an unprecedented amount of information at anyone’s fingertips.
While health care records are the focus of the TeraCLIN prototype, the applications for this technology are broad-based. The system is designed for any massive database applications in which huge amounts of data must be parsed among a large number of users. Among the prime candidates that could benefit from the capabilities of TeraCLIN are the oil and gas industry, which must continuously examine millions of lease records at great expense; pharmaceutical companies that compare data on large numbers of components used in the development of new drugs; and even large retail chains seeking to compare customer shopping habits with inventories.
“Our customers ask us all the time to show them a proof point that has a similar profile,” says HBOC’s Lewis. “TeraCLIN gives HBOC the ability to refer to a location that has SQL 7 technology deployed in an environment that is representative of what our users are going to require. Combine that with Data General’s 99.9 percent guaranteed uptime for Windows NT and SQL Server 7.0 and its excellent performance for Windows NT and SQL Server, and you have a compelling proposal.”
Reliability and trust in data that doesn’t require technical interpretation is key for any medical organization. Many patients still long for a time when a single traditional “country” doctor took care of an individual from birth to death. TeraCLIN’s ability to give doctors and clinicians complete records that are easy to access and understand has the potential to transform an impersonal relationship based on medical record numbers into the intimate doctor-patient relationship many patients seek.
