Applications for using couchDB and a RDBMS together - database

Wondering if there was a scenario where one would use a document-based DB and a relational DB together in a best-of-both-worlds scenario?

In my view, until I see an actual (open source or otherwise transparent) application successfully doing this, I will remain skeptical that it's worthwhile for projects with fewer than a dozen developers.
I suspect that by choosing one database over another and sticking with it--in good times and in bad--developers will reduce both the complexity of the data model and the maintenance cost of the code. Also, by choosing two databases, one runs the risk of a worst-of-both-worlds scenario, with data which is both difficult to manipulate and report on (CouchDB) and also not scalable (RDBMS).

One idea is to use a relational database as the main data store and a document-based db as a data distribution mechanism from the back end to the front end(s).

We use a mix of RDBMS and CouchDB. The RDBMS (IBM DB/2) is used for "exact" data where transactions make things easier. Examples are bookkeeping of money and inventory. CouchDB is used for archival of "finished" records from the RDBMS, digital asserts (JPEGs, scanned documents) and badly structured information, e.g. information acquired via shipping companie's track and trace systems.

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Scalable database technology and architecture

I've been trying to learn more about database scaling in a distributed system, and I am stuck in between RDBMS and NoSQL.
Some articles online suggest that NoSQL is the solution to modern Big Data. Others say NoSQL is just a hype and RDBMS can be just as scalable with good design, and it provides good data structure.
Instead of reading others' opinions, I'd love to judge the two myself, but I do not understand exactly what is required for a scalable RDBMS and a scalable NoSQL.
I've done a bit more readings on RDBMS, and it seems that the solution requires leveraging memcache and sharding to reduce database size and the number of DB queries. Are there other tricks? Can you still use tables with many columns? Or use less columns and more joins?
As for NoSQL, I've read a little about MongoDB. I understand that it encourages data aggregation. But how does that make it more scalable? I'm also starting to learn Cassandra because I read that it scales much better than MongoDB, but I have no idea how it is more scalable.
I would very much appreciate a basic (or advanced, if you have the patience to type it out) condensed and down-to-the-core explanation on scaling RDBMS and NoSQL, or good articles online or books that explain the topic. :)
I won't cover ways you can scale by implementing things on your own and putting a memcache server in between, ... I'll just cover what comes right out of the box...
Let's start first with RDBMS:
I think setting up an RDBMS cluster is more complicated than a NoSQL cluster, but that's just my opinion. Usually what you have is one Master and multiple Slaves. You have to send all your writes to the master and can read from any slave you want. Since you have RDBMS and ACID, the system should somehow guarantee you, that you won't read old data. So the thing here is, that you assume that your application writes once and reads often (as it's usually the case). For those purposes, one Server for read/write and multiple servers for read is great. The problem is if you'r writes are so often that you can't keep up with them anymore on the one machine. That is your bottleneck. Additionally to the build in solutions from Oracle for instance - which are huge - there is also http://www.scalearc.com/ which can cache queries, ... and handle the scaling for you.
NoSQL:
There is no 1 NoSQL schema which is implemented by all the DBs. Every system is a bit different. MongoDB for instance is quite similar to RDBMS, it also has only one Master and several slaves to which it can replicate data, but additionally you can also create shards. Data is split between shards, and replicated to slaves. So you could have multiple different masters which are responsible for smaller parts. Afterwards when you read, you can choose if you want to read from multiple slaves, from the master or from any slave - depending how urgently you need the latest data.
Cassandra on the other hand works totally differently. I'm not sure if you can write to multiple servers or how it works, but basically the servers keep a log of all the writes. So even if they can't process the writes immediately, they are stored in a log, to still give you a fast response. Afterwards when you read, you can say again how urgently you want to have the new data, and if you really want the latest latest data, Cassandra will need to check the log, if there are any updates written, and it will cost you a lot of time.
Key-Value stores like ElasticSearch, CouchDB, CouchBase work again differently. Here the of the item is hashed, and based on the hash, sent to one node which will be responsible for it. This way, when you read after the key was written, you get again up to date information, because you'll read from the same node. The idea of this design is, that no one single key will be of everyone's interest, but the load will be distributed. These are also the DBs which I think scale the best, and make it the easiest to add more servers to the cluster, but you loose the power of complex queries, like you have it in MongoDB and Cassandra - and of course RDBMS. ElasticSearch has some simple search queries, and CouchDB and CouchBase have only Views which are produced by MapReduce, where you can get data which you want, if it fits the view. Otherwise you can only access it by the key.
http://kkovacs.eu/cassandra-vs-mongodb-vs-couchdb-vs-redis - is a very comprehensive summary of the most common NoSQL DBs, what are their strengths and weaknesses, and the most common usage scenarios.
In the end, the question is also, why do you want to scale? how many records are you going to have in the database? Few millions is not a problem at all. Few hundred millions is also not a problem for most of the RDBMS on a powerful enough server. And if designed the DB and it's indices properly even a billion records per year should be still fine.

