Multi-tenant by construction, not by convention
Every clinical row in our database carries a tenant_id. Every query filters by it through a database-layer filter that cannot be bypassed by application code. New developers cannot accidentally write a query that crosses tenants, because the framework will refuse to execute it. We run an automated isolation test on every deploy that proves it: tenant A logs in, tenant B's data must not appear in any list, search, or report.
Hospitals on our premium tier get a dedicated database instead of a shared one — full physical isolation, same code.