Systems for large-scale reuse of electronic health record data is claimed to have the potential to transform the current health care delivery system. In principle three alternative solutions for reuse exist: centralized, data warehouse, and decentralized solutions. This chapter focuses on the decentralized system alternative. Decentralized systems may be categorized into approaches that move data to enable computations or move computations to the where data is located to enable computations. We describe a system that moves computations to where the data is located. Only this kind of decentralized solution has the capabilities to become ideal systems for reuse as the decentralized alternative enables computation and reuse of electronic health record data without moving or exposing the information to outsiders. This chapter describes the Snow system, which is a decentralized medical data processing system, its components and how it has been used. It also describes the requirements this kind of systems need to support to become sustainable and successful in recruiting voluntary participation from health institutions.
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