Hi @thomabig , I also encountered the same issue. However, I followed these steps to resolve it: 1) First, modify the AWS Parameter Store (add or delete the configuration setting parameter). 2)After that, update the medplum.[env name].config.json file (add or delete the same configuration setting parameter that was modified in the AWS Parameter Store). 3)Upgrade the AWS infrastructure. ---> npx cdk deploy -c config=medplum.[env name].config.json 4)Finally, upgrade the app. ---> npx medplum aws update-app [env name] I hope this helps! @rahul1 can you just verify these steps?