Every department, every role, every data flow — from patient entry to GST filing, ABHA claims, and payroll.
The hospital is one connected system. A single patient visit touches 8–12 departments. The MRN (Medical Record Number) is the common key that ties everything together. Every department screen shows the same patient, just from their own angle.
Pharmacy is a shop inside the hospital. It buys medicines (Purchase), stores them (Inventory), sells them (Dispensing), and must file GST returns just like any business. The GST reports (GSTR-1 and GSTR-3B) come directly from pharmacy sales data.
Pharmacy places Purchase Order (PO) to medicine
supplier/distributor:
→ Select medicines needed (system shows low-stock alerts
automatically)
→ PO approved by pharmacy in-charge or purchase committee
→ Supplier delivers with invoice + batch details
→ GRN (Goods Receipt Note) created: batch
number, expiry date, quantity, purchase price
→ Stock added to inventory.
GSTIN of supplier recorded — this is needed for
Input Tax Credit (ITC)
Each medicine tracked by
batch number + expiry date (FEFO — First Expiry
First Out):
→ System auto-alerts when stock falls below reorder level
→ System auto-alerts for medicines expiring within 60/30/15
days
→ Cold chain medicines tracked separately
(temperature-sensitive vaccines, insulin etc.)
→ Monthly stock audit: physical count vs system count →
discrepancies investigated
Patient brings prescription (or pharmacist sees it on screen by
MRN):
→ Pharmacist scans or enters MRN → prescription appears on
screen
→ System checks stock availability for each medicine
→ Pharmacist selects batch (system suggests earliest expiry
batch first)
→ Substitution alert: if generic available,
show option (with doctor's approval flag)
→ Bill generated → stock deducted →
GST calculated per medicine HSN code
For admitted patients, medicines dispensed to ward:
→ Doctor writes medication order in Treatment Chart
→ Pharmacy receives
ward indent automatically
→ Pharmacist prepares and sends to ward with
indent slip
→ Nurse receives, records in
MAR (Medication Administration Record)
→ Each dispensing auto-adds to patient's running IPD bill
→ Controlled drugs (narcotics/psychotropics)
require special register + dual signature
When IPD patient is discharged — unused medicines returned to
pharmacy:
→ Ward nurse returns medicines with return slip
→ Pharmacist verifies and accepts (only unopened, unexpired
medicines accepted)
→ Stock added back. Credit note issued →
deducted from patient's final bill
→ GST adjustment done via credit note (reflected in GSTR-1 as
negative sale)
→ Expired medicines separately written off →
destruction record maintained
Hospital pharmacy is GST-registered as a business. Medicines have different GST rates (0%, 5%, 12%, 18%). The software must track GST on every sale and purchase, and auto-generate GSTR-1 and GSTR-3B reports for filing.
| Medicine Category | GST Rate | Example | HSN Code Range |
|---|---|---|---|
| Life-saving drugs, vaccines | 0% (Exempt) | Insulin, certain vaccines, blood products | 3002, 3006 |
| Medicines notified at 5% | 5% | Ayurvedic, common OTC drugs, some branded | 3003, 3004 |
| Medicines at 12% | 12% | Most finished pharmaceutical products | 3004 |
| Medical devices / consumables | 12% / 18% | Syringes, gloves, IV sets, implants | 9018, 9021 |
| Surgical instruments | 12% | Scalpels, forceps, sutures | 9018 |
| Hospital services (OPD/IPD) | Exempt | Consultation, nursing charges, bed charges | N/A |
GSTR-1 captures every medicine/consumable sale made by the pharmacy. The software auto-generates this from daily sales transactions.
GSTR-3B is a monthly self-declaration summary. The software computes all figures automatically from pharmacy sales + purchases.
