Client-server, Distributed Database Strategies in a Health-care Record System for a Homeless Population

H. C. Chueh, G. O. Barnett
1994 JAMIA Journal of the American Medical Informatics Association  
Obiective: To design and develop a computer-based health-care 'record system to address the needs of the patients and providers of a homeless population. Design: A computer-based health-care record system being developed for Boston's Healthcare for the Homeless Program (BHCHP) uses client-server technology and distributed database strategies to provide a common medical record for this transient population. The differing information requirements of physicians, nurses, and social workers are
more » ... fically addressed in the graphic application interface to facilitate an integrated approach to health care. This computer-based record system is designed for remote and portable use to integrate smoothly into the daily practice of providers of care to the homeless. The system uses remote networking technology and regular phone lines to support multiple concurrent users at remote sites of care. Results: A stand-alone, pilot system is in operation at the BHCHP medical respite unit. Information on 129 patient encounters from 37 unique sites has been entered. A full client-server system has been designed. Benchmarks show that while the relative performance of a communication link based upon a phone line is 0.07 to 0.15 that of a local area network, optimization permits adequate response. Conclusion: Medical records access in a transient population poses special problems. Use of clientserver and distributed database strategies can provide a technical foundation that provides a secure, reliable, and accessible computer-based medical record in this environment. n A computer-based health-care record system is being developed for Boston's Healthcare for the Homeless Program (BHCHP) to help providers manage the diverse health-care needs of Boston's homeless population. Recent studies of the homeless population have emphasized the complexity of health-care issues in this group.' Their use of the health-care system is sporadic, and access to health services does not occur through traditional channels. Patients are often seen by different BHCHP providers at multiple sites. Effective treatment of this transient population requires better access to medical records than the current pa-Affiliation of the authors:
doi:10.1136/jamia.1994.95236148 pmid:7719799 pmcid:PMC116196 fatcat:psb7ky5xjvgwxckbdwpz5v7bnq