Which NoSQL backend to store trace data from webpage

In our web application we need to trace what users click, what they write into search box, etc. Lots of data will be sent by AJAX. Generally functionality is a bit similar to google analytics, but we need to customize it in different ways.
Data will be collected and once per day aggregated and exported to PostgreSQL, so backend should be able to handle dozens of inserts. I don't consider usage of traditional SQL database, because probably it won't handle so many inserts efficiently.
I wonder which backend would you use for such task? Actually I think about MongoDB or Cassandra. But maybe you know better software for that task? Maybe something different then NoSQL database?
Web application is written in Ruby on Rails so support for Ruby would be nice but that's definitely not the most important.
Sounds like you need to analyse your specific requirements.
It may be that the best solution is to split / partition / shard a conventional database and then push the data up from there.
Depending on what your tolerance for data loss is, there are a lot of options. If you choose a system which has single-server durability, a major source of write bottleneck will be fdatasync() (assuming you use hard drives to store your data on).
If you can tolerate syncing less often than on every commit, then you may be able to tune your database to commit at timed intervals.
Depending on your table, index structure etc, I'd expect that you can get rather a lot of inserts with a "conventional" db (e.g. postgresql), if you manage it correctly and tune the durability (if it supports that) to your liking.
Sharding this into several instances of course will enable you to scale this up. However, you need to be mindful of operational requirements (i.e. what happens if some of the instances are down). Talk to your Ops team about what they're comfortable managing.

When NOT to use Cassandra? [closed]

