How Edenlab Built a High-Load, Low-Code FHIR Server to Deliver Healthcare for 40 Million Plus Patients

The Kodjin FHIR server has speed and scale in its DNA.

Edenlab, the Ukrainian company behind Kodjin, built our original FHIR solution to digitize and service the entire Ukrainian national health system. The learnings and technologies from that project informed our development of the Kodjin FHIR server.

At Edenlab, we have always been driven by our passion for building solutions that excel in speed and scale. With Kodjin, we have embraced a modern tech stack to deliver unparalleled performance that can handle the demands of large-scale healthcare systems, providing efficient data management and seamless interoperability.

Eugene Yesakov, Solution Architect, Author of Kodjin

Built for speed and scale

While most healthcare projects involve handling large volumes of data, including patient records, medical images, and sensor data, the Kodjin FHIR server is based on a system developed to handle tens of millions of patient records and thousands of requests per second, to ensure timely access and efficient decision-making for a population of over 40 million people. And all of this information had to be processed and exchanged in real-time or near real-time, without delays or bottlenecks.

This article will explore some of the architectural decisions the Edenlab team took when building Kodjin, specifically the role MongoDB played in enhancing performance and ensuring scalability. We will examine the benefits of leveraging MongoDB's scalability, flexibility, and robust querying capabilities, as well as its ability to handle the increasing velocity and volume of healthcare data without compromising performance.

About Kodjin FHIR server

Kodjin is an ONC-certified and HIPAA-compliant FHIR Server that offers hassle-free healthcare data management. It has been designed to meet the growing demands of healthcare projects, allowing for the efficient handling of increasing data volumes and concurrent requests.

Its architecture, built on a horizontally scalable microservices approach, utilizes cutting-edge technologies such as the Rust programming language, MongoDB, ElasticSearch, Kafka, and Kubernetes. These technologies enable Kodjin to provide users with a low-code approach while harnessing the full potential of the FHIR specification.

A deeper dive into the architecture approach - the role of MongoDB in Kodjin

When deciding on the technology stack for the Kodjin FHIR Server, the Edenlab team knew that a document database would be required to serve as a transactional data store.

In an FHIR Server, a transactional data store ensures that data operations occur in an atomic and consistent manner, allowing for the integrity and reliability of the data. Document databases are well-suited for this purpose as they provide a flexible schema and allow for storing complex data structures, such as those found in FHIR data.

FHIR resources are represented in a hierarchical structure and can be quite intricate, with nested elements and relationships. Document databases, like MongoDB, excel at handling such complex and hierarchical data structures, making them an ideal choice for storing FHIR data.

In addition to supporting document storage, the Edenlab team needed the chosen database to provide transactional capabilities for FHIR data operations. FHIR transactions, which encompass a set of related data operations that should either succeed or fail as a whole, are essential for maintaining data consistency and integrity. They can also be used to roll back changes if any part of the transaction fails.

MongoDB provides support for multi-document transactions, enabling atomic operations across multiple documents within a single transaction. This aligns well with the transactional requirements of FHIR data and ensures data consistency in Kodjin.

Implementation of GridFS as a storage for the terminologies in Terminology service

Terminology service plays a vital role in FHIR projects, requiring a reliable and efficient storage solution for terminologies used. Kodjin employs GridFS, a file system within MongoDB designed for storing large files, which makes it ideal to handle terminologies.

GridFS offers a convenient way to store and manage terminology files, ensuring easy accessibility and seamless integration within the FHIR ecosystem. By utilizing MongoDB's GridFS, Kodjin ensures efficient storage and retrieval of terminologies, enhancing the overall functionality of the terminology service.

Kodjin FHIR server performance

To evaluate the efficiency and responsiveness of the Kodjin FHIR server in various scenarios we conducted multiple performance tests using Locust, an open-source load testing tool.

One of the performance metrics measured was the retrieval of resources by their unique ids using the GET by ID operation. Kodjin with MongoDB achieved a performance of 1721.8 requests per second (RPS) for this operation. This indicates that the server can efficiently retrieve specific resources, enabling quick access to desired data.

