With all the mhealth, ehealth, and cloud solutions now available, we are nearing the point where a "complete" health system can be built from inexpensive or free resources. People have discussed an "open mHealth ecosystem" as opposed to a "stove-pipe" approach. But how do those in developing countries who are trying to build health infrastructure approach the problem? With so many solutions and so many "one-off" projects-- can we provide a road map or instruction manual for IT professionals in the developing world? Gerry Douglas' recent publication in PLOS is an inspiring start, as are many discussions here on GHD. What are the next steps?