I strongly suspect that your db is not normalized properly. I have no doubt that you need all the information you're capturing, but I do believe that you are putting most of it in the wrong table. I'll give you an example. I'm going to assume that many of the fields are direct responses to health related questions, i.e. various codes for types of services performed, medications, procedures, etc... In all likelyhood, a patient will have many such records. Possibly, one for each visit. If this is the case, then many of these fields are left blank. Only used if/when that particular procedure is performed.
Correct me if I'm wrong, but in all my experience, I've never seen a case where anyone needed to collect 240 different specific pieces of information that apply to one entity. Usually, when someone builds a table with that many fields they misunderstand what an entity and it's descriptors really is. They have fields that, on first blush, appear to be descriptors of the entity but actually describe a dependent entity. An example would be an office visit, a prescription, a procedure, all of which HAPPEN to a patient but are not really a part of that patient.
Think of it this way: An entity is something you can hold in your hand(literally or figuratively), if your hand were big enough, that cannot be broken down into individual components without damaging it. A descriptor is an attribute that the entity has that is not likely to change and is unique to the entity. In your case, an entity is a patient, descriptors would be name, current address, SSN, DOB, etc. Something that DOES NOT describe the patient is their temperature, medication they're on, the doctor they're seeing today, a procedure performed on them while at the hospital, etc....
