Databases and database management systems are widely used in healthcare, and it is hard to imagine a modern effectively functioning clinic which is not using databases. Often, there are different databases working with internal and external information, which are focused at different needs of various stakeholders involved in the process. The purpose of this paper is to identify databases used at Cleveland Clinic, and to consider the structure, records, indexes, limitations and standards associated with this database and the effectiveness of using or not using standardization for the chosen database.
It should be noted that Cleveland Clinic is a well-known healthcare innovator: it partners with different companies such as Google, Microsoft, Dossia and InterSystems to develop online and offline tools and systems for managing healthcare information. In addition to this, employees of Cleveland Clinic have implemented a number of registries and databases for storing clinical research. It is possible to name about 17 registries and databases implemented by the clinic (Search Cancer Clinical Trials, 2011). In 2009 the clinic has launched an online database for searching all cancer clinical trials registered at the clinic in order to improve cancer treatment and to develop better methods of treating cancer (Search Cancer Clinical Trials, 2011). This database allows to search by the location of clinic (hospital), type of cancer, stage of cancer and by the physician. The information about the clinical trial provided to online visitors includes description and objectives of the study, inclusion and exclusion criteria, hospitals where this trial is implemented, and answer line where visitors can find out more information about the trials.
At the start page of the search related to cancer clinical trials, it is possible to select type of the disease, hospital, phase associated with the trial, and it is also possible to search using IRB and CC numbers, which are aligned with the standards of Cancer Consortium and Institutional Review Board (Wager, Lee & Glaser, 2009). After performing the search, the system shows a table with all appropriate trials and shows key characteristics of these trials. It is possible to view the details of each trial.
The results of the search for a particular trial consist of three parts. The first part contains key information about the trial, including diseases, hospital, phase and stage, type of trial and drugs used in the trial. The second part includes contact information and description of the trial, and the last part of the report contains inclusion and exclusion criteria (Search Cancer Clinical Trials, 2011). IRB and CC numbers are also indicated for the results of the search.
According to the structure of the search input and the resulting reports, there are the following base tables in the database: hospitals, types of diseases, phases of trial, stages of trial, types of trials and drugs. More complex tables include basic info about the trial, detailed trial info, table listing what trials are linked to which hospitals, and table listing what trials are linked to which drugs, and contact information for trials. The records in the base table are likely to use auto incremental fields for encoding basic entities (except the types of diseases, which might be coded according to international standards). The most important table will be the basic info about the trial, where internal key of the trial will have to be generated, IRB and CC numbers of the trial will be listed, phase and stage of the trial, and type of the trial.
Key record for every trial will be used in the table using many-to-many relationships, such as trial-hospital and trial-drug tables. Index fields will be IRB and CC fields, type of the disease (associated key) and stage of the trial (associated key). The table with details of the trial will include key identifier of the trial and several memo fields containing the description, inclusion and exclusion criteria for the trial.
The limitations of this database are related mainly to the method of accessing it: since every online visitor can see the information about trials, the records cannot contain sensitive information, and the presentation of trial information cannot contain appropriate laboratory research, images and other useful information. The structure of the database also does not allow to search on the inclusion and exclusion criteria of the trials, as well as on the description of trials. Such searches might be highly useful for volunteers and for people dealing with non-precisely diagnosed diseases with cancer-like symptoms. Improved search would make this database even more effective that it is now. It should be noted that the use of standards, namely the inclusion of IRB and CC codes into the database, makes it highly effective for medical research and for medical professionals dealing with cancer (Tyrrell, 2002). Overall, Cleveland Clinic managed to implement a powerful instrument fostering the development of clinical research.
Search Cancer Clinical Trials. (2011). Cleveland Clinic. Retrieved from http://my.clevelandclinic.org/cancer/clinical_trials/trials.aspx?utm_campaign=cancerclinicaltrials-url&utm_medium=offline&utm_source=redirect
Tyrrell, S. (2002). Using information and communication technology in healthcare. Radcliffe Publishing.
Wager, K.A. & Lee, W.L. & Glaser, G.P. (2009). Health Care Information Systems: A Practical Approach for Health Care Management. John Wiley and Sons.