DATABASE

EDWYN SALEH
DATABASE MANAGEMENT SYSTEM

Data are at the center of all decision making in health care.

Data should therefore be reliable, complete, and well
structured
Computers may assist in fulfilling these requirements.
A software shell around the data assists the user in all storage
and retrieval operations, controls the access to the data, and
keeps a log file of all data transactions. This software shell is
called a database management system (DBMS).
The application programs in an advanced information system
do not themselves retrieve data from the computer but
operate via the DBMS, which handles all data operations for
the programs.
TERMINOLOGY
Data are usually stored in a database, which structures data
that belong together. A database is a collection of files.
A file is a data storage entity that has a name, the file name.
Files are created and deleted by the computer's file system.
Files are accessed by giving the file name as one of the
parameters of a command.
A file is further subdivided into logical data records, which
are the smallest units for data storage in the database.
The computer's file system is responsible for the physical
storage of the data onto a disk, which is called a mass storage
device.
TERMINOLOGY

Database management system

terminology
Data Structure in Paper-Based Patient
Records
Data Structure in Computers
Data structure in computer based patient record
Differences between paper based and computer based
patient records
The DBMS for Data Structuring
PAPER BASED
A paper-based patient record is an ordered set of
documents that contain all medical, patient-related
data collected for the care of one patient
Such a paper-based patient record is organized in a
special way, in which we can distinguish
administrative data such as name, birth date, patient
identification, and health insurance; permanent
medical data such as gender, blood group, and
allergies (single occurrence); and variable and other
medical data (multiple occurrences of data or time-
dependent data).
PAPER BASED (2)
The variable data can be further split into different subgroups
such as:
patient history,
physical examination and follow-up examinations,
laboratory results,
drug prescriptions,
images (such as X-ray pictures and scintigrams), and
biological signals (electrocardiograms, spirograms, etc.).
In the paper-based patient record these data are grouped
together in different sections, such as a section containing the
patient history, collected during the first patient visit, and
subsections for each follow-up visit, a section for laboratory
results, a section for drug data, and so forth.
In the section for patient history and follow-up visits the data
are ordered chronologically.
COMPUTER BASED
When patient data are stored in computers it is not important
to keep all data for one patient physically together as long as
the data can be quickly retrieved when, where, and in the
format that they are needed for patient care.
For reasons of efficiency and quality control it may even be
better to leave the laboratory results for all patients in one
laboratory database, all drug data in a pharmacy database, all
diagnostic codes in a separate database, all ECGs and their
interpretations in an ECG database, or all X-ray pictures in a
radiology database.
Therefore, the ordering of patient data in a computer-based
record should not necessarily mimic that in the paper-based
record
Differences between paper based and
computer based patient records

Data may be organized differently in computers than in

paper-based records. The reasons are as follows:
A paper-based record is static; a computer-based record is not.
A paper-based record can only be at one place at a time; computer-
based data can be presented at multiple locations.
Paper-based records have a fixed ordering of the data; computers can
retrieve data in different sorting orders and can retrieve data
selectively on the basis of user-defined criteria.
In a paper-based record the user must browse the pages to search for
the data he or she wants to see; a computer enables the user to
retrieve instantly all data related to the actual health status of the
patient (e.g., by retrieving the last available and still valid data).
A DBMS solves the problem as to the computer and the
memory location where the data are located.
The DBMS for Data Structuring
In computer terms, the file is usually considered the smallest
named storage unit in which data are grouped together
A file could be, for instance, a patient history taken at some
earlier date or laboratory results reported on some other date.
Such files could be stored either in different databases (e.g., a
database of all laboratory results) or together in one database
(e.g., a database of all patients in a clinical department).
Information systems make use of a DBMS to store, modify,
or retrieve data
By using a DBMS, users can access and modify data for
different purposes
The DBMS for Data Structuring
Each purpose requires a separate view of the data
and specific rules for achieving consistency and
maintaining the integrity of the data
The quality of the data (correctness and
completeness) is of vital and even legal importance
for the correct interpretation of the data in an
information system.
Therefore, it must be guaranteed that no program
can delete or modify data in a way that violates the
correctness, completeness, consistency, and integrity
rules of the database. This is also a task of a DBMS.
Operating system independence
DBMS is a software system that takes care of the storage,
retrieval, and management of large data sets.
All data are stored in files managed by the computer's file
system, which is used by the DBMS.
In order to optimize data retrieval and to provide fast access
to the data, detailed knowledge of the computer's operating
system and its file system organization is essential.
However, the user does not need to know this, because the
DBMS takes care of it.
The file system organization is different for the operating
systems of different computers. In fact, the DBMS shields
the physical implementation of the data files from the user,
and provides an operating system-independent interface that
makes storage, retrieval, and data management much easier
Data model independence