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There has been a lot of talk related to Cassandra lately.
Twitter, Digg, Facebook, etc all use it.
When does it make sense to:
use Cassandra,
not use Cassandra, and
use a RDMS instead of Cassandra.
There is nothing like a silver bullet, everything is built to solve specific problems and has its own pros and cons. It is up to you, what problem statement you have and what is the best fitting solution for that problem.
I will try to answer your questions one by one in the same order you asked them. Since Cassandra is based on the NoSQL family of databases, it's important you understand why use a NoSQL database before I answer your questions.
Why use NoSQL
In the case of RDBMS, making a choice is quite easy because all the databases like MySQL, Oracle, MS SQL, PostgreSQL in this category offer almost the same kind of solutions oriented toward ACID properties. When it comes to NoSQL, the decision becomes difficult because every NoSQL database offers different solutions and you have to understand which one is best suited for your app/system requirements. For example, MongoDB is fit for use cases where your system demands a schema-less document store. HBase might be fit for search engines, analyzing log data, or any place where scanning huge, two-dimensional join-less tables is a requirement. Redis is built to provide In-Memory search for varieties of data structures like trees, queues, linked lists, etc and can be a good fit for making real-time leaderboards, pub-sub kind of system. Similarly there are other databases in this category (Including Cassandra) which are fit for different problem statements. Now lets move to the original questions, and answer them one by one.
When to use Cassandra
Being a part of the NoSQL family, Cassandra offers a solution for problems where one of your requirements is to have a very heavy write system and you want to have a quite responsive reporting system on top of that stored data. Consider the use case of Web analytics where log data is stored for each request and you want to built an analytical platform around it to count hits per hour, by browser, by IP, etc in a real time manner. You can refer to this blog post to understand more about the use cases where Cassandra fits in.
When to Use a RDMS instead of Cassandra
Cassandra is based on a NoSQL database and does not provide ACID and relational data properties. If you have a strong requirement for ACID properties (for example Financial data), Cassandra would not be a fit in that case. Obviously, you can make a workaround for that, however you will end up writing lots of application code to simulate ACID properties and will lose on time to market badly. Also managing that kind of system with Cassandra would be complex and tedious for you.
When not to use Cassandra
I don't think it needs to be answered if the above explanation makes sense.
When evaluating distributed data systems, you have to consider the CAP theorem - you can pick two of the following: consistency, availability, and partition tolerance.
Cassandra is an available, partition-tolerant system that supports eventual consistency. For more information see this blog post I wrote: Visual Guide to NoSQL Systems.
Cassandra is the answer to a particular problem: What do you do when you have so much data that it does not fit on one server ? How do you store all your data on many servers and do not break your bank account and not make your developers insane ? Facebook gets 4 Terabyte of new compressed data EVERY DAY. And this number most likely will grow more than twice within a year.
If you do not have this much data or if you have millions to pay for Enterprise Oracle/DB2 cluster installation and specialists required to set it up and maintain it, then you are fine with SQL database.
However Facebook no longer uses cassandra and now uses MySQL almost exclusively moving the partitioning up in the application stack for faster performance and better control.
The general idea of NoSQL is that you should use whichever data store is the best fit for your application. If you have a table of financial data, use SQL. If you have objects that would require complex/slow queries to map to a relational schema, use an object or key/value store.
Of course just about any real world problem you run into is somewhere in between those two extremes and neither solution will be perfect. You need to consider the capabilities of each store and the consequences of using one over the other, which will be very much specific to the problem you are trying to solve.
Besides the answers given above about when to use and when not to use Cassandra, if you do decide to use Cassandra you may want to consider not using Cassandra itself, but one of the its many cousins out there.
Some answers above already pointed to various "NoSQL" systems which share many properties with Cassandra, with some small or large differences, and may be better than Cassandra itself for your specific needs.
Additionally, recently (several years after this question was originally asked), a Cassandra clone called Scylla (see https://en.wikipedia.org/wiki/Scylla_(database)) was released. Scylla is an open-source re-implementation of Cassandra in C++, which claims to have significantly higher throughput and lower latencies than the original Java Cassandra, while being mostly compatible with it (in features, APIs, and file formats). So if you're already considering Cassandra, you may want to consider Scylla as well.
I will focus here on some of the important aspects which can help you to decide if you really need Cassandra. The list is not exhaustive, just some of the points which I have at top of my mind-
