MSMIT

CST 597

Database Systems Management & Technology

Vasquez 361 B Fitch Avenue Monterey, CA 93940 T 831-224-2778 christophevasquez@mac.oom http://web.mac.com/christophevasquez/CSU

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Project Case: Mountain View Community Hospital, CH 1

1. What are some of the important benefits that Mountain View Community Hospital
should seek in using databases? As much as possible, relate your response to the
hospital environment.

a. There are many advantages in using a database approach -many that far outweigh
the costs of switching to a database. There are 10 advantages according to our text
which include:

i. Program-data independence

ii. Minimal data redundancy

iii. Improved data consistency

iv. Improved data sharing

v. Increased productivity of application development

vi. Enforcement of standards

vii.Improved data quality

viii.Improved data accessibility and responsiveness

ix. Reduced program maintenance

x. Improved decision support

b. There are two areas that quickly come to mind as key users of this database. The
first, and most obvious, are the medical care providers such as the doctors and
nurses who rely on accurate patient data. The use of a database will quickly allow a
large amount of relevant and accurate data to be processed for enhanced decision
making. The second benefit of a database is for the billing and HMO support that
quickly gains hundreds of charges per visit. In order to keep an accurate and

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reliable source of billing data, the Hospital can share their data with HMOs or billing
departments. This reduces the risk of error on both the part of the hospital and of
the billing department.

2. What are some of the costs and risks of using databases that the hospital must manage
carefully?

a. There are several costs and risks that must be evaluated before accepting a
database approach:

i. New, specialized personnel

ii. Installation and management cost and complexity

iii. Conversion costs

iv. Need for explicit backup and recovery

v. Organizational conflict

b. Naturally a hospital will weigh the costs vs benefits and make a wise choice. The
database approach, although not free of costs, is nearly a necessity to keep up in
the modern industrialized world. However in a smaller or rural environment, it may
be easier to maintain analog data or manually updated files on a PC or simple server.
An important factor to consider immediately is the conversion costs... whereas
technology is becoming cheaper, the amount of data required by modern care
providers is only continuing to increase, and the manual labor required to convert
these files will also only grow / increase in scope and cost.

3. At present, Mountain View Community Hospital is using relational database technology.

Although this technology is appropriate for structured data such as patient or
accounting data, it is less well suited to unstructured data such as graphical data and
images. Can you think of some types of data maintained by a hospital that fit this latter

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category? What types of database technology might better be suited to these data
types rather than relational?

a. Whereas it is easy to relate items like customer ID and customer Room on a

relational database, it is extremely difficult to store critical medical data such as the
results of a heart monitor EKG or the image of a baby from an ultra-sound. Another
example of data that is graphical in nature are X-rays and CAT scans.

b. The type of database technology that is better suited to deliver this type of graphic
data is a LAN or Intranet system that includes a search function for meta-data. A
secondary method is to attach file names to a patient’s relational database data and
keep records just like the ‘old fashioned’ physical records.

4. How are data in the PATIENT and PATIENT CHARGES tables related? That is, how can
a user find the relevant charges for a particular patient?

a. The simple data tables both include a PATIENT NUMBER that, when queried, will
deliver both a patient and patient charges depending on the database pulled. The
common key on both tables is the PATIENT NUMBER.

5. What are some ways the hospital could use the internet?

a. The internet is by far the greatest advantage a hospital could utilize for reasons far
beyond the databases described in this chapter. First, and foremost, the internet
can be used as a massive source of medical information for care providers to
research, spot trends, and correctly treat their patients. Secondly, the internet could
be used a a way to host and access data that is far more media rich than the
relational database example from above -pulling everything from articles to imaging.
A third advantage is the ability to use web applications to capitalize on wireless
mobility and client-side processing. An example would be a web-based prescription
filler for care providers to add prescriptions for their patients without having to go to
a special computer. A fourth advantage of using the internet is that there are fewer

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specialized applications that require a hospital administrator to monitor. For

example, a search function can be as simple as an intra-net version of Google’s
popular search application -maintained by Google. As well, these applications and
others such as WebMD’s database of case studies and health information are often
free of charge.

