hospital db
server db
temp work db
both hospital and server put changes to temp db which has a copy of server db at a specific point in time like 00:05 am during the day as things are update replace the hospital db with tempdb using a copy function. at midnight replace server with tempdb rinse and repeat. Might want to ask tablizer to verify but it should be able to be done in xbase in a matter of hours. Trouble is your not using xbase.
thanx,
bill