Of monoliths and modules

Experience has shown me that talking about IT platforms is no easy task, as again and again, the concept threatens to slip through my fingers. In search of a straightforward, plausible definition for VISUS as a healthcare IT provider, I always get stuck on the tension between monolithic and modular. On the one hand you have the monolith (from the Greek word monolithos = made of one stone)—an impregnable, immovable block that thwarts change, with all of our efforts simply bouncing off of it. On the other hand, multiple modular building blocks of different shapes combine into a whole that grows taller and broader in an orderly way and continuously adapts its shape to current demands. Achieving that requires two things: coherent rules for docking and anchor modules that can serve as a core for larger groups. As I see it, both are important aspects of an IT platform.

Within this landscape, the productive IT systems in healthcare facilities are often software modules. The rules that connect them are interfaces—ideally based on common standards such as HL7, FHIR and DICOM or on IHE profiles. Standards ensure that not all modules have to come from the same manufacturer, instead giving the hospital the freedom to decide whether it wants to use or replace, say, a blue or a green building block. Examples of critical anchor modules in a hospital could include a hospital information system, the billing system or the PACS.

A highly central module in any technical platform at a hospital should enable organization-wide access to patient medical data. This kind of module could be a healthcare content management system, an XDS affinity domain, or a combination of the two. The critical factor is that the information can be prepared according to international standards, transferred via standard interfaces and permanently archived. That makes this module a pillar of efforts to build bridges to the community, through telematics infrastructure applications, for example, which likewise represent a platform with many modules.
Bridges to the world—and telematics infrastructure is just one of these—will ideally be built using smaller, more flexible modules, each customized to meet the needs of a specialized application. These include modules for transferring data to the Medical Service of the Health Funds (MDK) and to fellow physicians in other hospitals, or to link to electronic patient files.

Hospitals that move away from a monolith and toward the use of a diverse range of modules on a single IT platform will need a sensible strategy—a platform strategy that provides management both with the resources it needs and with generous support.