Real-Time Healthcare Platform Ecosystem

Business Challenge

Healthcare Platforms (Clinics, Practices, Hospitals) traditionally operated in silos — patient records, appointments, and billing data were stored at the clinic level. This caused:

• Patients struggling with inconsistent access to records.

• Limited ability for mobile apps or third-party integrations to work reliably.

• High latency in syncing data between clinics and central systems.

With 500+ Healthcare Units and an average of 10,000 patients per unit (~5M patients in total), the system needed to:

• Scale to millions of interactions.

• Handle real-time updates (appointments, payments, patient records).

• Remain secure and compliant for healthcare data.

High-Level Goal (Vision & Strategy)

The vision was to create a connected healthcare ecosystem where:

• Patients interact via mobile apps and portals.

• Healthcare systems synchronize in real-time with central services.

• Third-party systems can integrate through a controlled and secure interface.

The architectural strategy focused on a dual-gateway model:

1. API Gateway → managing all external REST/HTTPS traffic.

2. WebSocket Gateway → enabling persistent, low-latency communication with each healthcare unit.

Architecture Design

High-Level Flow

• API Gateway at the portal server handles patient apps, web apps, and third-party requests.

• WebSocket Gateway acts as a bridge between the API Gateway and 500+ healthcare units.

• Local Services at each healthcare unit maintain persistent WebSocket connections.

• Requests are routed to the correct healthcare unit based on patient → healthcare-unit mapping.
  

  

Components Interactions

• API Gateway

  • Authentication (JWT) & Authorization.

  • Traffic routing & throttling.

  • Partner and mobile app integration.

• WebSocket Gateway

  • Persistent bidirectional connections.

  • Session management for 500+ healthcare-units.

  • Routing engine to forward patient-specific requests.

• Healthcare Units Services

  • Windows Service maintaining always-on connection.

  • Local caching for resilience.

  • Automatic retries on disconnection.

Detailed Flow (Component View)

• Patient request hits API Gateway → authenticated and routed.

• Gateway pushes request into WebSocket Gateway → mapped to correct healthcare unit.

• Healthcare unit Service processes request, updates DB, and sends real-time response.

Architectural Decisions (ADRs)

1. API vs WebSocket

   • REST for stateless, request/response flows.

   • WebSocket for real-time healthcare-unit synchronization.

2. Multi-Tenant Routing

   • Patient requests routed via healthcare-unit ID mapping.

   • Ensures isolation of each healthcare unit’s traffic.

3. Resilience & Fault Tolerance

   • Auto-reconnect policies for healthcare-unit services.

   • Fallback queues for failed messages.

4. Security

   • End-to-end TLS encryption.

   • JWT for patient identity and healthcare-unit authentication.

   • Data segregation to meet healthcare compliance.

Key Achievements (Business Impact)

The new architecture delivered:

• 5M+ users served seamlessly across 500+ healthcare-units.

• Real-time communication between patients and healthcare units (appointments, billing, medical history).

• Enabled mobile-first experience for patients.

• Trusted by business owners due to reliability and scalability.

• Created foundation for future services (tele-health, AI-driven patient engagement).