Deployment Architecture for database server for Web based software across multiple locations

I have 4  units spread over different geographical location  within a  distance of 100KM radius.  We want to deploy an hospital information system across all the 4 locations. We need to design deployment architecture for the same .

I need the following information from the experts
 
   Which one of the following is better and pros and cons of the same.

    1.  Having a single sql server database instance at a cartelized location (datacenter) and make clients at all the 4  
         locations connect to single instance

   2..  Have a separate database instance at each location.  

  ( There are around 700 clients from all the locations put together (Loc1 - 425 clients, loc2 -  50 , loc3 - 25 and loc4 - 200).
venkataramanaiahsrAsked:
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Aaron TomoskySD-WAN SimplifiedCommented:
if you are writing to a database, making it centralized is definitely the easiest route. Otherwise how do you plan on keeping them all in sync?
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venkataramanaiahsrAuthor Commented:
What i meant was

 is it better to have separate instance of Hospital information system application at each location talking to location specific db instance and later look for a data warehousing  application for data consolidation  

 (Pros/Cons - i can immediately think of  is this architecture involves less expenditure on networking/connectivity infrastructure)

OR

Is it better to have centralized instance and make all location specific instance of application  talk to central server thro mpls LAN  etc. ( more expenditure on on networking/connectivity infrastructure)
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Aaron TomoskySD-WAN SimplifiedCommented:
I would build it as a single database. If it turns out you have performance problems you can't solve except by running multiple copies, then you can try to create a sync program. Syncing can get really hard, especially when dealing with conflicts.

If the db is central, you could do this at the network layer with VPN tunnels or Mpls. However you could also do ssl web services or alternatives at the application layer.
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Ryan McCauleyData and Analytics ManagerCommented:
If you've got a reliable network from the remote locations to a central office, then a single centralized database server is the easiest and cheapest option. I'd only look to split it up and put a database at each site for these reasons:

1) Unreliable network - if you can't depend on the remote sites having a connection back to the central server, then they won't be able to use the application when the network is down.
2) Speeds too slow over distance - if your app has constantly database transactions or is written to assume the database is local, it can slow down the app when queries take even a few seconds to come back from the central server
3) Remote sites can't see each others' data - I assume there aren't any data security concerns here, but if you have a situation where each site is absolutely not allowed to see other site's data, then you can put a database at each site that contains only their data. If you can trust you app to keep the data safe, though, it makes sense to locate them all together.

Central is easy and cheap (single server license), and can quickly get complicated if you have to keep things in sync at multiple locations. It would be my design by default unless you had a really compelling reason to put local database servers at each site.
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Microsoft SQL Server 2008

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