Sustainable healthcare architecture for payers, ministries, hospitals, medical-device makers, ISVs, and founders. Modular, FHIR-native, carbon-aware. Built to last a decade.
FHIR domain stays separate from EHR, payer, and patient adapters. A new Epic release or CMS-0057-F payer API does not force a rewrite.
Workload placement, right-sizing, and idle shutdown are decided in sprint one. CO2e is measured, not estimated at audit time.
EHDS, state medical-records laws, C5, and HDS mapped to regions before infrastructure-as-code is written. Active-active only where required.
One FHIR domain feeds the EHR integration, the payer API, the patient app, and the analytics warehouse. No second source of truth.
Every architecture decision is written as an ADR and checked into the codebase. The team in year four can still read the reasoning from year one.
Right-sized compute, spot for batch, and idle PaaS shutdown keep the cloud bill from growing faster than the user base.
Outcomes from healthcare architectures we have built, and the ones we are still operating today across AWS, GCP, and Azure.
Architecture lifespan before the next re-platform is on the table.
Cloud cost and carbon reduction after a Life Value architecture review.
Carbon footprint measured with our open-source Cloud Carbon Footprint CLI.
We design healthcare architectures that survive vendor changes, residency changes, and a decade of regulatory drift without a re-platform.
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Two things at once. Technical sustainability means the architecture is still the right one in year seven. Hexagonal layering separates the FHIR domain from the EHR adapter, the payer adapter, and the patient adapter, so a new Epic release or a new CMS-0057-F payer API does not force a rewrite. Ecological sustainability means the workload is right-sized, carbon-aware, and idle compute is shut down. Both belong in the first architecture decision record, not bolted on at year three.
With the Cloud Carbon Footprint CLI, a Life Value open-source project that reads AWS, GCP, and Azure billing and usage data and converts it into kilowatt-hours and CO2e by region. A hospital CIO sees the kilograms of CO2e produced by the imaging archive last quarter. A payer infrastructure lead sees which claims-processing region runs on the dirtiest grid. The output maps to GHG Protocol scope 3 categories and feeds the CSRD report the sustainability team has to file.
Residency rules are mapped per jurisdiction first. EHDS and national health data spaces in the EU. State-specific medical-records and HIPAA constraints in the US. C5 in Germany. HDS in France. The architecture then runs active-active only where a residency rule or a recovery time objective requires it, and active-passive everywhere else. A ministry of health pays for the regions the law forces. An ISV running a multi-tenant platform routes each tenant to the region their contract specifies. No paying twice for compute that the regulator never asked for.
The re-platform usually happens because the early team made three decisions that were cheap then and expensive now. They coupled the FHIR layer to one EHR vendor. They picked a managed service that does not exist in the new buyer's preferred cloud. They skipped the architecture decision record, so nobody remembers why. We use hexagonal architecture, FHIR R4 as the canonical data model, and event-driven integration only where it earns its complexity. Each ADR is checked into the repo. The team in year four can still read the reasoning from year one.
Whether you're launching a new solution or scaling an existing product, Life Value gives you the clarity, speed, and compliance needed to move with confidence.
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