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The Fossible Stack — The Complete Digital Health Stack ​

For Rapid Digital Health Parity

Healthcare IT has a layering problem.

Most organizations assemble their digital health infrastructure one vendor at a time — a CRM here, a practice management system there, a separate lab system, a bolted-on analytics tool, a compliance layer bought from yet another vendor. Each system has its own data model, its own API (if you're lucky), its own login, and its own upgrade cycle. The result is a fragile, expensive patchwork where data flows through duct-tape integrations and every new requirement means another procurement cycle.

The Fossible Stack is the opposite of that.

It's a complete, vertically integrated digital health stack — from omni-channel patient engagement at the top to a FHIR-compliant clinical data warehouse at the bottom — where every layer is open-source, API-first, and designed to work together natively. One stack. No vendor lock-in. Full ownership of your data, your code, and your roadmap.

The Stack at a Glance ​

The Fossible Stack is organized into five layers, each solving a distinct problem, each open-source, and each connected to the layers above and below through standard APIs and event-driven integrations.

  • Omni-Channel Customer Engagement — Frappe CRM for lead capture, support, and patient communication
  • Practice Management & CareOps — A Frappe-based single platform for PMS, LIS, RIS, Inventory, and ERP
  • Frappe Platform Features — The low-code engine underneath: auth, workflows, APIs, reporting, dashboards
  • Health Data Platform — FHIR Server (Medplum), real-time ETL, patient portals, and interoperability services
  • Clinical Data Warehouse & Analytics — Tuva Project on Redshift for AI-ready analytics, decision support, and reporting
Meta / WhatsAppWebsite / ChatbotCalendly / Typeform / APIs
Layer 1
Omni-Channel Customer Engagement
Frappe CRMLead CaptureSupport & CommsPatient Funneling
Webhooks & APIs ↓
Layer 2
Practice Management & CareOps
PMSLIS (LOINC)RIS / DICOM / PACSERPNextInventoryBilling & RCMSuperset / InsightsAI Decision Support
Runs on ↓
Layer 3
Frappe Platform Features
Auth / SSO / RBACWorkflow EngineREST APIsWebhooksLow-Code / DoctypesReports & DashboardsCron / Batch
Real-Time ETL (Kinesis + Redis) ↓
Layer 4
Health Data Platform
Medplum FHIR R4 ServerPatient Portal AppsSMART on FHIRHL7v2 / CDATerminology ServerHIPAA / ABDM / NABH
Standardized FHIR Data ↓
Layer 5
Clinical Data Warehouse & Analytics
Tuva ProjectRedshiftAI / ML ModelsDashboards & ReportingNotebooks (Jupyter)Population Health
100% Open Source · API-First · No Vendor Lock-In

Each layer is described in detail below.

Layer 1: Omni-Channel Customer Engagement ​

Where every patient relationship begins.

Healthcare organizations don't just need a website — they need a unified engagement layer that captures leads from every channel and funnels them into a single system of record.

Frappe CRM sits at the top of the stack as an omni-channel customer engagement platform for support and leads management. It captures inbound interest from:

  • Meta — WhatsApp Business and Messenger integrations for conversational engagement
  • Website / Chatbot — embedded chat widgets and AI-assisted chatbots for triage and scheduling
  • APIs, Calendly, Typeform — form-based lead capture, appointment scheduling, and custom intake flows

When a lead converts to a customer or patient, Frappe CRM hands off the record to the Practice Management layer below via webhooks and APIs — no manual data entry, no copy-paste, no dropped context.

Why this matters: Most healthcare organizations run their CRM, website, and communication tools as completely separate systems. The Fossible Stack treats engagement as the first layer of the clinical data pipeline — every touchpoint is captured, structured, and flows downstream automatically.

Layer 2: Practice Management & CareOps ​

One platform for clinical workflows, operations, and business.

This is the operational core of the Fossible Stack — a Frappe-based single platform for all Practice Management and Care Ops.

Core Modules ​

PMS (Practice Management System) — Patient registration, scheduling, encounter documentation, clinical workflows, billing, and revenue cycle management. Built on Frappe's doctype system, so every entity is customizable without forking.

LIS (Lab Information System) — LOINC-coded lab workflows, sample tracking, device integration, diagnostic reporting, and result publishing. High-volume, high-throughput, multi-location capable.

RIS (Radiology Information System) — DICOM and PACS integration, imaging order management, radiology reporting, and cross-departmental result sharing.

Inventory & ERP — Full ERPNext-powered inventory, procurement, accounting, HR, payroll, and asset management. Multi-warehouse, multi-currency, multi-company — the same ERP that 10,000+ organizations run worldwide, natively integrated with clinical workflows.

Analytics & BI ​

CareOps Analytics powered by Superset and Frappe Insights gives operational teams real-time visibility into clinical volumes, revenue, inventory levels, staff utilization, and departmental KPIs — without exporting data to a separate BI tool.

External Integrations ​

The CareOps layer connects outward to external systems via webhooks and APIs:

  • DICOM imaging systems and PACS for radiology
  • LIS/RIS device integrations for lab and imaging equipment
  • Logistics providers for pharmacy and supply chain
  • Medplum Agent for HL7 device data integration — bridging legacy medical devices into the modern stack
  • AI-powered decision support for practice management — clinical alerts, risk scoring, and operational recommendations

Why this matters: Traditional healthcare IT forces you to buy PMS, LIS, RIS, ERP, and analytics as five separate products from five separate vendors. The Fossible Stack delivers all of it on a single database, with a single API surface, and zero per-user licensing fees.

Layer 3: Frappe Platform Features ​

The low-code engine that powers everything above.

Every module in the CareOps layer runs on the Frappe Framework — a mature, battle-tested low-code platform that provides the foundational capabilities most healthcare IT vendors charge extra for (or don't offer at all).

Auth / Authz & SSO — Role-based access control, fine-grained document-level permissions, multi-factor authentication, and single sign-on. Your IT team controls who sees what, down to the field level.

Workflow Engine — Visual workflow designer for clinical and business processes. State transitions, conditions, approvals, email alerts, and automatic field updates — no code required for standard workflows.

REST API / Integrations — Every doctype in the system exposes a full RESTful API automatically. No separate API development. Every entity is queryable, writable, and subscribable from day one.

Notifications / Webhooks — Event-driven notifications via email, push, SMS, and Slack. Outbound webhooks for real-time integration with external systems.

Reports / Excel / Print / PDFs — Script reports, query reports, report builder, print format designer, and PDF generation. Operational reporting without a separate BI tool.

Low-Code / Rapid Dev — Frappe's doctype system lets your team build custom entities, forms, list views, and dashboards in days — not months. Custom scripts (client-side and server-side) extend behavior without forking the core.

Cron / Batch Processing — Scheduled tasks, background jobs, and batch processing for ETL, data sync, automated billing runs, and scheduled reporting.

Module-Wise Dashboards and KPIs — Every module ships with its own operational dashboard. Clinical volumes, revenue metrics, lab turnaround times, inventory levels — all configurable, all real-time.

Why this matters: The platform layer is what makes the Fossible Stack extensible. You're not locked into a rigid product — you're building on a framework that your own team can customize, extend, and maintain. This is the difference between buying software and owning infrastructure.

Layer 4: Health Data Platform ​

Standardized, compliant, interoperable clinical data.

Above the operational layer, the Fossible Stack includes a standards-compliant health data platform for organizations that need FHIR interoperability, patient-facing applications, and regulatory compliance.

FHIR Server — Medplum ​

At the center of the health data layer is Medplum, an open-source FHIR R4 server that serves as the Standardized Clinical Data Repository. Clinical data from the CareOps layer flows into Medplum via real-time ETL — giving you a canonical, standards-compliant representation of every patient, encounter, observation, and procedure.

Real-Time ETL ​

Amazon Kinesis and Redis power the real-time data pipeline between the operational CareOps layer and the FHIR server. Clinical events — new encounters, lab results, medication orders — stream into the health data platform as they happen, not in nightly batches.