The search operation, which involves querying ElasticSearch to obtain the ids of the searched resources and retrieving them from MongoDB, exhibited a performance of 1896.4 RPS. This highlights the effectiveness of polyglot persistence in Kodjin, leveraging ElasticSearch for fast and efficient search queries and MongoDB for resource retrieval. The system demonstrated its ability to process search queries and retrieve relevant results promptly.

In terms of resource creation, Kodjin with MongoDB showed a performance of 1405.6 RPS for POST resource operations. This signifies that the system can effectively handle numerous resource-creation requests. The efficient processing and insertion of new resources into the MongoDB database ensure seamless data persistence and scalability.

Overall, the performance tests confirm that Kodjin with MongoDB delivers efficient and responsive performance across various FHIR operations. The high RPS values obtained demonstrate the system's capability to handle significant workloads and provide timely access to resources through GET by ID, search, and POST operations.

Conclusion

Kodjin leverages a modern tech stack including Rust, Kafka, and Kubernetes to deliver the highest levels of performance. At the heart of Kodjin is MongoDB, which serves as a transactional data store. MongoDB's capabilities, such as multi-document transactions and flexible schema, ensure the integrity and consistency of FHIR data operations. The utilization of GridFS within MongoDB ensures efficient storage and retrieval of terminologies, optimizing the functionality of the Terminology service.

To experience the power and potential of the Kodjin FHIR server firsthand, we invite you to contact the Edenlab team for a demo.

For more information On MongoDB’s work in healthcare, and to understand why the world’s largest healthcare companies trust MongoDB, read our whitepaper on radical interoperability.

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Accelerating to T+1 - Have You Got the Speed and Agility Required to Meet the Deadline?

