Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: 
A Multivocal Literature Review

Thomas Paul

doi:doi:10.11648/j.ajcst.20260901.14

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Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review

Thomas Paul^*

Published in American Journal of Computer Science and Technology (Volume 9, Issue 1)

Received: 19 January 2026 Accepted: 31 January 2026 Published: 9 February 2026

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Abstract

Healthcare organizations are modernizing core platforms such as electronic health records (EHRs), order-entry, and billing systems, but decomposing long-lived monoliths into microservices introduces a critical challenge: how to migrate without interrupting mission-critical care operations. Regulated healthcare environments impose strict requirements for availability, patient safety, privacy of protected health information (PHI), auditability, and compliance (e.g., HIPAA and GDPR), which makes conventional migration approaches that rely on downtime or temporary service degradation unsuitable. This study reports a multivocal literature review that synthesizes evidence from peer-reviewed research and high-relevance practitioner sources on strategies that enable continuous service during migration in healthcare settings. Across the reviewed studies, recurring patterns include event-driven integration, Change Data Capture (CDC), coordinated dual-write, backward-compatible schema evolution, progressive traffic shifting (canary and blue-green), and resilience controls such as circuit breakers, idempotent consumers, and controlled failover. These patterns are complemented by observability, governance, and security controls (encryption, access control, and immutable audit logs) that preserve compliance during transitional states. A total of 87 records were retrieved from IEEE Xplore, ACM Digital Library, and SpringerLink (Scopus and Web of Science returned zero records for the search string). After screening and full-text assessment using predefined criteria, a focused set of studies was selected for detailed synthesis. The findings provide practical guidance for planning and executing live migrations in regulated, data-intensive healthcare systems and highlight areas where additional empirical validation is needed.

Published in	American Journal of Computer Science and Technology (Volume 9, Issue 1)
DOI	10.11648/j.ajcst.20260901.14
Page(s)	30-38
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Microservices, Zero-Downtime Migration, Healthcare IT, EHR, Change Data Capture, Event-Driven Architecture, Transactional Consistency, Compliance Architecture

References

[1]	Newman, S. Building Microservices: Designing Fine-Grained Systems. O’Reilly Media; 2015.
[2]	Fowler, M., Lewis, J. Microservices. Available from: https://martinfowler.com/articles/microservices.html (accessed 10 November 2025).
[3]	Publishing body. Health Insurance Portability and Accountability Act (HIPAA), Pub. L. 104–191. United States; 1996. Available from: https://www.govinfo.gov/content/pkg/PLAW-104publ191/pdf/PLAW-104publ191.pdf (accessed 10 November 2025).
[4]	Publishing body. Regulation (EU) 2016/679 (General Data Protection Regulation—GDPR). European Union; 2016. Available from: https://eur-lex.europa.eu/eli/reg/2016/679/oj (accessed 10 November 2025).
[5]	Richardson, C. Microservices Patterns. Manning Publications; 2018.
[6]	Garousi, V., Felderer, M., Mäntylä, M. V. Guidelines for including grey literature and conducting multivocal literature reviews in software engineering. Information and Software Technology. 2019, 106, 101–121. https://doi.org/10.1016/j.infsof.2018.09.006
[7]	Kansara, M. Cloud Migration Strategies and Challenges in Highly Regulated and Data-Intensive Industries: A Technical Perspective. International Journal of Applied Machine Learning and Computational Intelligence. 2021. Available from: https://www.researchgate.net/publication/389254166_Cloud_Migration_Strategies_and_Challenges_in_Highly_Regulated_and_Data-Intensive_Industries_A_Technical_Perspective (accessed 10 November 2025).
[8]	Kagga, S. R. Migrating Legacy Healthcare Systems to Cloud-Native Microservices with AI: Best Practices and Pitfalls. International Journal of Applied Mathematics. 2025, 38(2s). Available from: https://ijamjournal.org/ijam/publication/index.php/ijam/article/view/123/119
[9]	Garcia-Molina, H., Salem, K. Sagas. ACM SIGMOD Record. 1987, 16(3), 249–259. https://doi.org/10.1145/38714.38742
[10]	Bernstein, P. A., Newcomer, E. Principles of Transaction Processing. 2nd ed. Morgan Kaufmann; 2009.
[11]	HL7 International. FHIR Release 4 (R4). 2019. Available from: https://www.hl7.org/fhir/R4/ (accessed 10 November 2025).
[12]	Fowler, M. Event Sourcing. Available from: https://martinfowler.com/eaaDev/EventSourcing.html
[13]	Office of the National Coordinator for Health Information Technology (ONC). 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. Federal Register. 2020. Available from: https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification
[14]	National Institute of Standards and Technology. Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource Guide. NIST Special Publication 800-66 Revision 2. 2024. https://doi.org/10.6028/NIST.SP.800-66r2
[15]	International Organization for Standardization. ISO/IEC 27001:2022 Information security, cybersecurity and privacy protection—Information security management systems—Requirements. Geneva, Switzerland: ISO; 2022.
[16]	HL7 International. FHIR Release 5 (R5). 2023. Available from: https://hl7.org/fhir/R5/
[17]	OWASP Foundation. OWASP API Security Top 10 – 2023. 2023. Available from: https://owasp.org/www-project-api-security/
[18]	Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021, 372, n71. https://doi.org/10.1136/bmj.n71