Don't consider Cassandra as the first choice when you have a strict requirement on the relationship (across your dataset).
Cassandra by default is AP system (of CAP). But, it supports tunable consistency which means it can be configured to support as CP as well. So don't ignore it just because you read somewhere that it's AP and you are looking for CP systems. Cassandra is more accurately termed “tuneably consistent,” which means it allows you to easily decide the level of consistency you require, in balance with the level of availability.
Don't use Cassandra if your scale is not much or if you can deal with a non-distributed DB.
Think harder if your team thinks that all your problems will be solved if you use distributed DBs like Cassandra. To start with these DBs is very simple as it comes with many defaults but optimizing and mastering it for solving a specific problem would require a good (if not a lot) amount of engineering effort.
Cassandra is column-oriented but at the same time each row also has a unique key. So, it might be helpful to think of it as an indexed, row-oriented store. You can even use it as a document store.
Cassandra doesn't force you to define the fields beforehand. So, if you are in a startup mode or your features are evolving (as in agile) - Cassandra embraces it. So better, first think about queries and then think about data to answer them.
Cassandra is optimized for really high throughput on writes. If your use case is read-heavy (like cache) then Cassandra might not be an ideal choice.
Right. It makes sense to use Cassandra when you have a huge amount of data, a huge number of queries but very little variety of queries. Cassandra basically works by partitioning and replicating. If all your queries will be based on the same partition key, Cassandra is your best bet. If you get a query on an attribute that is not the partition key, Cassandra allows you to replicate the whole data with a new partition key. So now you have 2 replicas of the same data with 2 different partition keys.
Which brings me to your next question. When not to use Cassandra. As I mentioned, Cassandra scales by replicating the complete database for every new partitioning key. But you can't keep making new copies again and again. So when you have a high variety in queries i.e. each query has a different column in the where clause, Cassandra is not a good option.
Now for the third question. The whole point of using RDBMS is when you want the ACID properties. If you are building something like a payment service and want each transaction to be isolated, each transaction to either complete or not happen at all, changes to be persistent despite system failure, and the money to be consistent across bank accounts before and after the transaction completes, an RDBMS is the only option that will help you achieve this.
This article actually explains the whole thing, especially when to use Cassandra or not (as opposed to some other NoSQL option) part of the question -> Choosing the best Database. Do check it out.
EDIT: To answer the question in the comments by proximab, when we think of banking systems we immidiately think "ACID is the best solution". But even banking systems are made up of several subsystems that might not even be dealing with any transaction related data like account holder's personal information, account statements, credit card details, credit histories, etc.
All of this information needs to be stored in some database or the another. Now if you store the account related information like account balance, that is something that needs to be consistent at all times. For example, if you try to send money from account A to account B, then the money that disappears from account A should instantaneousy show up in account B, and it cannot be present in both accounts at the same time. This system cannot be inconsistant at any point. This is where ACID is of utmost importance.
On the other hand if you are saving credit card details or credit histories, that should not get into the wrong hands, then you need something that allows access only to authorised users. That I believe is supported by Cassandra. That said, data like credit history and credit card transactions, I think that is an ever increasing data. Also there is only so much yo can query on this data i.e. it has a very finite number of queries. These two conditions make Cassandra a perfect solution.
Talking with someone in the midst of deploying Cassandra, it doesn't handle the many-to-many well. They are doing a hack job to do their initial testing. I spoke with a Cassandra consultant about this and he said he wouldn't recommend it if you had this problem set.
You should ask your self the following questions:
(Volume, Velocity) Will you be writing and reading TONS of information , so much information that no one computer could handle the writes.
(Global) Will you need this writing and reading capability around the world so that the writes in one part of the world are accessible in another part of the world?
(Reliability) Do you need this database to be up and running all the time and never go down regardless of which Cloud, which country, whether it's VM , Container, or Bare metal?
(Scale-ability) Do you need this database to be able to continue to grow easily and scale linearly
(Consistency) Do you need TUNABLE consistency where some writes can happen asynchronously where as others need to be certified?
(Skill) Are you willing to do what it takes to learn this technology and the data modeling that goes with creating a globally distributed database that can be fast for everyone, everywhere?
