Databases- Questions & Answers

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Once you've made the decision to have a Day2Day Solutions database, you will be faced with questions from staff, computer support people, administrators, and competitors about your choice. This section will provide you with answers to those questions.

Day2Day Solutions Keywords
4th Dimension database software is a client/server package
The Day2Day Solutions package is a customizable medical clinic, assessment, and management shell designed to run on 4th Dimension
What kind of budget should I be planning for?
First, using a Day2Day Solutions Database saves you money. The database shell containing 90% of your database is free. To start from scratch a customized database meeting your specific needs would cost you $50,000-$150,000.
With Day2Day Solutions you pay for the commercial database engine- 4th Dimension. A network database would normally consist of  the Server software running on a dedicated computer, and a group of client software on individual work stations. A typical cost of such a system with 10 users would be $4,500. With the suggested built in word processor (10 users) the price would increase to $5,500. To allow greater flexibility, a $500. web publishing licence is also recommended. This allows the server to provide access to your database through any web browser reducing the need to provide infrequent users with the 4D Client software, and training. It also allows you to have secure access to your data from offsite. Total price so far is $6,000.
Your next budget item is the "customization" of the shell- the screen displays, reports, specific data elements, navigation, variety of input screens for the various disciplines that will have access to the database etc. Day2Day provides service at an hourly rate of $120./hr. In the case of initial setup the special rate of $60./hr is used. On a new installation an estimated customization time would be between 300-400 hrs or at a cost of ~$18,000. This would also include a full year support from the start of the project.
Hardware cost will vary, but as a rule of thumb be expected to pay ~$2000 per computer. Of course existing workstations can be used. The computer holding the 4D server software should be dedicated to that use. Usually, it sits with other servers in a secure IT site. Day2Day Solutions uses a secure software service called "I'm InTouch" to access this server for setup, maintenance, and upgrades.
Post installation, a sum of $12,000. per year should be budgeted for maintainance and upgrading of the database.

Day2Day Solutions Keywords
128 SSL communication security
Internal multi-level user security
What about security and patient confidentiality?
There are many aspects to the issues of security and patient confidentiality. There's the network security- both external and internal. There's software accessibility, and within the software itself there's component accessibility. Here's the best way to answer the question. First, within the organization the database is as secure and in fact, better secured, than other software packages on your network since it has its own sophisticated security system. With a secure network, then access to the information within the database is secure from external access. The database's password system and built-in encryption and decryption package using 128 SSL adds an additional  level to the existing network security system. In fact, a significant difference in 4th Dimension to other database engines such as MS Access is the ability to use SSL encryption and authentication between 4D Client and 4D Server. This feature insures that information passing between the user and the database is not intercepted nor altered by internal or external forces.When the web publishing interface is used the same level of security provided by secured bank web sites is available.
4th Dimension incorporates a comprehensive password access system. The password system is used to selectively grant "read/write", "read only", or "non access at all" access to users to any parts of the database. Access can be granted, or denied, to input screens, view screens, report generation, schedule making etc depending on your site's requirements. For example, if you have volunteers, you can provide access to certain administration files, but deny access to the actual patient medical records maintaining patient confidentiality. The extent of this kind of protection at the user level is so flexible that it can be used to even deny a user access to a button action that may be present on a form. Multidiscipline data, or multi-user data is protected from accidental erasure or modification by other users throughout the database. A log system is maintained for every read/write action that takes place.

Day2Day Solutions Keywords
4D has wide range of accessibility tools to external data
Allows separation of data from presentation
write once, use many times, many ways
Why choose 4th Dimension as the software engine?
  • 4th Dimension compared to others-

FileMaker is too low end for creating medical databases. It simply doesn't provide you with enough built in flexibility. Oracle is too high end- and surprisingly also not as flexible. It's very expensive and in the end too rigid for the patient care field.Once created an Oracle database is not easily modifiable. MS Access is a possibility but it's design base is towards statistically data gathering with poor options with respect to input screens and report generation. Also the programming language Visual Basic is somewhat difficult to use. The 4th Dimension language is straight forward, easily applied, and easily learned by non programming trained users.

  • 4D can talk to virtually any modern application-

A major reason for using 4th Dimension is that 4th Dimension provides a wide range of accessibility tools to external data. Now it’s simple to call COM Objects, Web services, XML, OBDC, AppleScript, Perl Scripts and PHP Scripts and get results from these scripts. Web services is the glue that allows all standards-based applications to talk together.  XML is the new data interchange standard. All modern applications use XML as the means of interchanging data. 4D 2004 offers new support to allow developers to create XML data files quickly and conveniently.

