Swedish openEHR procurements & RFIs

The films from the first hour of each pre-procurement session are finally online!

Playlist https://www.youtube.com/playlist?list=PLhWi0RtmG26UIt0qtzmOLITbu10svShMK

Individual videos:

We learnt new interesting things from all of the different suppliers. Some surprises too regarding nice features and even a fire alarm during a demo…


The general COVID-19 work and scale-up preparations in Region Östergötland are changing the focus and amount of time available for staff involved in the openEHR platform procurement.

We also suspect that many of the suppliers interested in responding to the procurement are busy doing COVID-19-related things like the openEHR COVID-19 Project and we do not want to distract suppliers’ resources from that work.

We are thus postponing the finalizing and publishing of the actual final procurement. Likely to somwhere late in Q2.

However we’ll likely, before then, openly publish a “referral” version of many of the central points of the procurement. This is done in order to give suppliers more time to prepare and to comment before the final procurement.

One thing we’ll be interested in knowing via the public referral is if our intended split into several “tender areas” is feasible and can get enough responses. A split we make since we believe such a diverse market would be better for healthcare organisations (and likely many suppliers). Preliminary/potential split of areas:

  • Platform (Clinical Data Repository)
  • Development and maintenance tools
  • Consulting services

If you watch the films posted above you can likely sense that we are interested in what combination of tools have been tested with what platforms/CDRs. We do encourage suppliers to collaborate to test such combinations so that you are prepared for related questions/requirements. This of course appplies also to suppliers that did not have time to respond to the first pre-procurement invitation.

Testing how COVID-applications made using different tools can be combinied with different CDRs could of course be a good exercise in times like these.

Thoughts and reactions are very welcome below!


The COVID-19 extraordinary things have now been reduced and operations of IT and informatics are more or less back to normal (with a backlog). Thus the openEHR procurement is now picking up pace and the documents for the above described referral round are being finalized and will be published during the summer. This referral-round is the last chance for suppliers to comment and potentially influence what the questions in final procurement will look like.

Responses to the referral round will need to be submitted the 16:th of August. The referral documents will be published at least four weeks before that, but we hope a lot earier.

The last part “consulting services” mentioned earlier will likley not be part of this procurement, but rather included as one area in a general consulting services procurement later this fall.


Today the above mentioned referral request was published with the title “External referral of EHR platform and tools, based on openEHR” at Mercell TendSign

If you are system provider, please get the document and respond with comments via the tendsign-link above before Aug 16! That is the only official way to influence the content of the upcoming procurement that will follow shortly after the referral closes. By registering for free, logging in there and subscribing to the referral you’ll also be updated regarding and changes, new document versions and Q&A-notices regarding this referral.

Note that the future procurement will likely be split in different parts (areas) that can be responded to separately and thus could be contracted to different system suppliers:

  • Area 1 = EHR Platform and platform administration tools
  • Area 2 = Development and content maintenance tools, with the subsections “Form authoring and rendering” plus “AQL authoring and execution Tools”

If you’re not a system provider, but rather just curious and don’t want to register an account at Tendsign, then below you’ll find a snapshot of the referral document that may be an old version by the time you download it from here.
External referral EHR platform and tools, based on openEHR -1.pdf (1.2 MB)

A snapshot of the response form with some example responses is also available here: External referral comments v2.xlsx (30.0 KB)

If you are not a system provider intending to respond officially via tendsign, but anyway want to give us hints and advice, then feel free to comment directly here in this openEHR forum discussion thread.

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A little bit more than one week left to comment the openEHR procurement referral document discussed above. It can be interesting to browse through and comment also if you are potential future openEHR customer or otherwise interested in requirements for such systems.

You are very welcome to comment right here in this forum topic.

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Hi Erik,

that’s quite a comprehensive list of requirements and a very valuable source for any future procurement. I just have two opinionated and picky comments regarding GDL (I think this should normally be an external component) and TDS/TDD (could also be done outside the CDR).