If for any of these questions you thought "maybe" or "no," you should use something else. If you had "hell yes" as an answer to all of them, then you should use Cassandra.
Use RDBMS when you can do everything on one box. It's probably easier than most and anyone can work with it.
Heavy single query vs. gazillion light query load is another point to consider, in addition to other answers here. It's inherently harder to automatically optimize a single query in a NoSql-style DB. I've used MongoDB and ran into performance issues when trying to calculate a complex query. I haven't used Cassandra but I expect it to have the same issue.
On the other hand, if your load is expected to be that of very many small queries, and you want to be able to easily scale out, you could take advantage of eventual consistency that is offered by most NoSql DBs. Note that eventual consistency is not really a feature of a non-relational data model, but it is much easier to implement and to set up in a NoSql-based system.
For a single, very heavy query, any modern RDBMS engine can do a decent job parallelizing parts of the query and take advantage of as much CPU and memory you throw at it (on a single machine). NoSql databases don't have enough information about the structure of the data to be able to make assumptions that will allow truly intelligent parallelization of a big query. They do allow you to easily scale out more servers (or cores) but once the query hits a complexity level you are basically forced to split it apart manually to parts that the NoSql engine knows how to deal with intelligently.
In my experience with MongoDB, in the end because of the complexity of the query there wasn't much Mongo could do to optimize it and run parts of it on multiple data. Mongo parallelizes multiple queries but isn't so good at optimizing a single one.
Let's read some real world cases:
http://planetcassandra.org/apache-cassandra-use-cases/
In this article: http://planetcassandra.org/blog/post/agentis-energy-stores-over-15-billion-records-of-time-series-usage-data-in-apache-cassandra
They elaborated the reason why they didn't choose MySql is because db synchronization is too slow.
(Also due to 2-phrase commit, FK, PK)
Cassandra is based on Amazon Dynamo paper
Features:
Stability
High availability
Backup performs well
Read and Write is better than HBase, (BigTable clone in java).
wiki http://en.wikipedia.org/wiki/Apache_Cassandra
Their Conclusion is:
We looked at HBase, Dynamo, Mongo and Cassandra.
Cassandra was simply the best storage solution for the majority of our data.
As of 2018,
I would recommend using ScyllaDB to replace classic cassandra, if you need back support.
Postgres kv plugin is also quick than cassandra. How ever won't have multi-instance scalability.
another situation that makes the choice easier is when you want to use aggregate function like sum, min, max, etcetera and complex queries (like in the financial system mentioned above) then a relational database is probably more convenient then a nosql database since both are not possible on a nosql databse unless you use really a lot of Inverted indexes. When you do use nosql you would have to do the aggregate functions in code or store them seperatly in its own columnfamily but this makes it all quite complex and reduces the performance that you gained by using nosql.
Cassandra is a good choice if:
You don't require the ACID properties from your DB.
There would be massive and huge number of writes on the DB.
There is a requirement to integrate with Big Data, Hadoop, Hive and Spark.
There is a need of real time data analytics and report generations.
There is a requirement of impressive fault tolerant mechanism.
There is a requirement of homogenous system.
There is a requirement of lots of customisation for tuning.
If you need a fully consistent database with SQL semantics, Cassandra is NOT the solution for you. Cassandra supports key-value lookups. It does not support SQL queries. Data in Cassandra is "eventually consistent". Concurrent lookups of data may be inconsistent, but eventually lookups are consistent.
If you need strict semantics and need support for SQL queries, choose another solution such as MySQL, PostGres, or combine use of Cassandra with Solr.
Apache cassandra is a distributed database for managing large amounts of structured data across many commodity servers, while providing highly available service and no single point of failure.
The archichecture is purely based on the cap theorem, which is availability , and partition tolerance, and interestingly eventual consistently.
Dont Use it, if your not storing volumes of data across racks of clusters,
Dont use if you are not storing Time series data,
Dont Use if you not patitioning your servers,
Dont use if you require strong Consistency.
Mongodb has very powerful aggregate functions and an expressive aggregate framework. It has many of the features developers are accustomed to using from the relational database world. It's document data/storage structure allows for more complex data models than Cassandra, for example.
All this comes with trade-offs of course. So when you select your database (NoSQL, NewSQL, or RDBMS) look at what problem you are trying to solve and at your scalability needs. No one database does it all.
According to DataStax, Cassandra is not the best use case when there is a need for
1- High end hardware devices.
2- ACID compliant with no roll back (bank transaction)
It does not support complete transaction management across the
tables.
Secondary Index not supported.
Have to rely on Elastic search /Solr for Secondary index and the custom sync component has to be written.
Not ACID compliant system.
Query support is limited.

