Microservices vs Monolithic Architecture for EHR Development

During the last few months, most of the clients we encountered had one question in their questionnaire that they wanted to ask us.

‘Which EHR architecture is better, microservices or monolithic?’

Though we answered the question honestly, it got me thinking, and I hit the internet researching the EHR system architecture. And some of the results were as surprising as the question itself.

You see, most of the major vendors providing off-the-shelf EHR platforms are made up of monolithic architecture. This includes Epic, Oracle Health (Cerner Millennium), and others.

While there is no problem with using a monolithic architecture for your Electronic Health Record development, they have majorly formed the core architectural blueprint for hospital and healthcare systems.

However, upon digging deeper, it was found that these systems have a monolithic architecture with tightly integrated modules sharing one data model, even as deployment patterns. This makes the ecosystem look more modular, but the problems it brings with itself trouble you during EHR software design updates, or connecting different modules inside your system together, and most importantly, during scalability.

This made it clear why most of our clients were keenly asking about microservices vs monolithic architecture for EHR systems, along with EHR software architecture comparison for their custom EHR.

And this is the reason why I decided to pen down this blog for you today.

On that note, let’s deep dive into EHR software architecture comparison and help you in making a better choice for your custom EHR architecture for healthcare modernization.

EHR System Architecture

Most of you who have come here by the mercy of the internet must know what a software architecture is. However, for those who don’t, let me explain that to you in simple terms. So, a software architecture, or in this case, an EHR software architecture, is nothing but a blueprint that defines how different components of the software, like clinical modules, database, integrations, user interfaces, and security layers, are designed and connected. Other than that, it also determines how your EHR software works behind the scenes.

Now, there are two types of EHR software architecture: monolithic architecture and microservices architecture. While healthcare microservice adoption is on the rise, the healthcare industry still relies on monolithic EHR systems for its day-to-day activities.

On that note, let’s discuss the intricacies of the traditional architecture that is monolithic architecture.

Monolithic EHR Systems: The Traditional Architecture

Traditionally, almost all software systems were built on a monolithic architecture. In simple words, it is a traditional software design approach where all the components of the software are built, deployed, and run as a single unified unit.

The core components of the software architecture, like user interface, business logic, data access, and integrations, are tightly coupled within one codebase and one deployment package. The advantages that you get with a monolithic EHR system are as follows:

• Simple to develop initially

• Easier to test and debug

• Single deployment

• Lower initial infrastructure complexity

With all these considerations, monolithic EHR systems make a perfect choice for practices that are just starting out, or for MVP (Minimum Viable Product) development, or for those who have a limited scope.

Despite these benefits, there are some limitations in monolithic EHR systems that are forcing healthcare providers to make a shift to microservices in healthcare IT. On that note, here are some limitations of a monolithic EHR system:

• Poor scalability due to a unified and single module

• High risk during updates, as a complete revamp of the system is required

• Difficult integration due to system architectural complexity

• Slower innovation

• Vulnerabilities have a larger security impact

Now that you know briefly about monolithic architecture, let’s have a look at microservices in healthcare IT, a modular EHR architecture approach.

Microservices in Healthcare IT: A Modular EHR Architecture

One of the approaches that many of our clients insisted on adopting has been microservices in healthcare IT. In this approach, the EHR system is built as a collection of small and independent services or components, where each microservice is responsible for a specific function.

In simple words, instead of building one large application, a modular EHR using microservices operates as loosely coupled services communicating with each other using secure APIs. To give you an example, for instance, different components of your EHR system, like patient records, scheduling, billing, lab integrations, etc., are built separately and connected with your system through APIs.

By adopting this healthcare software modernization approach, here are some of the key benefits that you get:

• Scalability by design

• Faster innovation and updates, which are critical for a fast-paced, evolving healthcare landscape

• Stronger interoperability with an API-first architecture approach

• Improved reliability and resilience

• Easier specialty-specific customization

However, with healthcare microservices adoption, you gain a competitive edge; some of the core requirements for this are operational complexity and higher engineering maturity. On top of that, with microservices in healthcare IT, you can build an AI-ready architecture that can give your EHR systems the capabilities that support core modules like CDS, predictive analytics, and ambient documentation, all this without impacting the core EHR workflows of your software.

EHR Software Architecture Comparison: Microservices vs Monolithic

Given the base of each architecture module that each approach adopts, here are some of the key differences between microservices vs monolithic architecture for EHR systems. Refer to the table below:

Legacy EHR Modernization Using Microservices

Since most of the systems in the healthcare industry are predominantly using legacy systems with monolithic software architecture, many of the clients we have encountered are looking for their legacy EHR modernization using microservices.

This demand has come into the picture because, during the initial adoption of EHRs, the focus was on digitizing records. However, as time passed, the demands changed to interoperability, real-time data exchange, etc. And this is one of the major reasons why most of the legacy systems were built using a monolithic system architecture.

The challenges that many practices faced came at the time of scaling. These legacy systems with monolithic architecture simply struggled to scale efficiently. For instance, if you want to add new users, locations, or specialties, the performance of your system would be drastically impacted.

On top of that, integrations with modern labs, telehealth platforms, patient apps, or analytics tools become complex and fragile as they are tightly coupled code.

This is the reason why many providers are looking for legacy EHR modernization using microservices. You see, microservices in healthcare IT allow your practice to modernize selectively; instead of replacing the entire EHR system, you can replace or upgrade a specific component of your system. This way, the other activities can function without interruptions, which reduces dependency and minimizes disruption and risk.

Hybrid & Incremental Approaches: Practical Modernization Paths

Due to the largely adopted legacy systems in the healthcare industry, many practices are adopting a hybrid or incremental approach for their architecture. In this legacy EHR, cores coexist with modern microservices. Sounds interesting, right?

With the adoption of this incremental approach, you can enable continuous improvement to your EHR system, support regulatory updates, and spread modernization costs over time. However, one of the major benefits that this approach offers is a realistic balance by preserving existing clinical operations while steadily transitioning towards a modern and future-ready flexible EHR ecosystem.

Which EHR Architecture is Better for Your Organization?

To answer the question that many of our clients have been asking us, then clearly, microservices in healthcare IT or microservices architecture of your EHR software is the better choice.

However, when it comes to specific to your healthcare practices or organization, then the better option clearly depends on your needs and requirements. On that note, let’s see which one to choose for your custom EHR software development, to help you make better decisions.

When Monolithic EHR Architecture is the Right Choice

Monolithic EHR architecture is the right choice when your workflows are limited, and integration needs are minimal. Meaning, if you are a small clinic or an early-stage healthcare organization that requires MVP deployments, then monolithic EHR architecture is the right choice for you.

Furthermore, a few things that you need to know with regard to this are that this architecture works well when the user base is small, changes in the software blueprint are rare, and rapid initial development is required rather than long-term scalability.

When Microservices Become Necessary for Scale & Resilience

Microservices in healthcare IT become essential for your healthcare systems when your system grows in users, locations, data volume, and integration complexity. For instance, large or multi-specialty organizations require independent scaling, high availability, and frequent updates without downtime. This can be done with healthcare microservices adoptions, which enable isolated failures, faster innovation, and API-driven interoperability.

Now that you know when to choose which software architectural approach, there are some other factors that you should consider when making a decision. For instance, factors like organizational size, growth trajectory of your practice, technical maturity of your software, and the budget must be considered.

Frequently Asked Questions