  • The separation of presentation from data is a major step in developing applications that last-

XSLT enables the same XML data to be transformed from one "presentation" to another. 4D 2004 supports XSLT, allowing any developer to transform data from one format to another. So, for example, if your customer wants a report output to Excel today, and later asks to change the output to Word, you can simply change the Stylesheet your application is calling and transform the data without any change in your compiled application. Unlike MS Access and FileMaker Pro, 4th Dimension provides a simple end-user report generator. Called Quick Reports, the report generator allows endusers to create their own tabular type reports that include common items such as subtotals, counts, etc. as well as formatting options and control over appearance.


  • Connecting with other datasources has never been easier-

4D offers Export and Import from any ODBC Datasource.


  • The key to a good database system is balance-

A good database strikes a balance between the needs of developers and the needs of end-users. A good database offers flexibility and ease of development. A good database provides a comprehensive set of features without making database development nor database use more difficult. FileMaker Pro is fairly easy but limited. MS Access provides greater capability in some areas but less in others and is much more complex. 4th Dimension provides the greatest balance. It has much of the ease of development of FileMaker yet has a larger feature set than either of the other two products.

Day2Day Solutions Keywords

Fast and flexible implementation

Allows on-line modification without interrupting data input

Allows Offsite modifications and system implementation

How difficult and time consuming is it to implement a database into our environment?
Not difficult at all. First the developer meets with a senior staff member to determine needs and, just as important, general philosophy of the unit and its operational parameters. The developer provides a list of options based on his experience. After a few meetings, a general working document, and production guidelines are created .
A representative is chosen from each discipline that will be using the new database to interface with the developer and to provide the further insight of the day to day operation of their duties, the type of data they wish to place into the database, any the features that will simplify certain of their duties by avoiding needless repetition. Any resistance to a computerize system is easily overcome with a demonstration of the time saving elements that will soon be implemented.
Within a month an initial basic package can be installed for testing. The application, actual server software, and clients can be installed within a hour. The new application is then tested, modified, retested and expanded until satisfaction is achieved. Three months is a reasonable time frame for a medium to major site installation. The database is of course in use during that time period, and is monitored and tweaked over the next 9 months.

Day2Day Solutions Keywords
Relational database provides quick access to a wide variation of related data for processing, report generation, peer communication, and research
Relational databases reduces systemic error by avoiding data input duplication,
and as such, increases productivity and reduces workload
Relational databases increases charting accuracies by providing on screen charting guidelines, charting templates and keyword input
The literature describes 4th Dimension as a "relational" database. What does that actual mean and why should I use one?
A database can either be relational or linear. For example, in "real" life a file folder containing information about a patient, in a file cabinet, makes the cabinet a database. The file folder is a record within the database. As new information about a patient is gathered and is added to the folder, a simple linear time link between the documents within the patient record (the folder) is created. (Document A, lab results, is about the patient and was placed in the database on such and such a date. Document B, treatment plan, is about the same patient and was placed in the database a month later).  Searching for a specific patient information is simple enough since all the information is in the file folder. But a search for all patients that have an abnormal cholestrerol reading is more difficult and much more problematic. We know that there is a relationship between the folders, since the information is in each patient file but how do we get the information out?
How- by creating a relational database. Most modern databases are relational. In the "real world" it's very difficult to create a non computerized relational database. Your file cabinet would still contain all information about the patient but a second cabinet would be needed to contain all Document A's about every patient, and a 3rd cabinet would be need to hold all Document B's about all patient as well etc. That's a lot of duplication, and a lot of possibility of errors with respect to misfiling etc. But still, you would be able to search for high cholesterol readings by searching the cabinet that has all Documents A. But how would you search for all high cholesterol readings and a specific treatment plan? It would be difficult. It would require a fair amount of time.If all of the data within these cabinets were somehow combined in let's say, in a fourth dimension, that would allow rapid simultaneous searching of all the cabinets, life would be perfect.
A computerized relational database is a collection of information organized in such a way that a computer program can quickly select desired pieces of data. Relational databases are organized by fields, records, and tables. A field is a single piece of information; a record is one complete set of fields; and a table is a collection of records.  Storing content in fields rather than static pages makes that content appropriate for dynamic delivery.
In our example above- searching for all patients with high cholesterol over a given value and a specific treatment is simple. We search the records of the table Lab Results for data in the field Cholesterol value for the given value. Then knowing that these records are related to a patient name, we ask the computer to provide us with the set of records of the table Patients related to the Lab Result records. Then the computer relates the specified treatment in the Treatment Table and produces a second set of records of the table Patients. The intersection of these two sets, is the result that we are after.
In a more complex situation where information must be collated and sent as a report or as part of a document, the power of a relational database is easily demonstrated. For example, a template form can be created and on printing, the database would automatically search for demographic information in the Demographic table, determined the gender of the patient and switch words in the template that are gender specific to the proper gender (Mr. to Mrs, his to hers, he to she etc) refer to lab results from that table, appointment data from the Appointment table and so on and on. A day's work of report generation can be produced at a touch of a button, and the results available in minutes.

