The main aim of this document is to provide an overview of the main characteristics of the tender recently published by the Catalan Health Service under the title “Clinical knowledge management platform service in accordance with the openEHR standard for the Catalonian Government”. As the tender is published only in Catalonian, we aim this document to serve the purpose to facilitate international bidders in the process of understanding the nature of the services requested.

1. Key points of the Clinical Data Repository
tender for the Catalan Health Care System
November 2022

2. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
▣ Disclaimer
▣ Announcement
▣ The Catalan health system
▣ Objectives
▣ Components of the tender
Index

3. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Purpose of this document
The main aim of this document is to provide an overview of the main
characteristics of the tender recently published by the Catalan Health
Service under the title “Clinical knowledge management platform
service in accordance with the openEHR standard for the Catalonian
Government”.
As the tender is published only in Catalonian, we aim this document
to serve the purpose to facilitate international bidders in the process
of understanding the nature of the services requested.

4. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
This document is strictly informative. It does not supplement or
amend the tender which can be found at https://bit.ly/3WRlb9d.
Any query or request for additional information about the
tender must be addressed to consultalicitacio.ctti@gencat.cat in
accordance with the public tender process
Disclaimer

5. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
THE CATALAN HEALTH SYSTEM

6. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
7,722,203
Population in Catalonia on
January 1, 2020.
> 160
Health care entities to provide
health care services.
Universal coverage
The publicly health care system of Catalonia
was founded in 1990 under the principle of
universality; so, all individuals and
communities are able to receive the health
services.
>16,000
Applications across the Catalan Health System:
1 EMR for primary care.
> 29 EMR products in the Intermediate care
hospitals.
At least 10 different systems for social care records.
11,244 M€
Catalan Health Service budget for
2020. The system is funded from
general taxation and government
founds and contributions.
940
Facilities that range from primary health
care centres to hospitals and intermediate
care centres.
Highlights on Catalan Health System

7. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The Catalonian Digital Health Platform (1)

8. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The Catalonian Digital Health Platform (2)
Personal Health Folder (LMS)
Remote Consultations
(synchronous & asynchronous)
Mobile Health apps &
telemonitoring (mConnecta)
Shared Electronic Health Record of Catalonia (HC3)
Ambulatory Electronic Prescription (SIRE) Digital Imaging Archive (SIMDCAT)
Care Process Management (IS3)
Primary Care
EMR N=1
(98%)
Hospital
Information
System (HIS)
N=29
Intermediate
care EMRs
Community
Mental
Health
2009
2017
2007
1980
/90s
2014

9. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
2020
2018
2014
2009
2007
2006
Electronic Prescribing
(SIRE)
416 M of prescriptions
37,000 health care professionals as users
1,346 M dispensing of medicines
Personal Health Portal (LMS)
> 5.4 M citizens
National Patient Index
(RCA)
7,697,069 people (2021)
+ 43,224 previous year
2000
late 80s
early 90s
Care Process
Management (IS3)
> 15,6 M referrals
Central PACS System (SIMDCAT)
> 5,000 M images
Remote
Consultations
> 12 M
Primary care
EMR (1 product)
Hospitals
intermediate care
EMRs (29 products)
Social care
records systems
Shared Electronic
Health Record (HC3)
> 1,000 M documents
> 70% structured
information
Health care platforms in Catalonia

10. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Limitations of the current
information systems model
Broad ecosystem of
applications with buried
business logic and data models.
Old-fashioned
solutions and a dramatic
increase in technical debt.
Communication
between service providers and
the NHS through static and
incoherent interoperability
solutions.
High costs for maintenance,
corrective and evolutionary
development.
Difficulties to scale-up
innovations and best practices.
Rigid model that does not
foster adaptation to change.

11. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
OBJECTIVES

12. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Catching up the time:
Digital Health Strategy for Catalonia
https://bit.ly/3fXoMlg https://bit.ly/3WNwGhH

13. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Master Plan Goals
• Consolidate a person-centred model of
information systems that enables clinical
and managerial decision-making across
the care cycle.
• Establish a governance model of
information systems with a solid
community support while ensuring care
continuity.
• Set out a financing framework to ensure
implementation and sustainability over
time.
• Create environments and
opportunities to design
and implement
innovative person-
centred ICT-based care
services.
• Set out an ambitious
roadmap, yet realistic,
which will allow a long-
lasting, successful and safe
implementation of the
new model.

14. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Digital Health Strategy for Catalonia

15. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
A unique Electronic Health Record
The longitudinal Electronic Health Record (HES) is the main piece of the
SISCAT Information Systems Master Plan and represents the functional
and technical repository of all the information of the citizen that must
be registered and shared throughout the health system.
It is not just, or mainly, a technological update, but a model for data
management and an architecture of information systems that
corresponds to and anticipates the changes that are taking place in
the healthcare model in:
• citizen's relations with the healthcare system
• work processes
• relations between the professionals themselves
Mechanisms are also envisaged to intensify collaboration between the
different actors in the healthcare system, to define semantic and
technical standards and to share and take advantage of technological
innovation.

16. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
▣ We will decouple data from applications, storing data in an
open format
▣ This will enable data to follow the patient
▣ This will foster better integration and collaboration
▣ It will help scaling-up innovations
▣ We believe the key point is establishing a strong data
governance involving clinicians and industry
Our view for an open future

17. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The Catalonian Digital Health Platform:
future view

18. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
COMPONENTS OF THE TENDER

19. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
▣ The tender is aimed to procure a service of the type data as a service (DaaS), considering that the will of the
tenderer is to have a supplier that offers the end-to-end service. This ranges from the provision of a data
repository service based on the openEHR standard, the management of this same service and all the necessary
architecture and technology infrastructure to be able to provide and ensure all the associated services that are
required in a transactional system.
▣ The purpose of this service is to cover the systematic collection of clinical knowledge from the patients treated by
the Catalan Health Service (CatSalut), in accordance with the openEHR standard, and to persist the clinical data of
all patients treated by the Catalan health system, using an emerging international and widely used standard in
other health and hospital systems, both for primary and secondary usage of the data.
□ Article: The new electronic health record of Catalonia will be built with the open standard of international
reference openEHR.
▣ DaaS: Data as a Service (DaaS) is a data management strategy that use the cloud to deliver data storage, integration,
processing and/or analytics services via a network connection as a business asset to achieve greater business agility. It is
part of the "as a Service“ offerings that have become increasingly popular with the rise of cloud computing services,
which began with the introduction of Software as a Service (SaaS). Like other "as-a-service" models, DaaS provides a way
to manage the massive amounts of data that organizations generate every day, delivering that valuable information
across the enterprise as critical decision support based on data. DaaS builds on the concept that its data product can be
provided to the user on demand
Tender objective

20. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
RFP Structure
Repository
Management
Services
Repository
Services
Knowledge
Transfer
Governance
Model
Implementation & Service
delivery Calendar
SLAs
Innovation
projects (2)
Service Delivery
Conditions
CDR
Federation
Patient Resume
Support for the openEHR
archetype deployment process
openEHR technical design support
Adequacy assessment of the
openEHR standard
…
openEHR repository service
Other standards interoperability
service
Data analytics extraction service

21. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Manage and operate the hardware and software platform to offer the services in the CatSalut private cloud (ch.3.1)
▣ openEHR repository and document: storage, insert, updating, access and custody of data and documents of the
Electronic Clinical History based on the openEHR standard.
▣ Interoperability: mapping of openEHR EHR information to respond to openEHR, FHIR and HL7 standard requests.
▣ Extraction and replication: extraction and transformation into flat files of information from the openEHR EHR and
provision of a replica “read only” from the repository.
▣ The tender structure the Repository Services in:
□ openEHR repository services (ch.3.1.1)
□ Interoperability services of other standards (ch.3.1.2)
□ Extraction and replication service for data analytics (ch.3.1.3)
Repository Services (1)

22. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
▣ openEHR repository services (ch.3.1.1)
□ Servicing API openEHR std including indexing services and document repository according to IHE/XDS std
□ Access to external services: demography and terminology
□ Access control based on the interpretation of JWT tokens
□ Audit and monitoring
□ Massive insertion capabilities
□ Supporting tools for Repository Management Services (ch.3,2)
▣ Interoperability services of other standards (ch.3.1.2)
□ Manage and operate mappings to openEHR repository to service HL7 and FHIR requests developed
through the Repository Management Services (ch.3.2)
▣ Extraction and replication service for data analytics (ch.3.1.3)
□ Management and operation of the extractions to flat files and the resulting repository according to the
definitions of the extraction management service
□ Provision of a read-only replica of the openEHR elements, with near-real-time data update frequency with
a best effort level of service
Repository Services (2)

23. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Define an operational model, provide expert human resources and support tools for the development of the
following services (ch.3.2):
Repository Management Services (1)
Related to the openEHR repository:
▣ Technical support to the deployment of openEHR
archetypes.
▣ Validation of the openEHR standard compliance
▣ Maintenance of the openEHR Reference Model
▣ Management of access security definitions
Related to interoperability services:
▣ Interoperability services management.
Related to data extraction and replication for
analytics:
▣ Information availability for the extraction.
▣ Preparation of extractions.
▣ Extraction operation.
Related to repository services operations:
▣ Analysis and support in front of design
incidents.
▣ Support for the development teams and the
massive data integration projects.

24. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The tender structures the Repository Management Services in:
▣ Support to the openEHR archetypes deployment process (ch.3.2.1)
□ Validation of designed archetypes and impact analysis
□ Change Management
▣ openEHR technical design support (ch.3.2.2)
□ Servicing inquiries about the technical implementation of the repository
▣ Validation of the adaptation to openEHR std and improvement proposals (ch.3.2.3)
□ Propose changes to archetype design structures to improve performance, security,… (at least twice a year)
□ Change management
▣ Maintenance of the Reference Model and integrations with external services (ch.3.2.4)
▣ Interoperability management (ch.3.2.5)
□ Servicing mapping requests
□ Managing the approval and the design, deployment and maintenance
Repository Management Services (2)

25. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
▣ Information availability for extraction inquiries (ch.3.2.6)
□ Servicing inquiries about the availability of information for its extraction through a catalog tool
▣ Data extraction management (ch.3.2.7)
□ Servicing data extraction requests end to end
▣ Extraction and read-only replica operation (ch.3.2.8)
□ Manage the extractions in operation and monitor the usage
□ Ensure the availability of the read-only replica
▣ Support to design problems (ch.3.2.9)
□ Manage incidents originating from the design of the knowledge model and develop design improvement
proposals
▣ Support to development teams and massive insertion projects (ch.3.2.10)
□ Servicing knowledge platform and inquiries about the use of structures and services
□ Support the preparation of bulk data ingestion projects
▣ Change management (3.2.11)
□ Training and change management activities that facilitate the adoption of the services and their evolution
Repository Management Services (3)

26. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The tender includes the requirement to design two innovation projects to be developed during the contract period
(ch.3.3)
▣ Federation/synchronization project
The objective of the synchronization federation project is to respond to the synchronization use case raised in
the section "2.3.9 System Synchronization" of the document "EHR Extract Information Model"
▣ Optimized access to the patient clinical situation summary
The preparation of the initial screen of the patient's clinical situation causes a high consumption of resources
from the repository, due to the way in which clinical information is currently stored. With this innovation
project, it is intended to optimize this consumption of resources to obtain this information in the minimum
possible access, ideally one access, through the creation of new structures in the repository and processes that
allow this optimized query
Innovation projects

27. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The repository services must be offered through a platform (hw and sw) collocated in a Data Process Centre following
specific requirements for critical services (ch.4)
▣ The collocated platform will consume specific infrastructure services from DPC
▣ The platform must include networking (routing, balancing,…) elements and communication lines between main
and backup DPC. IP addressing, external connectivity and DNS will be provided by DPC (ch.4.1.1, 4.1.2, 4.1.3, 4.1.4,
4.1.5)
▣ The architecture will have High Availability between two DPC including the platform all hw, sw, networking and
communications elements in both DPC
▣ The tender includes the architecture requirements (ch.4.1.7) being required a specific architecture design of the
solution proposed (ch.4.1.8)
▣ The installation, configuration and post-implementation activities must include (ch.4.2)
□ Technical design coordinated with CTTI team
□ Installation, configuration and validation of the components
□ Installation documentation, CMDB population and maintenance, operation documentation
□ Post-implementation support (patches, capacity planning, performance management, disaster recovery
testing,…)
Technical requirements

28. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The calendar of the implementation will be phased with specified milestones (ch.5)
▣ Contract length. The initial contract will be thirty (30) months length with a possibility of extending it up to a
maximum of additional twenty-four (24) months. Maximum total: fifty-four (54) months.
▣ Calendar milestones:
Calendar
Month 6
Repository service and active repository
management services in the PRO
environment (second payment
milestone)
Month 0
Contract signed. Bidder has access to
CatSalut/CTTI installations
Month 3
Environment that allows the validation of the platform by the
operation committee (first payment milestone)
Month 12
Offer high availability (third payment milestone)
To the end of the contract
Services governed through SLAs and
Comittees

29. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The continuous transfer of knowledge is part of the services requested. Additionally, in the event of termination of the
contract the continuity of the operations must be assured (ch.6)
▣ A detailed plan for the transfer of knowledge must be defined including specific and formal training for the
personnel to be in charge of the operations
▣ The documentation of the solutions and the management procedures must be up-to-date and accessible
Knowledge Transfer

30. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The governance model aims to efficiently and effectively manage the available IT resources, in order to
guarantee the best service to the strategic, security and operational needs of the involved departments and
entities (ch.7)
▣ Specifically, this model aims to achieve the following main strategic objectives:
□ Quality: Guarantee quality in the provision of services and user satisfaction, according to the needs of the
different departments and entities of the Catalan Government.
□ Efficiency: Optimizing the use of resources thanks to the search for efficiencies, synergies and
optimization
□ Innovation: Transform and innovate in the administration according to the transversal IT strategy of the
Catalan Government and each of the departments and entities.
□ Knowledge: Generating knowledge from information managed with IT, to respond to the needs and
decision-making in the field of business of departments and entities.
▣ The governance is structured in three management committees (executive operational and Security) to ensure
compliance with the requirements of the conditions of service execution and execute the mechanisms to adjust
these conditions in accordance with the evolution of service needs (ch.7.3)
Governance Model

31. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The tender define the service execution characteristics regarding (ch.8.1):
Service Execution Conditions (1)
▣ Product support
▣ Communications model
▣ External connectivity
▣ Addressing
▣ DNS
▣ Traffic routing
▣ Network services
▣ DevOps
▣ Operations automation
▣ Criticality
▣ Traceability, visibility and monitoring
▣ Infrastructure monitoring
▣ Logs and tracing
▣ Services end to end monitoring
▣ Corporate observability
▣ Auxiliary systems
Also, includes the responsibility for controlling and ensuring that the services are available, accessible, maintained,
updated, informed and governed, and that they meet the expectations following the processes defined within the
Service Governance (ch.8.2)

32. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
Service Execution Conditions (2)
Additional services executions conditions of the tender:
▣ Control center (ch.8.3)
▣ Corporate/Enterprise Architecture Governance (ch.8.4)
▣ Security governance during the service (ch.8.5)
▣ Procurement Governance (ch.8.6)
▣ Accessibility of websites and applications from mobile
devices in the public sector (ch.8.7)
▣ Organizational structure and service team (ch.8.8)
▣ Calendar and service schedules (ch.8.9)
▣ Physical location and necessary resources (ch.8.10)
▣ Coordination with other teams (ch.8.11)
▣ Methodology, standards and deliverables (ch.8.12)
▣ Data governance (ch.8.13)
▣ Tools and licenses (ch.8.14)
▣ Continuity of service (ch.8.15)
▣ Change management (ch.8.16)
▣ Assurance and quality control and continuous
improvement (ch.8.17)
▣ Audits (ch.8.18)
▣ Guarantee (ch.8.19)
▣ Environmental regulations (ch.8.20)

33. "This document is strictly informative. It does not supplement or amend the tender which can be found at https://bit.ly/3WRlb9d Any query or request for additional information about the tender must be addressed to
consultalicitacio.ctti@gencat.cat in accordance with the public tender process”
The objective of the SLAs is to define the indicators and levels of service required, and establishes an objective and
measurable basis that reflects the commitment between the service provided by the successful bidder and CTTI to
ensure a required satisfactorily level is provided (ch.9)
▣ Have been established fourteen (14) SLAs related to the repository services (HESCDR-01 to HESCDR-14) and eight
(8) related to the security (SEG-01 ).
SLAs
Code Name
HESCDR-01 Maximum time for resolving incidents
HESCDR-02 Delay of agreed milestones of the calendar
HESCDR-03 Number of iterations to accept a deliverable
HESCDR-04 Deliver of technological obsolescence plan
HESCDR-05 Errors detected in the CTTI CMDD
HESCDR-06 Source code properly guarded
HESCDR-07 Architecture document correctly updated
HESCDR-08
Application with construction automation
implemented
… …
Code Name
SEG-01 Availability of cybersecurity tracking deliverables
SEG-02
Time of first response to an action in case of an incident, threat or
attack
SEG-03 Time of first containment to an incident, threat or attack
SEG-04
Response time for each of the requests for security information in
the event of an incident or threat
SEG-05
Correction of critical or high vulnerabilities of equipment
infrastructure: Level Security Infrastructures
SEG-06
Correction of infrastructure vulnerabilities of equipment with
active threat identified by the Agency: Infrastructure Security Level
SEG-07 Execution of backup recovery tests
SEG-08 Execution of disaster recovery tests in critical systems (SIC)