Different models can be used to look at the

data in a computer, depending on the
perspective or view one has in mind.
A user may look at the data differently than a
programmer, and the designer of the
computer system's file system may have an
even different view.
Main Tasks of a DBMS
Taking care of all database storage, modifications,
and retrieval operations:
mapping of the data from the user environment (the
external data model) to the conceptual data model, and
mapping of the data from the conceptual data model to the
physical file structure (the physiscal data model) of the
computer;
Checking the data integrity rules and the data
consistency rules;
Access control (authorization);
Concurrency control (multi-user access); and
Facilities for data protection (transaction logging).
Data modeling

In information systems we need, depending

on the user requirements, specific data
models to view and process the data. We can
distinguish the following data models:
External data model
Conceptual data model
Implementation data model
Internal data model
Physical data model
External data model
The user of the information system is primarily interested in
data associated with his or her current interest. Generally, he
or she uses the computer for data entry, data presentation,
and data processing. Take the following examples:
An administrative assistant who must make an appointment for a
patient wants to view in one display screen part of the administrative
data for the patient, the name of the clinician and the department, and
the time slots available for appointments.
Clinicians may want to obtain an overview of the actual health status
of a patient. They then ask the computer to present in one display
screen the actual patient data in alphanumeric and/or graphical form.
These views of the data in which the user is interested make
use of an external data model, that is, a model that offers an
external view of the data.
Conceptual data model
Data in a computer may have various properties.
Patient identification data are different for
laboratory data, or for computed tomograms. For
instance:
To identify a patient we want to store the properties name,
address, patient number, etc.;
For a laboratory test we want to store the type of test,
when the sample was collected and by whom, and by
whom or by what instrument the sample was analyzed.
Data groups that have similar properties are called
data entities
Conceptual data model (2)
For instance, patients, laboratory tests, or appointments are
data entities. Data entities are often interrelated: a laboratory
test is related to a blood sample derived from a patient with a
certain identification. Such relations are described in entity
relation diagrams (ERDs). Together, the entities and the
different relations between the data entities shape the
conceptual data model. Graphical tools that assist the user in
defining the conceptual model are available.
Now that we have the user's view defined in the external data
model and the relationships between the data have been
documented in the conceptual data model, the definitions can
be implemented in the DBMS. This is done by the
implementation data model.
Implementation data model
From the conceptual model the implementation data model
can be derived. The implementation data model is the data
model used by the DBMS.
Many implementation models can be designed, but the user
does not need to know how they operate
To realize the implementation data model in the DBMS, a
data definition language (DDL), which is provided by most
modern DBMSs, is used.
In a relational model, for instance, the DDL defines the
database as a set of tables, and it also describes constraints on
the data.
Some DBMSs automatically generate a DDL script from a
conceptual model as specified by the user.
Internal data model
The DBMS maps the implementation model onto a
model consisting of computer files and logical data
records.
We call this the internal data model. This mapping
is completely handled by the DBMS, and the user
has no need to be concerned about this, except to
know that some practical realizations of an internal
data model are more efficient than other ones.
This efficiency is largely determined by the
computer's file system, which is described by the
physical data model.
Physical data model
The file system of the computer takes care of the physical
storage of data files in disk blocks, that is, the storage of data
in groups of bytes on a mass storage device. The organization
of the data files on disk is called the physical data model.
The user should be involved in the design of the DBMS, but
only with respect to the external model and the conceptual
model.
The designer of the DBMS is responsible for mapping the
conceptual data model to the implementation data model.
The internal data model and the physical data model are only
of interest to computer experts and the designers of the
computer system and its operating system.
Data control

Some important aspects of a DBMS that are

essential for its proper functioning. They are,
consecutively:
concurrency control,
access control, and
integrity and consistency control.
Two other aspects also deserve attention:
transaction processing, and
data security.
Concurrency control
Concurrency control deals with conflicts between
simultaneous use of the database by different users who are,
for instance, entering or updating data in identical data files.
A DBMS provides automatic concurrency control to prohibit
the same data from being entered or changed by different
editors at the same time
An example is making an appointment for the same
diagnostic test at the same time by administrative personnel
A DBMS will solve this conflict by limiting the concurrent
entry of data: Only one user at a time may access the data for
data entry or data modification; the system is then blocked
for other users who want to use the same time slot.