Healthcare · Enterprise Systems · 2004–2024
20-year maintenance and development partnership for a hospital Medical Information System
A two-decade partnership maintaining and extending an enterprise Medical Information System for a large outpatient clinic. Built on InterSystems Caché — a specialised object-relational database platform widely deployed in hospital systems globally — the MIS manages the full clinical workflow: patient registration, appointment scheduling, physician workplaces, medical records, and reporting. Our role was continuous feature development, adapting the system to changing clinical requirements, and ensuring reliable operation at scale.
- 20+Years of partnership
- 40kPatients per year
- MISFull clinical workflow
- OngoingSystem evolution
Context
A clinic that needed a reliable long-term technology partner, not a one-off vendor
Healthcare IT systems cannot be replaced every few years. The clinic's Medical Information System had to evolve with changing medical regulations, updated clinical workflows, and growing patient volumes — while maintaining 100% availability during operating hours. This requires a partner who understands not just the technology, but the clinical processes, the data model, and the history of every decision made in the system over decades.
Challenge
Continuous evolution of a complex enterprise system without disrupting live clinical operations
InterSystems Caché is a powerful but highly specialised platform — it combines an object-oriented database, a proprietary query language (ObjectScript), an application server, and a web layer. Every change to the system touches live patient data and active clinical workflows. New features had to be developed, tested, and deployed without downtime, while maintaining data integrity across a deeply interconnected schema built up over 20 years.
Solution
Deep domain partnership — adapting clinical workflows, data, and reporting over two decades
Our team worked as an embedded technology partner for the clinic, continuously developing and adapting the MIS to new clinical requirements. The long-term relationship meant we accumulated deep knowledge of both the system internals and the clinic's operational needs.
InterSystems Caché development
Feature development in ObjectScript on the InterSystems Caché platform — a specialised object-relational database used in enterprise healthcare systems globally. New modules and workflow adaptations developed directly against the live system schema, with careful version management and zero-downtime deployments.
Clinical workflow adaptation
The MIS covers the full patient journey: registration, insurance verification, appointment scheduling, physician workplaces with access to medical records, procedure documentation, and administrative reporting. As clinical requirements changed — new regulations, updated treatment protocols, organisational restructuring — the system was continuously adapted to match.
Long-term data integrity
Over 20 years, the system accumulated a deep patient history database. Schema changes, data migrations, and new reporting requirements had to be handled without loss of historical data. Every modification was planned with full awareness of its downstream impact on existing records, queries, and reports.
IIS web layer and integrations
The application's web layer ran on IIS, serving clinical staff across the clinic's internal network. External integrations — including the InfoScan document scanning and recognition system developed in parallel — were connected through the MIS API layer to feed recognised patient data directly into existing records.
Engineering approach
How the partnership worked
Requirements
Clinical staff and administration formulated new requirements based on regulatory changes, workflow improvements, or new reporting needs. Our team translated these into technical specifications against the existing Caché data model.
Development
Features implemented in ObjectScript on the Caché platform, working directly with the object-relational schema. Changes reviewed for impact on existing data, queries, and dependent modules before deployment.
Validation
New functionality validated with clinical staff in a staging environment before release. Medical data integrity checks run against test datasets mirroring production record structure.
Deployment & support
Deployments scheduled outside peak clinic hours. Ongoing support and monitoring ensured system availability throughout operating hours. Incidents resolved with clinical context awareness — understanding which workflows depended on which data.
Results
Measured impact
- 20+Years continuous operation
- 40kPatients per year
- 100%Uptime during clinic hours
- 1Long-term clinic partner
Technology
Stack & capabilities
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