Healthcare Records Platform

Summary

An electronic health record (EHR) architecture built around strict auditability, HIPAA compliance, and append-only correctness. Clinical records are mutable by design (amendments, addenda) but corrections must be explicitly attributed, not silently overwritten. Event sourcing provides a reconstructable audit log; PostgreSQL row-level security enforces patient-level access control at the database layer; Kafka streams HL7 FHIR events to downstream clinical systems. The architecture must support breach detection, access auditing, and state reconstruction at any historical point: not just current state retrieval.

Problem Statement

Healthcare records demand a fundamentally different correctness model than most business applications. HIPAA requires detecting and reporting unauthorized access within 60 days. Clinical decisions made on stale or incorrect record state can cause patient harm. Records cannot be deleted: only amended with explicit attribution and reason. A patient's state at any historical point must be reconstructable for legal and clinical review. Inter-facility interoperability requires HL7 FHIR event streaming to external systems that may have different data models and availability characteristics. The architecture must enforce access control at the data layer (not just the application layer) because a misconfigured application code path must not expose records to unauthorized practitioners. Every record read, write, and amendment must be captured in a tamper-evident audit log before the operation is acknowledged.