Patient-Facing Applications ​

With a FHIR server in place, the stack supports:

  • Patient Portal Apps — patient-facing applications for appointment booking, lab results, medication history, and secure messaging
  • SMART on FHIR EHR Apps — third-party applications that plug into the stack via the SMART on FHIR standard, extending functionality without custom integration work

Interoperability Services ​

The health data platform provides a suite of interoperability capabilities:

  • SMART on FHIR Apps — launch and integrate certified EHR applications
  • Clinical Data Standards Migration Services — migrate from proprietary formats to FHIR R4
  • Healthcare Compliance — HIPAA, ABDM, NABH, and regional regulatory alignment
  • Interoperability Services — HL7v2, FHIR, and CDA document exchange
  • Terminology Server — ICD-10, SNOMED-CT, LOINC, and custom code system management

Why this matters: Most practice management systems store clinical data in proprietary formats. The Fossible Stack treats FHIR compliance not as an add-on but as a core architectural layer — your clinical data is standardized, portable, and ready for analytics, AI, and regulatory reporting from day one.

Layer 5: Clinical Data Warehouse & Analytics ​

AI-ready analytics on standardized clinical data.

The bottom layer of the Fossible Stack is where clinical data becomes actionable intelligence.

Tuva Project — Clinical Data Warehouse ​

Tuva is an open-source clinical data warehouse purpose-built for healthcare analytics and AI. It takes standardized FHIR data from Medplum and transforms it into analytics-ready datasets — pre-built data models for claims, clinical events, quality measures, and population health.

Analytics Infrastructure ​

  • Redshift (or any columnar analytics database) as the analytics engine
  • Dashboards + Reporting — operational and clinical dashboards for leadership, department heads, and care teams
  • Decision Support — AI-powered clinical decision support that feeds recommendations back into the practice management layer
  • Notebooks — Jupyter-style notebooks for data science teams to build custom models, run cohort analyses, and develop predictive analytics

The AI Layer ​

The clinical data warehouse is where AI becomes practical — not theoretical. With standardized, longitudinal patient data in a queryable warehouse, you can build:

  • Risk stratification models
  • Readmission prediction
  • Clinical outcome analytics
  • Operational forecasting (patient volumes, staffing, inventory demand)
  • Population health dashboards

Why this matters: Analytics in healthcare is usually an afterthought — a reporting tool bolted onto a system that wasn't designed for it. The Fossible Stack treats the data warehouse as a first-class layer, fed by real-time ETL from a FHIR-compliant source. Your analytics aren't running on stale CSV exports — they're running on live, standardized clinical data.

The Open-Source Advantage ​

Every layer of the Fossible Stack is built on open-source foundations. This isn't an ideological position — it's a practical one.

You own everything. The code, the data, the deployment. No vendor can revoke your access, raise your subscription, or sunset a feature you depend on.

No per-user licensing. Frappe, ERPNext, Medplum, Tuva, Superset — all GPL or Apache licensed. Scale to 10,000 users without a single license negotiation.

Full API surface. Every layer exposes standard APIs — REST, FHIR, webhooks. Integration isn't a premium feature. It's how the stack is built.

Host anywhere. Cloud, on-premise, hybrid, air-gapped. Your infrastructure, your rules. The Fossible Stack runs wherever you need it.

Community-backed, enterprise-ready. Frappe has 50,000+ community members. ERPNext runs in 10,000+ organizations across 140+ countries. Medplum is backed by a growing FHIR ecosystem. You're not betting on a single vendor's roadmap — you're building on platforms with escape velocity.

Low-code extensibility. Your team doesn't need to fork the stack to customize it. Frappe's doctype system, workflow designer, and scripting layer let you build custom modules, entities, and automations in days — not months of vendor change orders.

Who the Fossible Stack Is For ​

  • Multi-site hospital groups that need a unified platform across locations — clinical, operational, and financial
  • Diagnostic lab chains running high-volume LIS workflows with device integration and cross-location analytics
  • Specialty and multi-specialty clinics that need configurable clinical workflows per department
  • Health-tech startups building care delivery platforms that need clinical + operational backbone on day one
  • Government and public health programs that require open-source, standards-compliant, locally hostable infrastructure
  • Organizations pursuing ABDM, HIPAA, or NABH compliance that need FHIR-native architecture, not retrofitted compliance

Ready to Deploy the Complete Stack? ​

The Fossible Stack is deployed and managed through Espresso Cloud — our enterprise CI/CD and managed infrastructure platform. We handle the DevOps, monitoring, scaling, and SLAs so your team focuses on clinical outcomes and product development.

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The Fossible Stack is built and maintained by Fossible Works Inc. For technical documentation, deployment guides, and architecture deep-dives, visit our solutions page.