Microsoft OS and SQL Server Compatibility Matrix

Compatible combinations of Microsoft operating systems and SQL Server.

  • Some customers have reported performance issues after installing MedicalDirector applications on a SQL Server 2025 instance or upgrading their existing MedicalDirector application's SQL Server installation to SQL Server 2025. MedicalDirector applications perform normally on SQL Server 2022 and earlier versions. After investigation, the performance issues appear to be related to changes in SQL Server 2025’s query processing engine that were introduced in an update late in 2025.  At this time, it is not recommended that MedicalDirector customers upgrade to SQL Server 2025. MedicalDirector is investigating the matter further and recommends that customers install only the SQL Server versions listed in the matrix below.
  • SQL Server 2019 Express Edition and SQL Server 2022 Express Edition have a maximum database limit of 10GB. For larger databases, a full Microsoft SQL Server is required. If you want to use a full Microsoft SQL Server product, consult the compatibility matrix below.
  • The SQL Server installation cannot be made on read-only, mapped, or compressed drives. SQL Server setup via Terminal Services Client is not supported.
  • Ensure you have a minimum .NET 3.5 Service Pack 1 installed in order to run the SQL Server 2019 installation.
  • The SQL Server 2019 installation will install .NET4.0 automatically if not already present. This requires an active internet connection for the .NET4.0 installation files to be downloaded.
  • Clinical uses the highest version of TLS available on your computer to communicate securely across the network but requires at least version TLS 1.2.
  • Always install the latest Service Pack.
Table 1. Minimum Supported Microsoft Operating Systems and SQL Server Products
OS-SQL Compatibility SQL 2014 SQL 2016 SQL 2017 SQL 2019 SQL 2022
Server 2016 ✓ ✓ ✓ ✓ ✓
Server 2019 ✓ ✓1 ✓1 ✓ ✓
Server 2022 X X X ✓ ✓
Server 2025 X X X X ✓
Windows 102 ✓3 ✓ ✓ ✓4 ✓
Windows 11 ✓ ✓ ✓ ✓ ✓
1 With the appropriate service packs.
2 When you run Clinical for the first time after upgrading to Windows 10 or 11, the Clinical installation might repair itself. In most cases, the repair process completes automatically – no user interaction is required. However, if you are prompted for the installer, contact MedicalDirector Customer Service for assistance.
3 Any version. SP1 is required.
4 SQL Standard and SQL Express are supported. SQL Enterprise is not supported.