What exactly is NoSQL?

What exactly is NoSQL? Is it database systems that only work with {key:value} pairs?
As far as I know MemCache is one of such database systems, am I right?
What other popular NoSQL databases are there and where exactly are they useful?
Thanks, Boda Cydo.
I'm not agree with the answers I'm seeing, although it's true that NoSQL solutions tends to break the ACID rules, not all are created from that approach.
I think first you should define what is a SQL Solution and then you can put the "Not Only" in front of it, that will be more accurate definition of what is a NoSQL solution.
With this approach in mind:
SQL databases are a way to group all the data stores that are accessible using Structured Query Language as the main (and most of the time only) way to communicate with them, this means it requires that the database support the structures that are common to those systems like "tables", "columns", "rows", "relationships", etc.
Now, put the "Not Only" in front of the last sentence and you will get a definition of what means "NoSQL". NoSQL groups all the stores created as an attempt to solve problems which cannot fit into the table/column/rows structures or even in SQL Statements, in most of the cases these databases will not support relationships, they're abandoning the well known structures just because the problems have changed since their conception.
If you have a text file, and you create an API to store/retrieve/organize this information, then you have a NoSQL database in your hands.
All of these means that there are several solutions to store the information in a way that traditional SQL systems will not allow to achieve better performance, flexibility, etc etc. Every NoSQL provider tries to solve a different problem and that's why you wont be able to compare two different solutions, for example:
djondb is a document store created to be used as
NoSQL enterprise solution supporting transactions, consistency, etc.
but sacrifice performance of its counterparts.
MongoDB is a document store (similar to
djondb) which accomplish great performance but trades some of the
ACID properties to achieve this.
CouchDB is another document store which
solves the queries slightly different providing views to retrieve the
information without doing a full query every time.
...
As you may have noticed I only talked about the document stores, that's because I wanted to show you that 3 different document stores implementations have different approach, therefore you should keep in mind the golden rule of NoSQL stores "Use the right tool for the right job".
I'm the creator of djondb and I've been doing a lot of research even before trying to start my own NoSQL implementation, but this is a field where the concepts will keep changing the way we see the information storage.
From wikipedia:
NoSQL is an umbrella term for a loosely defined class of non-relational data stores that break with a long history of relational databases and ACID guarantees. Data stores that fall under this term may not require fixed table schemas, and usually avoid join operations. The term was first popularised in early 2009.
The motivation for such an architecture was high scalability, to support sites such as Facebook, advertising.com, etc...
To quickly get a handle on NoSQL systems, see this blog post I wrote: Visual Guide to NoSQL Systems. Essentially, NoSQL systems sacrifice either consistency or availability in favor of tolerance to network partitions.
What is NoSQL ?
NoSQL is the acronym for Not Only SQL. The basic qualities of NoSQL databases are schemaless, distributed and horizontally scalable on commodity hardware. The NoSQL databases offers variety of functions to solve various problems with variety of data types, where “blob” used to be the only data type in RDBMS to store unstructured data.
1 Dynamic Schema
NoSQL databases allows schema to be flexible. New columns can be added anytime. Rows may or may not have values for those columns and no strict enforcement of data types for columns. This flexibility is handy for developers, especially when they expect frequent changes during the course of product life cycle.
2 Variety of Data
NoSQL databases support any type of data. It supports structured, semi-structured and unstructured data to be stored. Its supports logs, images files, videos, graphs, jpegs, JSON, XML to be stored and operated as it is without any pre-processing. So it reduces the need for ETL (Extract – Transform – Load).
3 High Availability Cluster
NoSQL databases support distributed storage using commodity hardware. It also supports high availability by horizontal scalability. This features enables NoSQL databases get the benefit of elastic nature of the Cloud infrastructure services.
4 Open Source
NoSQL databases are open source software. The usage of software is free and most of them are free to use in commercial products. The open sources codebase can be modified to solve the business needs. There are minor variations in the open source software licenses, users must be aware of license agreements.
5 NoSQL – Not Only SQL
NoSQL databases not only depend SQL to retrieve data. They provide rich API interfaces to perform DML and CRUD operations. These are APIs are move developer friendly and supported in variety of programming languages.
Take a look at these:
http://en.wikipedia.org/wiki/Nosql#List_of_NoSQL_open_source_projects
and this:
http://www.mongodb.org/display/DOCS/Comparing+Mongo+DB+and+Couch+DB
I used something called the Raima Data Manager more than a dozen years ago, that qualifies as NoSQL. It calls itself a "Set Oriented Database" Its not based on tables, and there is no query "language", just an C API for asking for subsets.
It's fast and easier to work with in C/C++ and SQL, there's no building up strings to pass to a query interpreter and the data comes back as an enumerable object rather than as an array. variable sized records are normal and don't waste space. I never saw the source code, but there were some hints at the interface that internally, the code used pointers a lot.
I'm not sure that the product I used is even sold anymore, but the company is still around.
MongoDB looks interesting, SourceForge is now using it.
I listened to a podcast with a team member. The idea with NoSQL isn't so much to replace SQL as it is to provide a solution for problems that aren't solved well with traditional RDBMS. As mentioned elsewhere, they are faster and scale better at the cost of reliability and atomicity (different solutions to different degrees). You wouldn't want to use one for a financial system, but a document based system would work great.
Here is a comprehensive list of NoSQL Databases: http://nosql-database.org/.
I'm glad that you have had success with RDM John! I work at Raima so it's great to hear feedback. For those looking for more information, here are a couple of resources:
Video Overview of RDM's General Architecture
Free Evaluation Download of RDM

