diff --git a/src/Microsoft.Health.Fhir.Core.UnitTests/Features/Storage/FhirMemoryCacheTests.cs b/src/Microsoft.Health.Fhir.Core.UnitTests/Features/Storage/FhirMemoryCacheTests.cs
new file mode 100644
index 000000000..88cbb8fa1
--- /dev/null
+++ b/src/Microsoft.Health.Fhir.Core.UnitTests/Features/Storage/FhirMemoryCacheTests.cs
@@ -0,0 +1,194 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using System;
+using System.Collections.Generic;
+using Microsoft.Extensions.Logging;
+using Microsoft.Health.Fhir.Core.Features.Storage;
+using Microsoft.Health.Fhir.Tests.Common;
+using Microsoft.Health.Test.Utilities;
+using NSubstitute;
+using Xunit;
+
+namespace Microsoft.Health.Fhir.Core.UnitTests.Features.Storage
+{
+    [Trait(Traits.OwningTeam, OwningTeam.Fhir)]
+    [Trait(Traits.Category, Categories.Security)]
+    public sealed class FhirMemoryCacheTests
+    {
+        private readonly ILogger _logger = Substitute.For<ILogger>();
+
+        private const string DefaultKey = "key";
+        private const string DefaultValue = "value";
+
+        [Theory]
+        [InlineData(01, 01 * 1024 * 1024)]
+        [InlineData(14, 14 * 1024 * 1024)]
+        [InlineData(55, 55 * 1024 * 1024)]
+        public void GivenAnEmptyCache_CheckTheCacheMemoryLimit(int limitSizeInMegabytes, long expectedLimitSizeInBytes)
+        {
+            var cache = new FhirMemoryCache<string>(Guid.NewGuid().ToString(), limitSizeInMegabytes, TimeSpan.FromMinutes(1), _logger);
+
+            Assert.Equal(expectedLimitSizeInBytes, cache.CacheMemoryLimit);
+        }
+
+        [Fact]
+        public void GivenACache_RaiseErrorsIfParametersAreInvalid()
+        {
+            Assert.Throws<ArgumentNullException>(
+                () => new FhirMemoryCache<string>(
+                    null,
+                    limitSizeInMegabytes: 0,
+                    TimeSpan.FromMinutes(1),
+                    _logger));
+
+            Assert.Throws<ArgumentOutOfRangeException>(
+                () => new FhirMemoryCache<string>(
+                    Guid.NewGuid().ToString(),
+                    limitSizeInMegabytes: 0,
+                    TimeSpan.FromMinutes(1),
+                    _logger));
+
+            Assert.Throws<ArgumentNullException>(
+                () => new FhirMemoryCache<string>(
+                    Guid.NewGuid().ToString(),
+                    limitSizeInMegabytes: 1,
+                    TimeSpan.FromMinutes(1),
+                    null));
+
+            var cache = CreateRegularMemoryCache<string>();
+
+            Assert.Throws<ArgumentNullException>(() => cache.GetOrAdd(null, DefaultValue));
+            Assert.Throws<ArgumentNullException>(() => cache.TryAdd(null, DefaultValue));
+            Assert.Throws<ArgumentException>(() => cache.GetOrAdd(string.Empty, DefaultValue));
+            Assert.Throws<ArgumentException>(() => cache.TryAdd(string.Empty, DefaultValue));
+            Assert.Throws<ArgumentNullException>(() => cache.GetOrAdd(DefaultKey, null));
+            Assert.Throws<ArgumentNullException>(() => cache.TryAdd(DefaultKey, null));
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValue_ThenValueShouldBeAdded()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            var result1 = cache.GetOrAdd(DefaultKey, DefaultValue);
+            Assert.Equal(DefaultValue, result1);
+
+            const string anotherValue = "Another Value";
+            var result2 = cache.GetOrAdd(DefaultKey, anotherValue);
+            Assert.NotEqual(anotherValue, result2);
+            Assert.Equal(DefaultValue, result1);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValue_ThenValueShouldBeAddedAndCanBeRetrieved()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(DefaultValue, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValueIfIgnoreCaseEnabled_ThenMultipleSimilarKeysShouldWorkAsExpected()
+        {
+            var cache = new FhirMemoryCache<string>(Guid.NewGuid().ToString(), limitSizeInMegabytes: 1, TimeSpan.FromMinutes(1), _logger, ignoreCase: true);
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(DefaultValue, result);
+
+            Assert.True(cache.TryGet(DefaultKey.ToUpper(), out result));
+            Assert.Equal(DefaultValue, result);
+
+            Assert.True(cache.TryGet("Key", out result));
+            Assert.Equal(DefaultValue, result);
+
+            Assert.True(cache.TryGet("kEy", out result));
+            Assert.Equal(DefaultValue, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenGettingAnItemThatDoNotExist_ThenReturnFalse()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            Assert.False(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(default, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValueIfIgnoreCaseDisabled_ThenMultipleSimilarKeysShouldWorkAsExpected()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet("key", out var result));
+            Assert.Equal(DefaultValue, result);
+
+            Assert.False(cache.TryGet("KEY", out result));
+
+            Assert.False(cache.TryGet("Key", out result));
+
+            Assert.False(cache.TryGet("kEy", out result));
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValue_ThenValueShouldBeAddedAndCanBeRetrievedUsingTryGetValue()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(DefaultValue, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValue_ThenValueShouldBeAddedAndCanBeRetrievedUsingTryGetValueWithOut()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(DefaultValue, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenAddingValue_ThenValueShouldBeAddedAndCanBeRetrievedUsingTryGetValueWithOutAndValue()
+        {
+            var cache = CreateRegularMemoryCache<string>();
+
+            cache.GetOrAdd(DefaultKey, DefaultValue);
+
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(DefaultValue, result);
+        }
+
+        [Fact]
+        public void GivenAnEmptyCache_WhenRunningOperations_ThenItemsShouldBeRespected()
+        {
+            var cache = CreateRegularMemoryCache<long>();
+
+            cache.GetOrAdd(DefaultKey, 2112);
+            Assert.True(cache.TryGet(DefaultKey, out var result));
+            Assert.Equal(2112, result);
+
+            Assert.True(cache.Remove(DefaultKey));
+
+            Assert.False(cache.TryGet(DefaultKey, out result));
+        }
+
+        private IMemoryCache<T> CreateRegularMemoryCache<T>()
+        {
+            return new FhirMemoryCache<T>(Guid.NewGuid().ToString(), limitSizeInMegabytes: 1, TimeSpan.FromMinutes(1), _logger);
+        }
+    }
+}
diff --git a/src/Microsoft.Health.Fhir.Core/Features/Storage/FhirMemoryCache.cs b/src/Microsoft.Health.Fhir.Core/Features/Storage/FhirMemoryCache.cs
new file mode 100644
index 000000000..68bc4ffc4
--- /dev/null
+++ b/src/Microsoft.Health.Fhir.Core/Features/Storage/FhirMemoryCache.cs
@@ -0,0 +1,166 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using System;
+using System.Collections.Generic;
+using System.Collections.Specialized;
+using System.Runtime.Caching;
+using EnsureThat;
+using Microsoft.Extensions.Logging;
+
+namespace Microsoft.Health.Fhir.Core.Features.Storage
