Diversity in digital health.
Clinicians and patients are better served by a market with more than one kind of vendor in it. This is NORHI’s position on why that diversity matters, how it gets lost, and why interoperability is what keeps it possible.
Local shops and supermarket chains.
Every town needs both. Neither replaces the other, and a town that has only one of them is poorer for it.
The supermarket chain
Scale, consistency, and a supply chain a corner store cannot match. One relationship for everything, and a familiar name on the purchase order. Large platforms bring the same to digital health: broad integration, national reach, and the comfort of procurement familiarity.
The local shop
The product the chain would never stock, an owner who knows what the neighbourhood actually needs, and the willingness to try something first. Smaller vendors bring the same: specialisation, speed, and the ideas that have not been tried yet — a tool built for one specialty, a system that runs where connectivity does not, a record designed around one community’s governance rather than a national default.
A market with only one category is anticompetitive twice over. Financially, because a single kind of supplier sets the price and the terms. Creatively, because a single kind of supplier decides what gets built — and the ideas that come from the edge of a system, from the clinic that is nothing like the average, stop arriving.
Digital health is that market with higher stakes. A health system served by only one kind of vendor pays more, gets less, and loses the ability to choose the product that fits over the one that was easiest to procure.
Moats that are built, not earned.
Some advantages are earned: a better product, a lower price, a track record. Others are built — mechanisms that keep a market closed regardless of merit. In digital health the most common are procurement vehicles that only the incumbent qualifies for, certification programmes whose cost and timeline only a well-funded vendor can absorb, and proprietary formats and interfaces that make leaving a system more expensive than staying with it.
Vendor-of-record arrangements and prequalified supplier lists are the clearest example. They exist for sound reasons: a health authority cannot re-evaluate every vendor for every purchase. But when the list becomes the only door, it stops measuring merit and starts measuring who was already inside. The effect is a market that favours the entrenched and the heavily funded over the better-suited — and a clinician who ends up with whatever was simplest to buy.
None of this requires bad intent. Moats accumulate by default, one reasonable decision at a time. Keeping a market open takes deliberate choices from buyers, from regulators, and from vendors — including us. Canada’s Competition Bureau says as much to public buyers in its guide to unlocking competition in public procurement: avoid unnecessarily restrictive requirements, review qualification criteria so they do not exclude capable suppliers, avoid contract terms that make switching hard, and structure tenders so smaller suppliers can bid.
Not every preference is a moat
A fair reader will raise Indigenous procurement. NORHI is a CCIB-certified Indigenous-owned business, and Canada’s federal government requires that a minimum of 5% of the value of its contracts go to Indigenous businesses, with set-asides considered where the people served are mostly Indigenous. That is an advantage created by policy, and we benefit from it. We think the distinction holds anyway, and it is worth being precise about why.
The test is not whether a rule created the advantage — every procurement rule advantages someone — but which way it moves the market. A moat narrows the field to whoever is already inside, and it hardens the longer it stands. Indigenous procurement widens the field: it brings suppliers into a market that had largely left them out, adds a category of vendor that was not there before, and reserves a share of public buying for them without fencing the rest of the market off from anyone. Certification here is a key to an additional door, not a gate across the only one.
That is the diversity argument again, applied to policy. A supply ecosystem with more kinds of supplier in it is more resilient and more inventive than one with fewer, and a measure that adds a kind is the opposite of one that removes them. We would apply the same test to any preference, including the ones we benefit from: does it add suppliers to the market, or subtract them? How we work within that framework is on our Indigenous procurement page.
Interoperability is what makes diversity possible.
A supermarket and a corner store can coexist because a customer can shop at both in the same afternoon. Digital health has no such freedom unless the systems talk to each other.
Interoperability — the ability to move records, notes, and workflows between systems without a rebuild — is the condition that lets a clinic add a specialised tool without abandoning its platform, lets a small vendor compete for one part of the workflow instead of all of it, and lets a buyer leave when a product stops serving them. Where it is absent, every purchase becomes a lifetime commitment and the market narrows to whoever is already installed.
It is also the honest test of a vendor’s intentions. A company that expects to win on merit has every reason to make its product easy to add and easy to leave. A company that expects to win on lock-in has every reason not to.
How NORHI builds for it
Alongside, not instead of
NORHI Scribe and NUAMP run alongside the EMR you use today. The finished note goes into your system of record; nothing about using them requires replacing it.
The record is your choice
NUCP becomes your system of record only when you add it, and migration support is included when you do. Until then, the record stays where it is.
Built on open components
Our systems incorporate open-source software and openly licensed AI models, disclosed in our Open-Source Notices — the same open foundations that let any vendor, large or small, build a complete stack.
A perimeter you define
Customer-defined sovereign AI: on-premises and airgap-capable, deployed inside a boundary you set rather than one we set for you.
We would rather win a fair evaluation than own a closed one.
NORHI is the local shop in this analogy, and we intend to remain one the supermarket has to compete with. We compete on the product and on the price, and our pricing is published. We will not seek to entrench ourselves through exclusive procurement vehicles, certification gatekeeping, or rules that raise the cost of entry for others — a market we want to be in should stay open to the vendor that comes after us.
We hold the same view of the market as a whole. Health systems are better served when the large and the small both have a door to walk through, and when the buyer — not the vendor — decides which one to use.
Running a competitive evaluation?
We answer procurement questionnaires, pilot alongside your current EMR, and our pricing is already public. If you are comparing vendors, we would like to be one of them.