On May 28, 2024, the Securities and Exchange Commission (SEC) will implement a move to a T+1 settlement for standard securities trades , shortening the settlement period from 2 business days after the trade date to one business day. The change aims to address market volatility and reduce credit and settlement risk. The shortened T+1 settlement cycle can potentially decrease market risks, but most firms' current back-office operations cannot handle this change. This is due to several challenges with existing systems, including: Manual processes will be under pressure due to the shortened settlement cycle Batch data processing will not be feasible To prepare for T+1, firms should take urgent action to address these challenges: Automate manual processes to streamline them and improve operational efficiency Event-based real-time processing should replace batch processing for faster settlement In this blog, we will explore how MongoDB can be leveraged to accelerate manual process automation and replace batch processes to enable faster settlement. What is a T+1 and T+2 settlement? T+1 settlement refers to the practice of settling transactions executed before 4:30pm on the following trading day. For example, if a transaction is executed on Monday before 4:30 pm, the settlement will occur on Tuesday. This settlement process involves the transfer of securities and/or funds from the seller's account to the buyer's account. This contrasts with the T+2 settlement, where trades are settled two trading days after the trade date. According to SEC Chair Gary Gensler , “T+1 is designed to benefit investors and reduce the credit, market, and liquidity risks in securities transactions faced by market participants.” Overcoming T+1 transition challenges with MongoDB: Two unique solutions 1. The multi-cloud developer data platform accelerates manual process automation Legacy settlement systems may involve manual intervention for various tasks, including manual matching of trades, manual input of settlement instructions, allocation emails to brokers, reconciliation of trade and settlement details, and manual processing of paper-based documents. These manual processes can be time-consuming and prone to errors. MongoDB (Figure 1 below) can help accelerate developer productivity in several ways: Easy to use: MongoDB is designed to be easy to use, which can reduce the learning curve for developers who are new to the database. Flexible data model: Allows developers to store data in a way that makes sense for their application. This can help accelerate development by reducing the need for complex data transformations or ORM mapping. Scalability: MongoDB is highly scalable , which means it can handle large volumes of trade data and support high levels of concurrency. Rich query language: Allows developers to perform complex queries without writing much code. MongoDB's Apache Lucene-based search can also help screen large volumes of data against sanctions and watch lists in real-time. Figure 1: MongoDB's developer data platform Discover the developer productivity calculator . Developers spend 42% of their work week on maintenance and technical debt. How much does this cost your organization? Calculate how much you can save by working with MongoDB. 2. An operational trade store to replace slow batch processing Back-office technology teams face numerous challenges when consolidating transaction data due to the complexity of legacy batch ETL and integration jobs. Legacy databases have long been the industry standard but are not optimal for post-trade management due to limitations such as rigid schema, difficulty in horizontal scaling, and slow performance. For T+1 settlement, it is crucial to have real-time availability of consolidated positions across assets, geographies, and business lines. It is important to note that the end of the batch cycle will not meet this requirement. As a solution, MongoDB customers use an operational trade data store (ODS) to overcome these challenges for real-time data sharing. By using an ODS, financial firms can improve their operational efficiency by consolidating transaction data in real-time. This allows them to streamline their back-office operations, reduce the complexity of ETL and integration processes, and avoid the limitations of relational databases. As a result, firms can make faster, more informed decisions and gain a competitive edge in the market. Using MongoDB (Figure 2 below), trade desk data is copied into an ODS in real-time through change data capture (CDC), creating a centralized trade store that acts as a live source for downstream trade settlement and compliance systems. This enables faster settlement times, improves data quality and accuracy, and supports full transactionality. As the ODS evolves, it becomes a "system of record/golden source" for many back office and middle office applications, and powers AI/ML-based real-time fraud prevention applications and settlement risk failure systems. Figure 2: Centralized Trade Data Store (ODS) Managing trade settlement risk failure is critical in driving efficiency across the entire securities market ecosystem. Luckily, MongoDB integration capabilities (Figure 3 below) with modern AI and ML platforms enable banks to develop AI/ML models that make managing potential trade settlement fails much more efficient from a cost, time, and quality perspective. Additionally, predictive analytics allow firms to project availability and demand and optimize inventories for lending and borrowing. Figure 3: Event-driven application for real time monitoring Summary Financial institutions face significant challenges in reducing settlement duration from two business days (T+2) to one (T+1), particularly when it comes to addressing the existing back-office issues. However, it's crucial for them to achieve this goal within a year as required by the SEC. This blog highlights how MongoDB's developer data platform can help financial institutions automate manual processes and adopt a best practice approach to replace batch processes with a real-time data store repository (ODS). With the help of MongoDB's developer data platform and best practices, financial institutions can achieve operational excellence and meet the SEC's T+1 settlement deadline on May 28, 2024. In the event of T+0 settlement cycles becoming a reality, institutions with the most flexible data platform will be better equipped to adjust. Top banks in the industry are already adopting MongoDB's developer data platform to modernize their infrastructure, leading to reduced time-to-market, lower total cost of ownership, and improved developer productivity. Thank you to Ainhoa Múgica and Karolina Ruiz Rogelj for their contributions to this post. Looking to learn more about how you can modernize or what MongoDB can do for you? Zero downtime migrations using MongoDB’s flexible schema Accelerate your digital transformation with these 5 Phases of Banking Modernization Reduce time-to-market for your customer lifecycle management applications MongoDB’s financial services hub

May 25, 2023
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MongoDB’s 2024 Year in Review

It’s hard to believe that another year is almost over! 2024 was a transformative year for MongoDB, and it was marked by both innovation and releases that further our commitment to empowering customers, developers, and partners worldwide. So without further ado, let’s dive into MongoDB’s 2024 highlights. We’ll also share our executive team’s predictions of what 2025 might have in store. A look back at 2024 MongoDB 8.0: The most performant version of MongoDB ever In October we released MongoDB 8.0 , the fastest, most resilient, secure, and reliable version of MongoDB yet. Architectural optimizations in MongoDB 8.0 have significantly improved the database’s performance, with 36% faster reads and 59% higher throughput for updates. Our new architecture also makes horizontal scaling cheaper and faster. Finally, working with encrypted data is easier than ever, thanks to the addition of range queries in Queryable Encryption (which allows customers to encrypt, store, and perform queries directly on data). Whether you’re a startup building your first app, or you’re a global enterprise managing mission-critical workloads, MongoDB 8.0 offers unmatched power and flexibility, solidifying MongoDB’s place as the world’s most popular document database. Learn more about what makes 8.0 the best version of MongoDB ever on the MongoDB 8.0 page . Delivering customer value with the MongoDB AI Applications Program AI applications have become a cornerstone of modern software, and MongoDB is committed to equipping customers with the technology, tools, and support they need to succeed on their AI journey. That’s why we launched the MongoDB AI Applications Program (MAAP) in 2024, a comprehensive program designed to accelerate the development of AI applications. By offering customers resources like access to AI specialists, an ecosystem of leading AI and tech companies, and AI architectural best practices supported by integrated services, MAAP helps solve customers’ most pressing business challenges, unlocks competitive advantages, and accelerates time to value for AI investments. Overall, MAAP’s aim is to set customers on the path to AI success. Visit the MongoDB AI Applications Program page or watch our session from AWS re:Invent to learn more! Advancing AI with MongoDB Atlas Vector Search In 2024, MongoDB further cemented its role in the AI space with enhancements to MongoDB Atlas Vector Search . Recognized in 2024 (for the second consecutive year!) as one of the most loved vector databases , MongoDB continues to provide a scalable, unified, and secure platform for building cutting-edge AI use cases. Recent advancements like vector quantization in Atlas Vector Search help deliver even more value to our customers, enabling them to scale applications to billions of vectors at a lower cost. Head over to our Atlas Vector Search quick start guide to get started with Atlas Vector Search today, or visit our AI resources hub to learn more about how MongoDB can power AI applications. Search Nodes: Performance at scale Search functionality is indispensable in modern applications, and with Atlas Search Nodes, organizations can now optimize their search workloads like never before. By providing dedicated infrastructure for Atlas Search and Vector Search workloads, Search Nodes ensure high performance (e.g., a 40–60% decrease in query times), scalability, and reliability, even for the most demanding use cases. As of this year , Search Nodes are generally available across AWS, Google Cloud, and Microsoft Azure. This milestone underscores MongoDB’s commitment to delivering powerful solutions that scale alongside our customers’ needs. To learn more about Search Nodes, check out our documentation or watch our tutorial . Looking ahead: MongoDB’s 2025 predictions After the excitement of the past few years, 2025 will be defined by ensuring that technology investments deliver tangible value. Organizations remain excited about the potential AI and emerging technologies hold to solve real business challenges, but are increasingly focused on maintaining a return on investment. “Enterprises need to innovate faster than ever, but speed is no longer the only measure of success. Increasingly, organizations are laser-focused on ensuring that their technology investments directly address critical business challenges and provide clear ROI and competitive advantage—whether it’s optimizing supply chains, delivering hyper-personalized customer experiences, or scaling operations efficiently,” said Sahir Azam, Chief Product Officer at MongoDB. “In 2025, I expect to see organizations make significant strides in driving this innovation and efficiency by applying AI to more production use cases and by maturing the way they leverage their data to build compelling and differentiated customer experiences.” Indeed, we expect to see organizations make more strategic investments in emerging technologies like gen AI—innovating with a sharp focus on solving business challenges. “In 2025, we can expect the focus to shift from ‘what AI can do’ to ‘what AI should do,’ moving beyond the hype to a clearer understanding of where AI can provide real value and where human judgment is still irreplaceable,” said Tara Hernandez, VP of Developer Productivity at MongoDB. “As we advance, I think we’ll see organizations begin to adopt more selective, careful applications of AI, particularly in areas where stakes are high, such as healthcare, finance, and public safety. A refined approach to AI development will be essential—not only for producing quality results but also to build trust, ensuring these tools genuinely support human goals rather than undermining them.” With more capable, accessible application development tools and customer-focused programs like MAAP at developers’ fingertips, 2025 is an opportunity to make a data-driven impact faster than ever before. "Right now, organizations have an opportunity to leverage their data to reimagine how they do business, to more effectively adapt to a changing world, and to revolutionize our quality of life,” said Andrew Davidson, SVP of Products at MongoDB. “By harnessing our latest technologies, developers can build a foundation for a transformative future." Head over to our updates page to learn more about the new releases and updates from MongoDB in 2024. Keep an eye on our events page to learn what's to come from MongoDB in 2025!

December 19, 2024