I would look at porting some of these macros to an add-in. Nevertheless, VBA, but can be used for several files and receives code far from the data (which is usually a programming victory).
- Edit-- Regarding scaling and size ... I think it's all in the design. If it is put together, productivity will suffer. The file can handle the overall size, but there are restrictions on the size of the module (64k) and the size of the procedure (not well documented, but the IDE will tell you when you hit it). If you start to approach 30 MB of text, then you will want to find another solution.
You did not mention security, but since it is related to medical information, it should be said that VBA is unsafe. If the code is proprietary and offered to external sources, you can wrap it in .xll and install it as an add-on. It can also provide faster lead times.
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