+{
+    public sealed class FhirMemoryCache<T> : IMemoryCache<T>
+    {
+        private const int DefaultLimitSizeInMegabytes = 50;
+        private const int DefaultExpirationTimeInMinutes = 24 * 60;
+
+        private readonly string _cacheName;
+        private readonly ILogger _logger;
+        private readonly ObjectCache _cache;
+        private readonly TimeSpan _expirationTime;
+        private readonly bool _ignoreCase;
+
+        public FhirMemoryCache(string name, ILogger logger, bool ignoreCase = false)
+            : this(
+                name,
+                limitSizeInMegabytes: DefaultLimitSizeInMegabytes,
+                expirationTime: TimeSpan.FromMinutes(DefaultExpirationTimeInMinutes),
+                logger)
+        {
+        }
+
+        public FhirMemoryCache(string name, int limitSizeInMegabytes, TimeSpan expirationTime, ILogger logger, bool ignoreCase = false)
+        {
+            EnsureArg.IsNotNull(name, nameof(name));
+            EnsureArg.IsGt(limitSizeInMegabytes, 0, nameof(name));
+            EnsureArg.IsNotNull(logger, nameof(logger));
+
+            _cacheName = name;
+            _cache = new MemoryCache(
+                _cacheName,
+                new NameValueCollection()
+                {
+                    { "CacheMemoryLimitMegabytes", limitSizeInMegabytes.ToString() },
+                });
+            _expirationTime = expirationTime;
+            _logger = logger;
+            _ignoreCase = ignoreCase;
+        }
+
+        public long CacheMemoryLimit => ((MemoryCache)_cache).CacheMemoryLimit;
+
+        /// <summary>
+        /// Get or add the value to cache.
+        /// </summary>
+        /// <typeparam name="T">Type of the value in cache</typeparam>
+        /// <param name="key">Key</param>
+        /// <param name="value">Value</param>
+        /// <returns>Value in cache</returns>
+        public T GetOrAdd(string key, T value)
+        {
+            EnsureArg.IsNotNullOrWhiteSpace(key, nameof(key));
+            if (value == null)
+            {
+                throw new ArgumentNullException(nameof(value));
+            }
+
+            key = FormatKey(key);
+
+            CacheItem newCacheItem = new CacheItem(key, value);
+
+            CacheItem cachedItem = _cache.AddOrGetExisting(
+                newCacheItem,
+                GetDefaultCacheItemPolicy());
+
+            if (cachedItem.Value == null)
+            {
+                // If the item cache item is null, then the item was added to the cache.
+                return (T)newCacheItem.Value;
+            }
+            else
+            {
+                return (T)cachedItem.Value;
+            }
+        }
+
+        /// <summary>
+        /// Add the value to cache if it does not exist.
+        /// </summary>
+        /// <param name="key">Key</param>
+        /// <param name="value">Value</param>
+        /// <returns>Returns true if the item was added to the cache, returns false if there is an item with the same key in cache.</returns>
+        public bool TryAdd(string key, T value)
+        {
+            EnsureArg.IsNotNullOrWhiteSpace(key, nameof(key));
+            if (value == null)
+            {
+                throw new ArgumentNullException(nameof(value));
+            }
+
+            key = FormatKey(key);
+
+            return _cache.Add(key, value, GetDefaultCacheItemPolicy());
+        }
+
+        /// <summary>
+        /// Get an item from the cache.
+        /// </summary>
+        /// <param name="key">Key</param>
+        /// <returns>Value</returns>
+        public T Get(string key)
+        {
+            key = FormatKey(key);
+
+            return (T)_cache[key];
+        }
+
+        /// <summary>
+        /// Try to retrieve an item from cache, if it does not exist then returns the <see cref="default"/> for that generic type.
+        /// </summary>
+        /// <param name="key">Key</param>
+        /// <param name="value">Value</param>
+        /// <returns>True if the value exists in cache</returns>
+        public bool TryGet(string key, out T value)
+        {
+            key = FormatKey(key);
+
+            CacheItem cachedItem = _cache.GetCacheItem(key);
+
+            if (cachedItem != null)
+            {
+                value = (T)cachedItem.Value;
+                return true;
+            }
+
+            _logger.LogTrace("Item does not exist in '{CacheName}' cache. Returning default value.", _cacheName);
+            value = default;
+
+            return false;
+        }
+
+        /// <summary>
+        /// Removed the item indexed by the key.
+        /// </summary>
+        /// <param name="key">Key of the item to be removed from cache.</param>
+        /// <returns>Returns false if the items does not exist in cache.</returns>
+        public bool Remove(string key)
+        {
+            key = FormatKey(key);
+
+            object objectInCache = _cache.Remove(key);
+
+            return objectInCache != null;
+        }
+
+        private string FormatKey(string key) => _ignoreCase ? key.ToLowerInvariant() : key;
+
+        private CacheItemPolicy GetDefaultCacheItemPolicy() => new CacheItemPolicy()
+        {
+            Priority = CacheItemPriority.Default,
+            SlidingExpiration = _expirationTime,
+        };
+    }
+}
diff --git a/src/Microsoft.Health.Fhir.Core/Features/Storage/IMemoryCache.cs b/src/Microsoft.Health.Fhir.Core/Features/Storage/IMemoryCache.cs
new file mode 100644
index 000000000..58ed05650
--- /dev/null
+++ b/src/Microsoft.Health.Fhir.Core/Features/Storage/IMemoryCache.cs
@@ -0,0 +1,24 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using System.Collections.Generic;
+
+namespace Microsoft.Health.Fhir.Core.Features.Storage
+{
+    public interface IMemoryCache<T>
+    {
+        long CacheMemoryLimit { get; }
+
+        T GetOrAdd(string key, T value);
+
+        bool TryAdd(string key, T value);
+
+        T Get(string key);
+
+        bool TryGet(string key, out T value);
+
+        bool Remove(string key);
+    }
+}
diff --git a/src/Microsoft.Health.Fhir.SqlServer/Features/Storage/SqlServerFhirModel.cs b/src/Microsoft.Health.Fhir.SqlServer/Features/Storage/SqlServerFhirModel.cs
index 4b4f4ab60..502c83d18 100644
--- a/src/Microsoft.Health.Fhir.SqlServer/Features/Storage/SqlServerFhirModel.cs
+++ b/src/Microsoft.Health.Fhir.SqlServer/Features/Storage/SqlServerFhirModel.cs
@@ -21,6 +21,7 @@ using Microsoft.Health.Fhir.Core.Configs;
 using Microsoft.Health.Fhir.Core.Features.Definition;
 using Microsoft.Health.Fhir.Core.Features.Operations;
 using Microsoft.Health.Fhir.Core.Features.Search.Registry;
+using Microsoft.Health.Fhir.Core.Features.Storage;
 using Microsoft.Health.Fhir.Core.Messages.Storage;
 using Microsoft.Health.Fhir.Core.Models;
 using Microsoft.Health.Fhir.SqlServer.Features.Schema;
@@ -30,6 +31,7 @@ using Microsoft.Health.SqlServer.Features.Client;
 using Microsoft.Health.SqlServer.Features.Schema;
 using Microsoft.Health.SqlServer.Features.Schema.Model;
 using Microsoft.Health.SqlServer.Features.Storage;
+using Namotion.Reflection;
 using Newtonsoft.Json;
 
 namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
@@ -52,8 +54,8 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
         private Dictionary<string, short> _resourceTypeToId;
         private Dictionary<short, string> _resourceTypeIdToTypeName;
         private Dictionary<Uri, short> _searchParamUriToId;
-        private ConcurrentDictionary<string, int> _systemToId;
-        private ConcurrentDictionary<string, int> _quantityCodeToId;
+        private FhirMemoryCache<int> _systemToId;
+        private FhirMemoryCache<int> _quantityCodeToId;
         private Dictionary<string, byte> _claimNameToId;
         private Dictionary<string, byte> _compartmentTypeToId;
         private int _highestInitializedVersion;
@@ -153,7 +155,7 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
         public bool TryGetSystemId(string system, out int systemId)
         {
             ThrowIfNotInitialized();
-            return _systemToId.TryGetValue(system, out systemId);
+            return _systemToId.TryGet(system, out systemId);
         }
 
         public int GetSystemId(string system)
@@ -175,7 +177,7 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
         public bool TryGetQuantityCodeId(string code, out int quantityCodeId)
         {
             ThrowIfNotInitialized();
-            return _quantityCodeToId.TryGetValue(code, out quantityCodeId);
+            return _quantityCodeToId.TryGet(code, out quantityCodeId);
         }
 