6. Give an example of how the hospital could use each of the types of databases
described in this chapter: Personal. Workgroup. Departmental. Enterprise. Internet.

a. Personal: The best use of a personal database is a contacts or notes list. For
example, if an MD wants to follow up with a department in the hospital, it would be
the easiest for him/her to use a PDA and flag a date to call back, utilizing a contact
number stored on a personal contacts list.

b. Workgroup: A workgroup is usually considered to be 2-25 people that need to have

access to a common set of data. An example of a workgroup application would be
the hospital’s external website. Typically designers and content providers collaborate
to build a dynamic and timely website. The files for a website and design notes
would be help by a work group. An excellent tool for this size is an Adobe product
called Dreamweaver.

c. Departmental: A larger group of 25-100 within an organization, such as marketing or

accounting, would best be suited by a departmental database. A reason for this
step up in capability is to design a more robust data server so that man users can
access large amounts of data quickly. The accounting department could use this
type of database to auto-generate mailed out bills or provide statistics for
administrative review.

d. Enterprise: The largest database, for 100 or more, is known as an enterprise level
database. The hospital would use this type of database to store all of its patient care
records and provide its care givers with instant access to several terabytes of data.

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Patient history, current data, current care, and family information could all be stored
and accessed in this database, available to all hospital employees with sufficient
privileges.

e. Internet: An internet database would be an excellent way to store patient location,

address books, rosters, and maps for the hospital and guests. The data could be
pulled from the enterprise database and made more graphically friendly for visitors or
display kiosks. It also allows for access across a variety of platforms such as mobile
phones, PDAs, and remote login.

Project Case: Mountain View Community Hospital, CH 2

1. Which information system planning matrixes (among those shown in this case study or
others not shown) might assist the study team at Mountain View Community Hospital
to determine a tiered location plan for databases? Why?

a. It would be advantageous to add two models while developing an enterprise model

and executing functional decomposition. The first is a Location-to-function model
which indicates which business functions are being performed at which business
locations. A second model is the unit-to-function model which identifies which
business functions are performed by or are the responsibility of which business units.
These additional models will help determine the tiered location plan since it will help
deliver where each tier is required: Client tier, Application / Web server tier, and the
Enterprise server tier.

2. In the project description, objectives are listed for one of the four critical success
factors, operating cost control. Write plausible objectives, given the structure and
plans of this hospital for the other three CSFs.

a. Quality of medical care:

i. Accurate and timely care

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ii. Provide caring bed-side manor

iii. Courteous and professional staff

iv. Maintain modern equipment and office equipment

b. Control of capital costs:

i. Utilize bulk purchases on items that do not expire

ii. Negotiate fair prices for business purchases

iii. Use varied suppliers to maintain a competitive and informed supply chain

c. Recruitment and retention of of skilled personnel, especially nurses:

i. Maintain a highly motivated staff

ii. Provide excellent support for staff

iii. Equip and train staff for success

iv. Promote hospital through organized University recruiting awareness programs

3. What additional activities might occur within the “volunteering” business function?

a. Volunteers could also contribute to quality care by assisting Nurses or staff with
routine delivery of information such as X-rays to the MD for analysis or expediting lab
results. The volunteer helps keep costs down by acting as unpaid labor, but they
also deliver a better business by improving the way the hospital operates. Another
example would be a host or hostess volunteer opportunity that improves the
customer satisfaction index of a hospital.

4. What activities might occur within the “risk management” business function?

a. Risk management is currently a business function for the facility, physician, patient,
medical / surgical item, and the vendor. A business application of risk management

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is required to broker a relationship with drug vendors to gather price trends, use
data, or even discover medical hazards associated with OTC drug use being
prescribed by the hospital staff. Another use could be to analyze the customer
satisfaction index to ensure that the goal of “quality of medical care” doesn’t start to
wain. A final application example may include a critical assessment of the facility to
ensure the proper level of care is being provided, and meeting patients’ needs.

5. What additional data entities, besides the 10 entities mentioned in this case, might the
risk management business function need?

a. In light of the fact that the database is being proposed, a risk manager should look
at the hazards of data loss, data leak, patient’s data rights protection, and risks
associated with network security and illegal data access. A risk manager should
work with an ethics advisor and a legal representative to ensure that the staff is
made aware of the risks associated with private data. Finally there should be great
care given to reducing the risk of corrupted data, for example during an accidental or
intentional destruction of data or altering of data to meet better numbers for health
insurance or hospital performance assessment matrixes.

6. Do you think that the study team will be able to identify all the data entities by doing the
kind of analysis they have been doing? If not, what other database development steps
will need to be done and when?

a. It is nearly impossible to capture all of the data required to make a ‘perfect’

database. The best next step is to develop an actual prototype and allow a limited
user group to test the application. Feedback from various and preferably diverse
groups can advise the project manager what should be added / changed before a
corporation-wide system is implemented. A development cycle includes project
identification, initiation, analysis, logical design, physical design, implementation, and
maintenance -yet change and prototyping can assist at any one of these stages. It
can also reveal faults that revert a manager back to one of the earlier stages.