voldemort vs. couchdb

I am trying to decide whether to use voldemort or couchdb for an upcoming healthcare project. I want a storage system that has high availability , fault tolerance, and can scale for the massive amounts of data being thrown at it.
What is the pros/cons of each?
Thanks
Project Voldemort looks nice, but I haven't looked deeply into it so far.
In it current state CouchDB might not be the right thing for "massive amounts of data". Distributing data between nodes and routing queries accordingly is on the roadmap but not implemented so far. The biggest known production setups of CouchDB use "tables" ("databases" in couch-speak) of about 200G.
HA is not natively supported by CouchDB but can build easily: All CouchDB nodes are replicating the database nodes between each other in a multi-master setup. We put two Varnish proxies in front of the CouchDB machines and the Varnish boxes are made redundant with CARP. CouchDBs "build from the Web" design makes such things very easy.
The most pressing issue in our setup is the fact that there are still issues with the replication of large (multi MB) attachments to CouchDB documents.
I suggest you also check the traditional RDBMS route. There are huge issues with available talent outside the RDBMS approach and there are very capable offerings available from Oracle & Co.
Not knowing enough from your question, I would nevertheless say Project Voldemort or distributed hash tables (DHTs) like CouchDB in general are a solution to your problem of HA.
Those DHTs are very nice for high availability but harder to write code for than traditional relational databases (RDBMS) concerning consistency.
They are quite good to store document type information, which may fit nicely with your healthcare project but make development harder for data.
The biggest limitation of most stores is that they are not transactionally safe (See Scalaris for an transactionally safe store) and you need to ensure data consistency by yourself - most use read time consistency by merging conflicting data). RDBMS are much easier to use for consistency of data (ACID)
Joining data is much harder too. In RDBMs you can easily query data over several tables, you need to write code in CouchDB to aggregate data. For other stores Hadoop may be a good choice for aggregating information.
Read about BASE and the CAP theorem on consistency vs. availability.
See
http://www.metabrew.com/article/anti-rdbms-a-list-of-distributed-key-value-stores/
http://queue.acm.org/detail.cfm?id=1394128
Is memcacheDB an option? I've heard that's how Digg handled HA issues.

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