Software is in the midst of substantial change.

The single vendor solution model is braking down, both because the
level of automation in hospitals is starting to exceed the ability of
any "single application" to address it (not to mention the ability of a
vendor to cobble one together through acquisitions), and IT
architectures like SOA and web services are making middleware a natural
solution for enterprise-wide services (think Emergin
and event management). Likewise it seems that every new application has
an engine for this and an engine for that - rules engines, messaging
engines, interface engines, positioning engines - geez, they're

As the proliferation of software engines, or "enginification" continues, the value inherent in an application rises from the application code itself to the intellectual property that's embodied in the definition and configuration of the underlying engines. Thus the foundation of clinical information systems (FDA regulated or otherwise) is increasingly based on these (almost) commodity engines that drive most of the key features in applications. And as engines become more prevalent, they are increasingly available as open source software.

A major portion of medical device connectivity is software. Due to the lack of interoperability standards, not only must vendors network enable their devices, but they must provide server and client applications - often at considerable cost. A the same time, much of a server or client is little more than commodity HIT software plumbing - basic databases, role based access control, web servers, HL7 interfaces - they've all been done many times before. Wouldn't it be nice if you could look at software like you look at computers - something off-the-shelf? Increasingly, you can.

A good example of this trend is the Mirth Project open source interface engine. Mirth is the evolution of what was the embodiment of proprietary intellectual property (the once nascent interface engine product category) and provides a common tool to be used by vendors and hospitals alike. The Mirth code base was developed by WebReach, a contract development shop that started as a fuzzy logic expert systems developer in the '90s. From expert systems, WebReach did development work for pharma and has evolved into an open source health care solutions company.

I'm still wrapping my mind around the many ways that Mirth could be used - the possibilities extend way beyond simple HL7 interfacing to EMRs and other typical HIT applications.