Health Systems Technologies

CACHÉ high-performance database underpins success of Western Cape's health IT infrastructure

The Provincial Government of the Western Cape (PGWC) is rolling out an upgraded and centralised version of the Clinicom hospital information service (HIS) to 38 hospitals and specialised care centres throughout the region in line with efforts to advance healthcare delivery to the province.

The Clinicom application, which is designed to provide a single electronic patient record (EPR) across the entire province, is underpinned by the CACHÉ post-relational database of Boston-based InterSystems, the world's fastest growing, independent vendor of databases.

The Clinicom application was successfully piloted at the three large academic hospitals in the Western Cape - Groote Schuur, Tygerberg and the Red Cross War Memorial Children's Hospital. These hospitals are specialised medical institutions aligned with the University of Cape Town and Stellenbosch University. The world-renowned Grootte Schuur Hospital was the site of the world's first heart transplant surgery in 1967, and the Red Cross Children's Hospital is the only dedicated comprehensive paediatric hospital in southern Africa. Rollout to the remaining 38 non-academic hospitals has commenced and will continue over the next 24 months.

The HIS implementation began in 2001 when HST, the South African distributor of the system, replaced the in-house-developed Cape Hospital System (CHS), a 25-year-old legacy mainframe system that was not Y2K-compliant. The project requirements of the implementation were initially to replace existing operational functionality from the legacy mainframe system with a Y2K-compliant system and to derive the benefit of a modern, internationally developed system for the management of healthcare at hospitals.

"The highly comprehensive functionality of the Clinicom solution is the result of years of research and development by a leading healthcare solution provider," says Steve Hurwitz, application development manager at the Centre for e-Innovation in the PGWC. "The consistent reliability and scalability of CACHÉ has provided the stable foundation for the Clinicom application to meet our requirements."

The scalability of the system has been a considerable advantage for the province's healthcare system. Grootte Schuur and Tygerberg each have about 1200 computers, some 40% of which operate concurrently during daily peak periods. The robust nature of the technology is designed to handle this load and, once in place across the entire province, an estimated additional 4 000 computers throughout the other 38 hospitals in the province.
"The fact that there don't have to be any dedicated database administrators responsible for ensuring the consistent performance of the system is indicative of the robust nature of the underlying technology of CACHÉ," adds Hurwitz. 

Gideon Gerber, acting senior manager for the health, social services and housing cluster within the PGWC, says the Clinicom solution has increased revenue generation for the department and improved efficiencies.  "The functionality and capabilities of the technology, which provides general and clinical data on patients, has also raised the level and quality of workflow. With no manual handling of paperwork, the quality of data has improved dramatically," says Gerber.  Looking forward, Gerber anticipates the use of the system will increase by more than 150% during the next five years.
"We have decided that a prerequisite of all additional software systems we implement in the future must be compliance with our electronic patient record system for patient information. We will also be using the same platform and interrogating the same centralised database for all additional categories of patients and chronic diseases," says Gerber.

Henry Adams, country manager of InterSystems, believes one of the toughest challenges in healthcare technology is the volume of structured and unstructured data.   "Relational databases and traditional legacy technologies are only designed to handle structured information, such as medical data. In healthcare there are doctors' notes, medical images, laboratory reports and a large volumes of other unstructured, free-flowing data that need to be stored on the database. Healthcare is a multidimensional environment and the robust nature of CACHÉ's architecture is engineered for the optimal management of such systems.  "As the leading database in healthcare worldwide, CACHÉ is uniquely capable of providing the reliability, scalability and robust design required for a project of this size and nature," says Adams.