Techniques for dynamically extracting electronic health records are described. Some embodiments provide an Operational Intelligence Platform (“OIP”) that is configured to dynamically extract electronic health record data from a source customer database that represents health records in a hierarchical format, and store the extracted data in a clinical data engine that represents the health records in a manner that logically preserves the hierarchical format while providing a relational access model to the health records. The OIP may extract health-record data in substantially real-time by performing on-the-fly capture and processing of data updates to the source customer database. Such real-time extraction may be performed in cooperation with large scale, batch extraction of records from the source customer database.