Hi all!

I wish I had not mentioned time in the header of this discussion thread. :wink:

The requirements for this procurement are now pretty solid and reviewed once externally, then adjusted and reviewed again internally, but a final publication will wait at least until some time after the Region’s next healthcare digitalisation steering group meeting the 27:th of January 2021.

We are now checking the possibility to publish a new “referral version” in the mean time, in case anybody is interested in seeing the updates after the last public referral. If any such referral is published it will be announced here and on other platforms.

I hope that some openEHR system providers have used the time to improve products and have tested interoperability with other products so that you can collaborate and make interesting offerings together.

Wishing you all happy holidays! //Erik

P.s. It is no secret that Region Östergötland is already a customer of Cambio. The Region could thus be interested in combining for example Cambio’s openEHR-based CDS product with other openEHR-based products.


The above mentioned new/second (and likely last) “referral version” is now online at Mercell TendSign
Creation of a (free) account is needed to log in. The referral period ends on 2021-01-26 (January 26)

Document copies below (for those that do not want to use/create a login and respond to the referral) are a snapshot in time and may get corrected/changed in the official (TendSign) procurement platform.

Worth noting from the invitation letter:

  • Please note the change of procurement areas from three separate (in the previous referral round) to one unified, as described in section 3.2.1. of the requirements document.

Consortia and collaboration between suppliers that may not individually have a full covering platform+tool suite is thus encouraged/requested by this change! We know there are openEHR tools and platforms that could be used together and hope that Region Östergötland will also get such combined proposals/bids in this procurement.

The market situation is changing a bit in Sweden.

I know of several Swedish regions that would like an openEHR market where tools for form- and AQL-authoring plus associated form renderering functions could be bought/licensed from several different providers and without locking in on a particular CDR provider. We have seen that e.g. Solit Clouds provides tools like this (as demoed further up in this thread) and hope that others will too, so that we get a market with many options.

Questions, thoughts and suggestions are very welcome.


We’ve heard it can be tricky to find sustainable business models for tools. It could be interesting to openly discuss possible licensing/payment options of openEHR platforms, tools and services. See separate thread for this:

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Karolinska University Hospital, the largest in Sweden (and recently ranked the world’s seventh* best hospital) is right now procuring openEHR systems, tools and services.

We have collaborated in the Swedish healthcare sector and lot of the requirement specifications shared in this discussion thread (based on feedback in Region Östergötlands procurement process) have been reused in Karolinska’s procurement. (I congratulate them on being faster in getting an actual procurement call off the ground.)

Karolinska are using a faster and potentially more dynamic procurement approach via existing fairly general national framework agreements, see avropa.se where openEHR vendors and service providers (including consultancy services) will respond via existing partners in the framework agreement.

If this works out well I believe we can get a more dynamic openEHR market situation in Sweden (and less cumbersome procurement processes). Other regions and organisations may follow Karolinskas procurement path, a path that still opens for other regions/organisations to pick other offers via the framework agreements than the ones Karolinska may pick.

I hope @patrikgh or someone else from Karolinska will provide some more info soon since the time for asking questions in Karolinskas call is closing very soon and then there are just a few weeks left to make offers.

If I have understood things correctly their plan is to use openEHR in both a data normalisation platform for research, integrations etc. and also over time to replace their current EHR piece by piece. A pretty audacious and very strategical move toward semantic sustainability and application/system agility.

Good luck all openEHR system, tool and service providers (including consultants)! And good luck Karolinska! This will be interesting!

*) Ranked seventh in the world means ranked second in Europe, right behind Charité in Berlin - a hospital that is also using openEHR, in the HiGHmed project


If I am correctly informed, Karolinska used the national framework agreement “Programvarulösningar”. I believe their call is closing today. It will be interesting to see how this kind of rapid procurement works in a Swedish setting!

