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InterSystems shows how the CACHÉ post-relational database handles 22 million medical records using  substantially less hardware and development resources than other technologies.

Eton, UK—September 11, 2003— InterSystems, the largest provider of database software to the NHS, with nearly 5,000 NHS installations and over 170,000 concurrent online users, today revealed details of an Electronic Medical Records scalability test undertaken in collaboration with EMIS.

InterSystems set out to provide answers to a key question facing suppliers to the NHS National Programme for IT, namely, how will database technology scale to provide the large Patient Record database envisaged by the Programme?

Implemented at the HP Healthcare Competency Centre, Reading, UK, on a pair of mid-range Alpha ES45 Servers running Open VMS version 7.3, and CACHÉ Version 5, the test environment currently holds 22 million individual medical records – almost half the population of England.

The database is derived from a Primary Care medical record schema deployed in the NHS today. The schema represents a lifelong patient history comprising repeating consultations, prescriptions, diagnoses and referrals. It also holds other relevant data such as allergies, controlled drugs, immunizations and medical alerts. The unique XML features of CACHÉ made it possible for the automatic creation of the computerized representation of this complex medical record with almost no development effort.

The database currently contains details of over 280 million medical encounters, 365 million medication prescriptions and more than 425 million clinical investigations.

“CACHÉ runs the largest Acute Hospital systems in the NHS – so weunderstand the implications of deploying these systems to thousands of concurrentusers,” explains Phil Birchall, Director of Healthcare Business Developmentat InterSystems.

“At the same time, there are successful Primary Care solutions that deliver genuine clinical benefit at the point-of-care. The majority of a patient’s lifetime healthcare activity is held within the Primary Care record, however this has previously only been available to the GP. As there are over 30 million individual Primary Care records already stored in our database technology today, we thought it important to examine the implications of moving these records into a single centralized database.”

The test system produces excellent query performance, even using relatively modest servers for an environment of this scale and scope. The system benchmarked in excess of 3 million completed Medical Encounters in an 8-hour working period – three times the NHS projected throughput for primary care in an individual LSP cluster. The unexpected discovery was the physical size of the database.

Birchall continues, “In this exercise we focused on transactional data rather than the storage of medical images or other binary data. We know from existing customers that the multidimensional database footprint of CACHÉ is much smaller than the relational equivalent, but we were delighted at how effectively CACHÉ was able to handle this challenge. The database contains over 1.5 billion rows of data, but uses only 300Gb of disk space!”

CACHÉ has advanced data compression and sparse-array capabilities that make it possible to be so frugal with physical disk. Additionally, CACHÉ’s high performance object-orientated capabilities allow developers to construct complex applications without the overhead normally associated with de-normalized data in relational databases.

Graham Frost, Managing Director at InterSystems says, “Existing application providers to the NHS already understand the capabilities of InterSystems technology. They have first-hand experience of how it delivers performance and scalability while requiring meager hardware resources. These factors are fundamental when delivering working solutions with public monies.”

InterSystems technology is in use by hospitals, labs, clinics and GP practices throughout the NHS with an estimated 500,000 staff having access to InterSystems’ databases. The top ten hospitals in the USA together with the Department of Defence and the Department of Veterans Affairs use InterSystems software for their healthcare solutions. Kaiser Permanente, the largest private healthcare group in the world, recently chose a CACHÉ based solution from Epic Systems to deliver the largest US healthcare system ever to be developed outside of Federal Government. With 11,000 clinicians in 9 states and a health plan membership of 8.4 million people, the Kaiser implementation draws comparison with the challenge facing LSP’s in the NHS National Programme.

“We want to do all we can to make the NHS IT Programme a complete success,” says Graham Frost, “therefore we are sharing the details of this test with those organizations who might benefit from the experience that we have acquired from this effort and throughout our 25 years as a leader in the Global Healthcare market.”

About InterSystems

Headquartered in Cambridge, Mass., InterSystems Corporation ( is a leading provider of high performance, low-maintenance database systems for Web applications, with over four million users worldwide. InterSystems’ flagship product, CACHÉ, is a post-relational database that uniquely offers three integrated data access options: a robust object database, high performance SQL, and rich multidimensional access. CACHÉ enables rapid Web application development, extraordinary transaction processing speed and real time queries against transactional data.

Trademark Notes:  Caché is a trademark of InterSystems Corporation.  Other trademarks belong to their respective owners.

Editorial Contacts

Julie Ronald
InterSystems House
Tangier Lane
Eton, Windsor
Tel: +44 (0)1753 855450
Fax: +44 (0)1753 855290