The healthcare industry is in the midst of a data revolution. From patient records to medical images, the demand for seamless, scalable, and secure data management has never been greater. At the heart of this transformation is Fast Healthcare Interoperability Resources (FHIR)—a framework that makes healthcare data accessible and shareable. But as the scale and complexity of healthcare data grow, so do the challenges of managing it effectively.

One healthcare provider faced these challenges head-on, transforming their approach to FHIR data management with a combination of HAPI FHIR and pgEdge Distributed PostgreSQL. This story highlights the power of innovative technology to drive meaningful change, showing what’s possible when the right tools come together to tackle complex challenges.

What to Do When Growth Becomes a Challenge

This forward-thinking healthcare provider had a clear mission: to deliver better care by leveraging data. But their growing reliance on FHIR resources was testing the limits of their existing infrastructure. The sheer volume of data—and the need to manage it across geographically distributed systems—introduced a web of challenges:

  • Distributed Data Management: Global operations require high availability and multi-region replication. Traditional PostgreSQL, while powerful, struggled with the demands of horizontal scaling and geographic distribution.

  • Handling Large FHIR Objects: HAPI FHIR uses PostgreSQL's OID data type to store large binary objects like medical images and documents. Unfortunately, PostgreSQL’s native replication couldn’t handle these large objects, risking incomplete or inconsistent data across regions.

  • Compliance and Security: Healthcare data is among the most sensitive information managed today. Ensuring compliance with HIPAA and GDPR while maintaining data integrity and accessibility was non-negotiable.

Faced with these obstacles, the provider needed a solution that could deliver distributed, scalable data management without compromising on performance or compliance.

Building the Right Solution: HAPI FHIR Meets pgEdge Distributed Postgres

Recognizing the scale of the challenge, the healthcare provider’s database team leveraged  pgEdge to craft a solution that combined the robust API capabilities of HAPI FHIR with the power of distributed PostgreSQL. Here’s how it all came together.

Step 1: Overcoming PostgreSQL’s Replication Limits with Large Object Logical Replication (LOLOR)

The first hurdle was clear: PostgreSQL’s native logical replication couldn’t handle the OID data type used by HAPI FHIR to store large objects. This limitation threatened the consistency of critical healthcare data across regions.

To address this, we implemented pgEdge’s LOLOR extension. By extending PostgreSQL’s native capabilities, LOLOR enabled seamless replication of OID-based large objects across the distributed database. Medical images, scanned documents, and other large FHIR resources could now be securely and reliably synced across regions without compromising performance or data integrity.

Step 2: Leveraging Seamless HAPI FHIR Integration

HAPI FHIR’s out-of-box compatibility with pgEdge PostgreSQL eliminated the need for extensive customization.  This allowed the team to focus on scaling the solution rather than troubleshooting integration issues. With this foundation, it set the stage for rapid deployment and future growth.

Step 3: Using Multi-Master Replication to Create a Distributed Database and Reduce Latency

Next, pgEdge’s distributed PostgreSQL was configured to operate across multiple geographic locations. Multi-master replication ensures that even if one region experiences downtime, other data centers will take over instantly, maintaining uninterrupted service.

The distributed architecture also minimized latency by routing queries to the nearest data center, delivering faster response times for users around the globe. With automatic failover capabilities, the system is primed to handle spikes in demand and scale effortlessly with growing data needs.

Step 4: Ensuring Compliance and Security

Handling sensitive healthcare data meant compliance was a top priority. The built-in auditing tools and support for the pgAudit extension provided detailed monitoring and access control, ensuring HIPAA and GDPR requirements were met.

Automated backups and recovery tools added an extra layer of security, enabling quick rollbacks if needed. This comprehensive approach gave the provider peace of mind, knowing their data was secure and fully compliant.

The Results: A New Standard for Healthcare Data Management

  • Seamless Replication: With the LOLOR extension, large FHIR resources like medical images are now reliably replicated across all regions, ensuring data consistency and availability.

  • High Availability: The distributed setup means the system remains operational even during regional outages, with automatic failover ensuring uninterrupted service.

  • Improved Performance: By routing queries to the nearest data center, the provider reduced latency and improved user experience, regardless of location.

  • Scalability: As data volumes grow, the system can scale horizontally without sacrificing performance.

  • Compliance and Security: Robust auditing and backup features keep sensitive data safe and compliant with industry regulations.

Looking Ahead: A Foundation for Growth

With their new system in place, the healthcare provider is ready to embrace the future of data-driven care. The combination of HAPI FHIR’s powerful API framework and pgEdge’s distributed Postgres capabilities has not only solved today’s challenges but also prepared them for the demands of tomorrow.

As healthcare data continues to expand in both size and importance, solutions like this one set a new standard for how the industry can manage, secure, and leverage its most critical resource: information.