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APA Style

Paul, T. (2026). Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. American Journal of Computer Science and Technology, 9(1), 30-38. https://doi.org/10.11648/j.ajcst.20260901.14

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ACS Style

Paul, T. Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. Am. J. Comput. Sci. Technol. 2026, 9(1), 30-38. doi: 10.11648/j.ajcst.20260901.14

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AMA Style

Paul T. Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. Am J Comput Sci Technol. 2026;9(1):30-38. doi: 10.11648/j.ajcst.20260901.14

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@article{10.11648/j.ajcst.20260901.14,
  author = {Thomas Paul},
  title = {Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: 
A Multivocal Literature Review},
  journal = {American Journal of Computer Science and Technology},
  volume = {9},
  number = {1},
  pages = {30-38},
  doi = {10.11648/j.ajcst.20260901.14},
  url = {https://doi.org/10.11648/j.ajcst.20260901.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcst.20260901.14},
  abstract = {Healthcare organizations are modernizing core platforms such as electronic health records (EHRs), order-entry, and billing systems, but decomposing long-lived monoliths into microservices introduces a critical challenge: how to migrate without interrupting mission-critical care operations. Regulated healthcare environments impose strict requirements for availability, patient safety, privacy of protected health information (PHI), auditability, and compliance (e.g., HIPAA and GDPR), which makes conventional migration approaches that rely on downtime or temporary service degradation unsuitable. This study reports a multivocal literature review that synthesizes evidence from peer-reviewed research and high-relevance practitioner sources on strategies that enable continuous service during migration in healthcare settings. Across the reviewed studies, recurring patterns include event-driven integration, Change Data Capture (CDC), coordinated dual-write, backward-compatible schema evolution, progressive traffic shifting (canary and blue-green), and resilience controls such as circuit breakers, idempotent consumers, and controlled failover. These patterns are complemented by observability, governance, and security controls (encryption, access control, and immutable audit logs) that preserve compliance during transitional states. A total of 87 records were retrieved from IEEE Xplore, ACM Digital Library, and SpringerLink (Scopus and Web of Science returned zero records for the search string). After screening and full-text assessment using predefined criteria, a focused set of studies was selected for detailed synthesis. The findings provide practical guidance for planning and executing live migrations in regulated, data-intensive healthcare systems and highlight areas where additional empirical validation is needed.},
 year = {2026}
}

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TY  - JOUR
T1  - Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: 
A Multivocal Literature Review
AU  - Thomas Paul
Y1  - 2026/02/09
PY  - 2026
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JF  - American Journal of Computer Science and Technology
JO  - American Journal of Computer Science and Technology
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PB  - Science Publishing Group
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AB  - Healthcare organizations are modernizing core platforms such as electronic health records (EHRs), order-entry, and billing systems, but decomposing long-lived monoliths into microservices introduces a critical challenge: how to migrate without interrupting mission-critical care operations. Regulated healthcare environments impose strict requirements for availability, patient safety, privacy of protected health information (PHI), auditability, and compliance (e.g., HIPAA and GDPR), which makes conventional migration approaches that rely on downtime or temporary service degradation unsuitable. This study reports a multivocal literature review that synthesizes evidence from peer-reviewed research and high-relevance practitioner sources on strategies that enable continuous service during migration in healthcare settings. Across the reviewed studies, recurring patterns include event-driven integration, Change Data Capture (CDC), coordinated dual-write, backward-compatible schema evolution, progressive traffic shifting (canary and blue-green), and resilience controls such as circuit breakers, idempotent consumers, and controlled failover. These patterns are complemented by observability, governance, and security controls (encryption, access control, and immutable audit logs) that preserve compliance during transitional states. A total of 87 records were retrieved from IEEE Xplore, ACM Digital Library, and SpringerLink (Scopus and Web of Science returned zero records for the search string). After screening and full-text assessment using predefined criteria, a focused set of studies was selected for detailed synthesis. The findings provide practical guidance for planning and executing live migrations in regulated, data-intensive healthcare systems and highlight areas where additional empirical validation is needed.
VL  - 9
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Author Information