         public async Task EnsureInitialized()
@@ -279,8 +281,6 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
                     var resourceTypeToId = new Dictionary<string, short>(StringComparer.Ordinal);
                     var resourceTypeIdToTypeName = new Dictionary<short, string>();
                     var searchParamUriToId = new Dictionary<Uri, short>();
-                    var systemToId = new ConcurrentDictionary<string, int>(StringComparer.OrdinalIgnoreCase);
-                    var quantityCodeToId = new ConcurrentDictionary<string, int>(StringComparer.OrdinalIgnoreCase);
                     var claimNameToId = new Dictionary<string, byte>(StringComparer.Ordinal);
                     var compartmentTypeToId = new Dictionary<string, byte>();
 
@@ -335,26 +335,26 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
                     // result set 5
                     await reader.NextResultAsync(cancellationToken);
 
+                    _systemToId = new FhirMemoryCache<int>("systemToId", _logger, ignoreCase: true);
                     while (await reader.ReadAsync(cancellationToken))
                     {
                         var (value, systemId) = reader.ReadRow(VLatest.System.Value, VLatest.System.SystemId);
-                        systemToId.TryAdd(value, systemId);
+                        _systemToId.TryAdd(value, systemId);
                     }
 
                     // result set 6
                     await reader.NextResultAsync(cancellationToken);
 
+                    _quantityCodeToId = new FhirMemoryCache<int>("quantityCodeToId", _logger, ignoreCase: true);
                     while (await reader.ReadAsync(cancellationToken))
                     {
                         (string value, int quantityCodeId) = reader.ReadRow(VLatest.QuantityCode.Value, VLatest.QuantityCode.QuantityCodeId);
-                        quantityCodeToId.TryAdd(value, quantityCodeId);
+                        _quantityCodeToId.TryAdd(value, quantityCodeId);
                     }
 
                     _resourceTypeToId = resourceTypeToId;
                     _resourceTypeIdToTypeName = resourceTypeIdToTypeName;
                     _searchParamUriToId = searchParamUriToId;
-                    _systemToId = systemToId;
-                    _quantityCodeToId = quantityCodeToId;
                     _claimNameToId = claimNameToId;
                     _compartmentTypeToId = compartmentTypeToId;
                     _resourceTypeIdRange = (lowestResourceTypeId, highestResourceTypeId);
@@ -422,9 +422,9 @@ namespace Microsoft.Health.Fhir.SqlServer.Features.Storage
             }
         }
 
-        private int GetStringId(ConcurrentDictionary<string, int> cache, string stringValue, Table table, Column<int> idColumn, Column<string> stringColumn)
+        private int GetStringId(FhirMemoryCache<int> cache, string stringValue, Table table, Column<int> idColumn, Column<string> stringColumn)
         {
-            if (cache.TryGetValue(stringValue, out int id))
+            if (cache.TryGet(stringValue, out int id))
             {
                 return id;
             }