A modern solution should include one of those high precision DACs, like the MAX5719.
Add some more bits on the MSB end, for example by making a quad isolated DAC similar to the IOTech DAC488/Keithley 213 and chain those DACs to one. That DAC for example has a basic resolution of 13 Bits. They used 12 Bit DAC parts and added the sign bit using a switched inverter. It generates +/- 10 V, so one step is 2.5 mV. I found that those steps are accurate to +/- 100 uV (INL) and stable to +/- 50 uV, although the DACs use very simple voltage references and outdated LF422 OpAmps. The 8 bit calibration DACs also included in that instrument can be used to interpolate. So in the end you can make it a +/- 40 V DAC with +/- 50 uV precision, all this based on 12 Bit DAC parts.
Regards, Dieter