From Policy to Practice: Implementing PROMs with openEHR in Switzerland

Switzerland has reached a milestone with its first productive deployment of openEHR. In a national pilot commissioned by the Eidgenössische Qualitätskommission (EQK), patient-reported outcome measures are now being collected, stored and used in routine clinical practice, with openEHR serving as the foundational standard and patient-reported outcomes at the centre of care.

National Quality Policy driving PROMs in Switzerland

Worldwide, Patient Reported Outcome Measures (PROMs) are increasingly recognised as a cornerstone of value-based, patient-centred healthcare. In Switzerland, this development is being actively shaped at national level by the Eidgenössische Qualitätskommission (EQK), an extra-parliamentary commission that advises the Federal Council on quality development within the framework of the Swiss Health Insurance Act.

The EQK’s mandate goes beyond strategy and recommendations. It commissions concrete programmes and pilot projects to translate national quality policy into operational, real-world practice.

The PROMs Pilot Project: scope and ambition

One of the EQK’s initiatives is its national pilot project for the implementation of PROMs, running from April 2025 to December 2027. Building on insights from earlier feasibility work, this project deliberately focuses implementation under routine conditions. Its core ambition is to generate practical experience in data collection, analysis, presentation and, most importantly, in the meaningful use of PROMs by patients, healthcare professionals and for system-level quality steering.

PROMs are explicitly positioned not as an administrative reporting exercise, but as instruments that deliver tangible value within clinical workflows and patient–clinician interactions.

Cross-Sectoral PROMs across the care continuum

The project aims to harmonise PROMs across care settings in Switzerland and to avoid fragmented or duplicate data collection. Validated, internationally established instruments are used and made available in multiple languages, reflecting the multilingual reality of Swiss healthcare.

Patients receive structured feedback on their own outcomes, while clinicians and institutions can use aggregated results to support shared decision-making, continuous quality improvement and system governance.

Following a national procurement process, the EQK awarded the project to a consortium comprising healthbrain GmbH, Clinical Trial Unit Hirslanden, Hirslanden AG, Patientenstelle Zürich, CSS Health Insurance, Amazon Web Services (AWS) and Intonate GmbH. This consortium combines clinical expertise, methodological and trial know-how, patient representation and digital health engineering, providing a strong foundation for both scientific rigour and practical applicability.

openEHR as the backbone of the technical solution

A central architectural decision of the project was the consistent use of open, vendor-neutral standards. The technical platform is provided by healthbrain and is based on a full openEHR Clinical Data Repository.

PROM data are persisted natively as structured openEHR compositions rather than as application-specific payloads. This approach ensures semantic interoperability, long-term reusability of data and independence from individual software products, which is particularly important for national quality initiatives with a long-term perspective.

Modelling Patient-Reported Instruments

Within the project, PROM and PREM instruments such as EQ-5D-5L, HOOS-12, KOOS-12 and NORPEQ were carefully modelled using openEHR archetypes and templates. Special attention was paid to the faithful representation of original questionnaires, explicit modelling of scores, and robust multilingual support tailored to the Swiss context.

The modelling work aligns with emerging international best practices and ongoing discussions within the openEHR community on how patient-reported questionnaires should be represented. This demonstrates that openEHR is well suited not only for classical clinical observations but also for complex, methodologically demanding patient-reported outcome data.

From Pilot to Production

Since November 2025, the solution has been running in a productive environment. Patients are actively onboarded, PROMs are distributed automatically according to configurable clinical workflows, and responses are collected and stored in the openEHR Clinical Data Repository as part of routine care. Clinicians and patients are already using the results in everyday practice.

To our knowledge, this represents the first productive deployment of openEHR in Switzerland. It marks a clear milestone in the Swiss digital health landscape, showing that openEHR has moved beyond pilots and proofs of concept and is now capable of supporting national, patient-facing use cases under real-world conditions.

Looking ahead

For the Swiss healthcare system, this project illustrates how national quality policy, patient-centred outcome measurement and interoperable digital infrastructure can be combined in a pragmatic and sustainable way.

For the international openEHR community, it provides a concrete real-world example of how open standards can bridge policy objectives and clinical practice while enabling scalable digital innovation.

EQK project:

Healthbrain:

https://healthbrain.online/

Hirslanden:

https://www.hirslanden.ch/en/corporate/home.html

Jean-Pierre Messerli is a physician and medical informatics specialist with a long-standing focus on medical-grade information systems and practice operations. He has held senior roles across software development, management, consulting, and project leadership, and has led 152 implementations of electronic health records for medical practices and centres.