Healthcare Database Concepts | HealthcareITSkills.com

databases in healthcare

One of the most important skills for Healthcare IT is an understanding of healthcare database concepts and structure. It doesn’t matter if you are a Project Manager, Application Analyst, or System Administrator; an understanding of databases in Healthcare will take you a long way in your career.

So with all the different Healthcare IT systems on the market, how can one article provide value? In my career I’ve worked with a medical supply software system, pharmacy systems, three different electronic medical records systems, a home health application, and various other products. They all had their differences, but had many things in common.

For example, just about every system has some kind of “departments” table. In some systems, it may be called locations, or areas- but the idea is the same. With that, I will try to use vendor-neutral descriptions. Let’s dive in.

First off, let’s review some basic database concepts:

  • A database is an organized collection of data and is hosted on a database server
  • A database contains tables, usually many
  • Tables contain rows
healthcare-database-concepts

For our example, let’s say we have one database called ‘HEALTH_PRODUCTION’, with many tables defined within that database. Here are some tables that are likely to exist:

 

The Enterprise Table

The enterprise table is defined to represent your organization at the highest level. There will have many departments under this entity, and reports sent to Federal regulatory agencies will reference the enterprise. It could also be called “Facility” or “Organization”.

  • “Smith County Hospital” is an Enterprise that has many departments
  • “Jones County Hospital” would be another Enterprise
the enterprise table
Enterprise Table Example

 

The Departments Table

The departments table contains all the departments in your enterprise. There will be clinical and non-clinical locations, and most but not all will have physical locations. Those without physical locations are sometimes called virtual departments, and are just for accounting or administrative purposes. Most will have some kind of cost center code. Here are some examples:

  • Davis Primary Care
  • East Side Urgent Care
  • Emergency Services
  • ICU
  • Information Technology
healthcare-technology-departments
Department Table Example

The Users Table

The users table contains all the users in a system. You might guess that all users in a particular system actually log into that system. However, that’s not always the case. An example would be a doctor who does not work for your organization whom you refer patients to. Referrals to this doctor are part of the patients’ official medical record, but that doctor has no direct connection with your organization. Users will have varying levels of security in any given system. Here are some examples of user types:

  • Dr. Joyce Carson, MD
  • James Carson, RN
  • Tom Duncan, CIO
  • Sarah Chang, CEO
  • James Reeves, Database Administrator
  • Richard Sherman, Materials Management
the users table
Users Table example

The Patients Table

The patients table will usually be huge, possibly having one row for each patient. It will have the demographic data on each patient, and may or may not have specific clinical information. For this example, let’s assume clinical visits and orders like current meds are not in this table.

databases-in-healthcare
Patients Table example

The Orders Table

The orders table contains  orders that get placed for patients, such as:

  • X-Ray of the left ankle, Stat
  • Keflex 100 mg once daily for seven days
  • Referral to Orthopedic specialist

Orders are almost always authorized and signed by a licensed provider such as a physician, therapist, and in some cases a nurse. In some systems, initial order entry could be done by a non-provider, but the order would be in a ‘pended’ status until signed by the provider.

medical-records-orders
Orders Table example

 

The Items Table

While the previous paragraph was about the orders that get placed, here we have the items, meds, or procedures themselves that are defined in their own table, waiting to be ordered. Duration, quantity, and timing are not usually hard-coded into this table, but are specified when specific orders are placed.

 

health-it-items-table
Items Table example

Example of Record Linking

If clinical information is not in each patient data row, then there will be pointers to other tables. A pointer is just an identifier in a table to provide linking to data in other tables. Notice here we have an order for Glucose Test Strips that has a column called “Ord_Item”…

order-pointer

 

 

 

That happens to be the same value we have in the Items table for column “Item_ID”…

health-item-pointer


The Medications Table

Medications usually have their own table, separate from other things that get ordered. Due to complexity, liability, and regulatory issues, most systems rely on imports from third-party firms that provide a comprehensive formulary of medications. One vendor who provides this data is First Data Bank, and we refer to the process as the “FBD Import”.

medical-records-medications

 

The Encounters Table

These are the events that occur when anything is done on a patient. Examples are:

  • Scheduled office visits
  • Surgeries
  • Admissions to the hospital
  • Telephone consultations

The Documentation Table

A system may have a table that stores notes that caregivers write to document a patient encounter. It may have a field that stores a large amount of free text to be displayed in an application, possibly using HTML or other formatting.

healthcare-documentation-table
Documentation Table example

 

The Diagnosis Table

This contains industry specified codes and descriptions for every condition, disease, or disorder imaginable. Like the medication formulary, this data is almost always downloaded from an outside data provider. The most popular one is Intelligent Medical Objects (IMO).

healthcare-diagnosis-table

 

 

 

This doesn’t cover all the possible databases that could exist in a Healthcare IT system, but should give you a good starting point.

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Summary
Healthcare Database Concepts
Article Name
Healthcare Database Concepts
Description
Healthcare database concepts article describes the basics of how many Healthcare IT databases are structured. It covers users, patients, and other tables.
Author
HealthcareITSkills.com
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Dave Newman
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Dave Newman

I have made my career in Healthcare Information Technology, and every day I love what I do. I have done project management, training, database work, some programming, and have implemented electronic medical records, interfaces, and more. I created HealthcareITSkills.com to help people begin careers in Healthcare Information Technology.
Dave Newman
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