Defense health record database growing too big

A Defense Department database of electronic health records is growing so fast that it is showing signs of collapsing under its own weight, prompting information technology managers to consider dividing the storage load among regional data centers, Military Health System officials told Nextgov.

Comment on this article in The Forum.The mammoth database, called the Clinical Data Repository, which stores patient records for 9.2 million active and retired military personnel and their families, is growing at a rate of 1.4 terabytes a month and has become one of the largest databases in the world, said Army Col. Claude Hines, program manager for the Defense Health Information Management System.

Charles Campbell, chief information officer for the Military Health System, said at that rate of growth, the repository was in danger of becoming unmanageable. While the database, developed by Northrop Grumman Corp., had more than a 99 percent uptime, it "was beginning to have problems" because it was so large, he said.

Tommy Morris, director of MHS, department technologies and support programs for force health protection and readiness programs, described the state of the repository as "failed" during a presentation at an American Engineering Association technology conference held in August at the College of DuPage in Glen Illyn, Ill.

Connections between military hospitals and the repository communicate on a direct, point-to-point basis, which means military clinicians could not gain access to the database if one of the circuits failed, Hines said. The Defense Information Systems Agency hosts the database at one of its data centers and provides backup at an undisclosed data center. (Nextgov will not disclose the locations of the data centers at the request of MHS due to security concerns.)

MHS plans to develop a mesh network to connect military hospitals to the repository to eliminate connection failures, and the Space and Naval Warfare Systems Center in Charleston, S.C., is testing a mesh network approach for MHS, Campbell said. A mesh network allows data to flow to different nodes on a network, avoiding any nodes that may be blocked or broken. "We need a CDR that never goes down, and one way we can to do that is with a regional data center approach," Campbell said.

The repository stores all patient records for the Armed Forces Health Longitudinal Technology Application system, which is at the center of a major change in how MHS manages and processes electronic health records. The agency plans to shift from using proprietary software found in the technology application to one based on commercial software and service-oriented architecture, Campbell said.

Decentralized databases have become the norm in the commercial health care industry, said David Brailer, who served as the first national health information technology coordinator in the Health and Human Services Department from 2004 to 2006. Kaiser Permanente, the largest commercial health care system in the country, built its HealthConnect electronic health record system around decentralized databases rather than a single database, said Brailer, now chairman of Health Evolution Partners, a San Francisco-based health care venture capital firm.

Joseph Dal Molin, founder of e-cology Corp. in Toronto, who works on deployments of electronic health record systems, said using a single database was an old method to store patient information. MHS should build in redundancy into how it stores patient information because "there are too many things that can go wrong" with a centralized database, he said.