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7. Why do you think the people on this business planning study team were selected for
this assignment? Would you have chosen different or additional people?

a. The reason they were chosen was that the tool of a database is only to assist a
corporation to do a better job. In this case, the administration chose to emphasize
quality of medical care, control of operating costs, control of capital costs, and
recruitment / retention of skilled personnel. All of these items are business functions.
However, it seems to reason that a medical professional like Dr Browne (listed as the
chief of physicians staff) should be on the team since a hospital tends to revolve
around a doctor and his/her patient. Dr Browne would be able to provide a current
top-down look at what would be required by those who work for him. I would have
also added a project manager from another successful project similar to what the
hospital is attempting to do in the role of consultant, or project manager is he/she
would accept.

8. In the case description, nine business rules are listed. The study team used these rules
to develop the MVCH. What other business rules, besides these nine, are implied or
depicted in that figure?

a. In addition to the model, there is an assumption that Vendors also supply other than
medical supplies to the medical professionals. Vendors must also supply the food,
cleaning, and maintenance supplies. Staff could be broken down to full time, part
time, or volunteer. The facility does not show ambulatory services, which would be
off the premises, yet still requires service, staff, and patients. It should also show
that many doctors would analyze the many tests performed by the laboratory, while
trying to treat the patients.

9. Even though the capital cost control is a critical success factor, only two business
functions in the MVCH mention this CSF. Why? What would need to be done to
enhance this figure so that more entries indicated a relationship between business
functions and this CSF?

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a. The MVCH model only shows an ‘essential’ mark for capital cost control in Surgery
and a ‘desirable’ for electrodiagnosis. To increase this category, one could either
combine operating cost control and capital cost control, since they are very similar,
or eliminate the capital cost control from the critical success factors. In reality, it is
almost in contrast to quality care and staff recruiting and retention. After all, no one
wants to be a part of a low cost, low quality solution. It would be possible to re-
word the capital cost control to include a simple comparison of costs to similar
industries and assess success based off of peer to peer comparison.

Chapter 8-13: Implementation Overview

Once a database is designed, there are many methods of data application and
processing available to meet the original performance requirements. The question moves
from what data is required to where the data should be stored and manipulated. The
ability to free up processing power can be done through the de-facto language for
creating and querying relational databases. In addition to the ANSI accepted language
there are tiered ways of distributing the architecture, to include client, database, and
application code servers. This thin client approach allows for scalability, technological
flexibility, and reduced long term costs. Despite the flexibility of client / server
architectures, many mission critical applications tend to remain on a mainframe.

The internet has provided a new way of delivering content rapidly by internet based
applications. Web services such as ASP and ColdFusion include web enabled databases
that often deliver a simple GUI. The internet is composed of a network of workstations,
servers, and data-servers, with each following a TCP/IP protocol. This network has
allowed for online shopping and data-rich web pages, but at the cost of developing and
employing firewalls, and lowered user privacy.

With the massive amount of data now available to managers, the challenge resorts
to a proper way to gather the critical information necessary for good decision making
processes. A problem with the sheer volume of data is not only the overload, but the

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increasingly difficult methods to locate data due to ‘generations’ of coding. The major
difference between what managers need and what they have is known as operational vs
informational systems. Operational systems are typically designed to be a quick way to
deliver a lot of processing, such as a render farm. Whereas an informational systems is
designed to aid decision makers, such as investors on Wall Street. A data warehouse
collects the massive amounts of data and distributes it across a 3-layer architecture. The
first layer is data throughout the various operational systems. The second is a centralized
data warehouse. And the third is a limited scope data delivery system, known as a data
mart and stored in a variation of the relational model known as a star schema. Naturally,
there are many different variations for on-line analytical processing, to include drill down
services and data-mining.

Once data is available to decision makers, it is still essential to maintain and

manage the database system. Security and administration become essential roles in
maintaining the technical advantage and avoiding threats such as data loss, corruption,
and loss of availability. The DBMS become responsible to meet the four database
properties: atomic, consistent, isolated, and durable. A quality administrator essentially
delivers the information to those who need it, and blocks those who do not. This can
include a challenge such as a distributed database, or a decentralized database. To have
this type of database, which allows for a higher level of reliability and accessibility, there
must be a DBMS that coordinates the access to data at the various user nodes. The
focus remains on the appearance of a single node, and is maintained by proper planning,
maintenance, scrubbing, and protection.

In conclusion, there are many ways to free resources and deliver data or information
to those who require it. The most common form is to distribute the data across many
nodes, and at the same time share processing power between client and servers. The
benefits of shared data include redundancy, reliability, and speed of processing.

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