Performance
Normally Performance would be the primary concern for most business applications that use databases. After all application performance was one of the necessities that brought about the development of some databases. There are some higher priorities in healthcare though, but performance is still one of the highest.
One of the things to look at when considering performance is the number of concurrent users there are vying for data from the database. For a higher number of users, flat file and ISAM databases usually suffer drastic reductions in efficiency. Client/Server databases are usually the answer when it comes to doling out data efficiently to large numbers of users.
Another thing to look for is the configuration of the database. How many computers will be requesting data from the database? With a high number of computers that will need data regularly, this is, again, where the Client/Server database shows its efficiency. Flat file or ISAM databases often need to pull down the entire database or table over network to retrieve data from their database. With many computers pulling down that much information at once, this often causes huge surges in network traffic causing delays and downtime. Now, that being said, if an application only has a few, or a single concurrent user on a single computer without any need of transmitting files over the network, Flat Files and ISAM databases will usually work perfectly fine.
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