While the use of database technology is ubiquitous throughout IT (and health IT in particular), it is not generally appreciated that, as a database increases in scope, certain designs are far superior to others. In biomedical domains, new knowledge is being generated continually, and the databases that must support areas such as clinical care and research must also be able to evolve while requiring minimal or no logical / physical redesign. Appropriately designed metadata, and software designed to utilize it effectively, can provide significant insulation against change.

Many of the...