Day2Day Solutions Keywords

One year included support,

Off site monitoring and modifications,

Backup and Restore Support,

Site training with aim for self-suffiency,

Open structure of shell for 3rd party access

How self sufficient can we be? How bound are we to Day2Day Solutions to maintain and upgrade our system? Is there after sales support?
Once you are up and running and the system is operational you are offered a yearly maintenance program ($12,000. /yr) that will make give you unlimited access to a Day2Day Solutions' designer. This provides you with an offsite monitoring and system database backup, monthly data "examination and clean up" process, monthly minor stats reporting, and quarterly major stats reports. As well, any modifications to the existing database with respect to reports, input screens, password maintenance, database upgrading, are all included. The only thing that is not included is the software upgrades of the 4th Dimension database engines that occur every 2 to 3 years. Any operational changes to the database that may be required due to an engine upgrade are covered.
That said, the site training provides training to one or two individuals that are considered to be database administrators. 4th Dimension is a multi-leveled database having 3 levels of operation- design, user, and custom. Custom uses the Day2Day Solutions' shell and all the site customization created for you. The user level allows the user access to manipulate the raw data stored in the database without the need of any knowledge of programming. Search editors, Print Report generators, Export and Import editors, Sort and Graph editors are accessible to database administrators. The design level can also be made accessible, allowing administrators, or third party programmers with 4th Dimension language experience to add customization to the database.

Day2Day Solutions Keywords
Maximum reliability,
Minimum down time,
Ease of use with high level of performance,
Built in scalability
How reliable and easy to maintain is a 4D database?
With the innovative features of 4th Dimension, you can easily maximize the reliability and availability of 4D applications. Maintaining a high level of reliability and availability is an important factor in minimizing the administrative tasks required for a database application.

The database engine of 4D includes a self-analyzing process that will identify many forms of possible data corruption. For example, data fields and indexes have checksums, and when 4D detects potential data corruption, it records information about the record in a special area of the data file, which is used when running the 4DTools application. These built-in automatic functions result in real-world databases that rarely experience corruption or need to be rebuilt. But on the rare occasion when damage is reported and is beyond the capabilities of the built-in functionality, there are several tools available.

The 4D Tools application, a standard part of the 4D environment, can perform additional detailed analysis and repair. Several third-party products are available, such as SanityCheck and DataCheck from Committed Software, which extend the analysis and repair possibilities even further.

Also integrated into 4D is a backup module called, appropriately enough, 4D Backup. This module allows quite a bit of flexibility for implementing automated backups, logging, mirroring, and more. A flexible user interface is available to simplify DBA interaction, and for a situation where automation may be required, the 4D Backup API extends the 4D language with commands that allow a 4D programmer to build the module’s functionality into an application.

4D’s Internet Commands plug-in allows you to easily add automated alert features to an application. For example, in the event of certain error conditions, you could design an application to automatically send an email to alert the appropriate technical personnel about the problem in order to allow a more rapid response.

4D has been used for 14 years to create powerful, mission-critical applications. In many enterprise projects, the 4D team was competing with other teams using well-known products, yet was able to deliver the 4D system in less time, at a lower cost, and with a superior interface and level of performance.

Down times on Day2Day Solutions sites are minimal. At a cardiac rehab site in Mississauga, a site that has a complicated, complex multidisciplinary database with over 5 gigabytes of patient information, inputted by 12 users of 5 different disciplines, patient photos, letters, lab reports, class attendance, compliance checks, appointments for patients with each discipline, and multi-paged progress reports and questionnaires customized to a patient's current status, the downtime is less than a total of 4 hours a year. The average requested site visit is 3 times a year, each consisting of 3 days. During changes to the structure the database was operational.

Day2Day Solutions * 1459 Waltham St * Ottawa * ON * Canada K1T 2T4 *613-738-1418