In case other healthcare providers follow Karolinska’s path, it might be a good idea for more openEHR system/tool/service-providers to initiate collaborations with one or more of the companies listed in the framework agreement linked above.

(In Region Östergötland some internal organisational changes together with potential offers within existing contracts/collaborations have delayed and complicated our procurement process. Meanwhile we look forward to seeing what Karolinska will do.)

A tip to others wanting to reuse parts of Region Östergötlands procurement document:

Regarding sections 2.5.1 “Versions of openEHR supported by form authoring
tools” or 3.5.2 “Authoring environment” make sure to add another reqirement stating that the tools need to expose and make it possible to use also unconstrained parts of the RM that have not neccesarily been mentioned in the template. The same goes for AQL authoring tools, sections 3.6.1 and/or 3.6.2 - they also need to expose/support unconstrained parts of the RM.

These things become obvious when using tools in varied and realistic scenarios and are thus usually available in mature openEHR tools, but certain newly created tools on the market have been found to not support this from the start.


This is essential, and it needs to go even a bit further, for example to enable app builders to be able to represent on forms:

  • demographic references and/or data
  • (optionally) version-related elements like VERSION.lifecycle_state - i.e. to be able to control whether data saved (e.g. a discharge summary) is draft, complete, deleted and so on.

Another area of necessary support is for the Instruction State Machine (ISM), such that templates based on Instruction and Action archetypes have the state machine behind them, and that for any given pathway step of some particular Action, it is visualisable which next state transitions (and therefore which next pathway steps) are available from that point.


Another tip regarding things to make sure your procured openEHR form authoring tool should support, that is not currenlty available in every openEHR form tool on the market:

At runtime letting the user add more instances of a form section based on a repeatable (n…m, e.g. 0…*) template subtree.

Example template snippet:

Example of a nice implementation in a form tool (by Better) - preview mode:


continued example of implementation in a form tool (by Better) - edit mode - nothing special needs to be done by form author, multiplicity correctly picked up from template:



Indeed, multiplicity is extremely useful and necessary when designing templates for histopathology. The examples below are taken from the wonderful work Erik did in the project in Stockholm and other regions of Sweden re implementation of openEHR templates and forms (with embedded SNOMED CT of course) and the exchange of generated data between different CDR’s.

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I updated the title of this thread (removed dates etc) in order to better fit new things…

There are rumours that several Swedish regions and organisations are again interested in doing RFIs and/or procurements regarding openEHR platforms and tools in the beginning of 2023. Also for some organisations existing openEHR-related contracts are due for reevaluation before possible renewal (or ending) before the summer.

I believe it would be clever for many/all Swedish actors to collaborate regarding RFI questions so that system vendors/suppliers do not need to answer many different actors.

When it then comes to actual procurement it may be harder to procure together and I believe vendors/suppliers would be smart to already now prepare for also providing their offerings via already existing Swedish framework agreements as described above in post 19: Swedish openEHR procurements & RFIs - #19 by erik.sundvall (That means you need to talk to framework actors listed at e.g. avropa.se)


Hello Erik,

How far are you with the latest openEHR RFI?

Best regards, Juha

Hi Juha and welcome to the openEHR forum!

The latest openEHR RFI in Sweden that I know of is the one described in The Swedish openEHR platforms and tools RFI 2023. It is finished, videos of meetings with suppliers and a final report are availabe in that thread.

After that RFI, Region Stockholm and Gotland started a procurement, coordinated by Karolinska University Hospital. It is now underway and framework agreements are expected to be signed in February or March 2024, followed by call-offs over time when different needs arise. See info about that procurement in the thread Karolinska/Stockholm procurement of Digital health platform (CDR, tools, services, consultants)

Thank you for the update, Erik!

Looking forward to hear final outcome soon.

Best regards,

ti 6. helmik. 2024 klo 9.39 Erik Sundvall via openEHR (discourse@openehr.org) kirjoitti: