Cost-Effective Fhir Interoperability For Colombian Ips: A Performance Benchmark

This study evaluates the operational viability of open-source HL7 FHIR architectures for low- and medium-complexity healthcare institutions in resourceconstrained environments, specifically within Colombia's regulatory framework. While current literature focuses on enterprise-grade deployments, this research benchmarks HAPI FHIR and PostgreSQL across three low-cost topologies: Monolithic, Decoupled, and Containerized (ECS). Using Locust, load tests simulated up to 200 concurrent clinical users. Results demonstrate that a decoupled architecture provides the optimal balance, sustaining 91.48 requests per second with a 0% failure rate, without requiring expensive hyper-converged infrastructure. Conversely, containerized deployments exhibited severe latency degradation (p99 of 10,000 ms) due to thread starvation during dynamic CapabilityStatement generation. The findings provide a Total Cost of Ownership (TCO) roadmap, proving that resourcelimited institutions can achieve mandatory interoperability and structural stability without prohibitive software licensing or complex orchestration costs.