The decision to stick with a two-decade-old platform usually comes down to three factors: cost, complexity, and stability. Many "line of business" applications were custom-built for specific industries (like manufacturing or specialized accounting) and would cost tens of thousands of dollars to recreate in a modern framework.
Database Engine: It utilizes the Jet 4.0 database engine, which was known for its stability and performance in small to medium-sized networking environments. System Requirements and Compatibility microsoft access runtime 2003
Upsizing to SQL Server: Moving the data to SQL Server while keeping the Access frontend can improve performance and data integrity. The decision to stick with a two-decade-old platform
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