Scaling Healthcare Platforms
What breaks when you scale from 10K to 10M patient records.
When we crossed 100,000 patient records, everything seemed fine. At 500,000, we started seeing query slowdowns. At 2 million, the whole system started creaking under its own weight.
Here’s what we learned about scaling healthcare platforms:
Data locality matters more than you think. Patient data isn’t uniformly distributed. Some facilities generate 100x more data than others. Your partitioning strategy needs to account for this, or you’ll have hot spots that kill performance.
HIPAA compliance adds overhead you can’t optimize away. Every query needs audit logging. Every access needs verification. That 2ms overhead per operation compounds when you’re doing millions of operations.
The hardest part isn’t the database. It’s the interoperability layer. HL7, FHIR, proprietary formats - they all need to be normalized, validated, and kept in sync. This is where most systems break.
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