Thomas Paul

Independent Researcher, International Scientific Society, San Francisco, United States of America

Contact Email

http://orcid.org/0009-0006-4151-3808

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APA Style

Paul, T. (2026). Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. American Journal of Computer Science and Technology, 9(1), 30-38. https://doi.org/10.11648/j.ajcst.20260901.14

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ACS Style

Paul, T. Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. Am. J. Comput. Sci. Technol. 2026, 9(1), 30-38. doi: 10.11648/j.ajcst.20260901.14

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AMA Style

Paul T. Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: A Multivocal Literature Review. Am J Comput Sci Technol. 2026;9(1):30-38. doi: 10.11648/j.ajcst.20260901.14

Copy | Download

@article{10.11648/j.ajcst.20260901.14,
  author = {Thomas Paul},
  title = {Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: 
A Multivocal Literature Review},
  journal = {American Journal of Computer Science and Technology},
  volume = {9},
  number = {1},
  pages = {30-38},
  doi = {10.11648/j.ajcst.20260901.14},
  url = {https://doi.org/10.11648/j.ajcst.20260901.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcst.20260901.14},
  abstract = {Healthcare organizations are modernizing core platforms such as electronic health records (EHRs), order-entry, and billing systems, but decomposing long-lived monoliths into microservices introduces a critical challenge: how to migrate without interrupting mission-critical care operations. Regulated healthcare environments impose strict requirements for availability, patient safety, privacy of protected health information (PHI), auditability, and compliance (e.g., HIPAA and GDPR), which makes conventional migration approaches that rely on downtime or temporary service degradation unsuitable. This study reports a multivocal literature review that synthesizes evidence from peer-reviewed research and high-relevance practitioner sources on strategies that enable continuous service during migration in healthcare settings. Across the reviewed studies, recurring patterns include event-driven integration, Change Data Capture (CDC), coordinated dual-write, backward-compatible schema evolution, progressive traffic shifting (canary and blue-green), and resilience controls such as circuit breakers, idempotent consumers, and controlled failover. These patterns are complemented by observability, governance, and security controls (encryption, access control, and immutable audit logs) that preserve compliance during transitional states. A total of 87 records were retrieved from IEEE Xplore, ACM Digital Library, and SpringerLink (Scopus and Web of Science returned zero records for the search string). After screening and full-text assessment using predefined criteria, a focused set of studies was selected for detailed synthesis. The findings provide practical guidance for planning and executing live migrations in regulated, data-intensive healthcare systems and highlight areas where additional empirical validation is needed.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Zero-Downtime Migration Strategies for Decomposing Monoliths into Microservices in the Healthcare Industry: 
A Multivocal Literature Review
AU  - Thomas Paul
Y1  - 2026/02/09
PY  - 2026
N1  - https://doi.org/10.11648/j.ajcst.20260901.14
DO  - 10.11648/j.ajcst.20260901.14
T2  - American Journal of Computer Science and Technology
JF  - American Journal of Computer Science and Technology
JO  - American Journal of Computer Science and Technology
SP  - 30
EP  - 38
PB  - Science Publishing Group
SN  - 2640-012X
UR  - https://doi.org/10.11648/j.ajcst.20260901.14
AB  - Healthcare organizations are modernizing core platforms such as electronic health records (EHRs), order-entry, and billing systems, but decomposing long-lived monoliths into microservices introduces a critical challenge: how to migrate without interrupting mission-critical care operations. Regulated healthcare environments impose strict requirements for availability, patient safety, privacy of protected health information (PHI), auditability, and compliance (e.g., HIPAA and GDPR), which makes conventional migration approaches that rely on downtime or temporary service degradation unsuitable. This study reports a multivocal literature review that synthesizes evidence from peer-reviewed research and high-relevance practitioner sources on strategies that enable continuous service during migration in healthcare settings. Across the reviewed studies, recurring patterns include event-driven integration, Change Data Capture (CDC), coordinated dual-write, backward-compatible schema evolution, progressive traffic shifting (canary and blue-green), and resilience controls such as circuit breakers, idempotent consumers, and controlled failover. These patterns are complemented by observability, governance, and security controls (encryption, access control, and immutable audit logs) that preserve compliance during transitional states. A total of 87 records were retrieved from IEEE Xplore, ACM Digital Library, and SpringerLink (Scopus and Web of Science returned zero records for the search string). After screening and full-text assessment using predefined criteria, a focused set of studies was selected for detailed synthesis. The findings provide practical guidance for planning and executing live migrations in regulated, data-intensive healthcare systems and highlight areas where additional empirical validation is needed.
VL  - 9
IS  - 1
ER  -

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