When pharmacist bills a medicine: system looks up medicine master → finds HSN code + GST rate → calculates CGST/SGST or IGST → saves to sale_gst_details table → adds to running GST ledger
System aggregates all sales of the month → groups by HSN → separates B2B and B2C → includes credit notes → exports as JSON file (GST portal format) or Excel ready to upload to GST portal (www.gst.gov.in)
System calculates: total output GST (from sales) − total ITC (from purchase invoices where supplier GSTIN was captured) = net GST payable. Shows breakup in 3B format. Accountant reviews, makes payment via GST portal, then files 3B.
| Field | Why Needed | Example |
|---|---|---|
| HSN Code | Required in every GST invoice and GSTR-1 Table 12 | 30049099 (general pharma) |
| GST Rate | To calculate CGST/SGST/IGST on each sale | 12% → 6% CGST + 6% SGST |
| Supplier GSTIN | To claim ITC on purchases — mandatory | 27AABCU9603R1ZX |
| Purchase Invoice No | GSTR-2A reconciliation with supplier's GSTR-1 | SUP/2026/001234 |
| Batch Number | For drug regulatory compliance + recall tracking | BT2026031 |
| MRP | Cannot sell above MRP — legal requirement | ₹250.00 |
| Schedule H/H1/X | Prescription-only drugs tracking + narcotics register | Schedule H = prescription only |
Laboratory is triggered by a doctor's order. The doctor orders a test in OPD or IPD → Lab receives the order on their screen → collects sample → runs test → enters result → report auto-generated → doctor notified. Patient never needs to explain why they're there — the order says everything.
Doctor selects tests from
Lab Test Catalog (CBC, LFT, KFT, Thyroid
Profile, HbA1c, Culture & Sensitivity, Urine Routine etc.)
Order saved → Lab Work Order created with MRN,
ordering doctor, ward/OPD, priority (ROUTINE / URGENT / STAT)
STAT = results within 1–2 hours (for emergency
or critical IPD patients)
Lab technician or phlebotomist goes to patient (IPD) or patient
comes to collection counter (OPD):
→ Scans patient wristband or enters MRN → order appears on
tablet/screen
→ Collects correct tube type (Red cap = serum, Purple cap = CBC,
Green cap = plasma etc.)
→ Labels tubes with barcode (auto-generated by
system — prevents mix-up)
→ Marks "Sample Collected" with timestamp → system updates order
status
→ For urine/stool: gives labelled container, patient collects
themselves
Barcoded tubes scanned into analyser machines:
→ Auto-analysers (Haematology, Biochemistry,
Immunology) send results directly to LIS (Lab Information
System) via interface
→ For manual tests (culture, histopathology, smear): tech enters
results manually
→ Delta check: system compares today's result
with patient's previous result — flags if abnormal change
detected
Before any report is released:
→ Senior lab tech or pathologist reviews results on screen
→ Critical value alert: if Potassium > 6.5,
Glucose < 50, Haemoglobin < 5 etc. → system marks as CRITICAL →
phone call made to doctor immediately (documented in system)
→ Pathologist digitally signs and validates the
report
→ Report status changes from "Pending" → "Verified" → "Released"
Report available via multiple channels:
→ Doctor's screen: instant notification when
report released — doctor sees result in OPD/IPD screen
→ Print: patient collects printed report at lab
counter
→ WhatsApp/SMS/Email: PDF sent to patient's
registered mobile
→ Patient portal: downloadable from hospital
app/website
→ ABHA: if linked, report pushed to patient's
ABHA health locker
Charges auto-added to patient's OPD bill or IPD running bill.
Radiology handles all imaging — X-Ray, Ultrasound (USG), CT Scan, MRI, Mammography, Fluoroscopy, Echo. Doctor orders imaging → Radiology schedules and performs → Radiologist reports → Report delivered to doctor and patient. Images stored in PACS (Picture Archiving and Communication System).
Doctor selects investigation (X-Ray Chest PA, USG Abdomen, HRCT
Chest, MRI Brain with contrast etc.)
→ Order sent to Radiology worklist automatically
→ Clinical indication mandatory (e.g., "cough 3
months" for chest X-ray) — needed for radiologist's report
→ For contrast studies: allergies and creatinine level checked
automatically from EMR
→ Pregnancy check alert for female patients
below 50 (X-ray/CT involve radiation)
For simple X-ray/USG: patient walks in, no appointment needed
For CT/MRI: appointment scheduled (machine availability +
preparation needs)
→ Preparation instructions sent via SMS (fasting for USG
abdomen, no metal for MRI etc.)
→ MRI safety screening: pacemaker, metal
implants, claustrophobia check — documented in system
→ Radiology receptionist marks patient as "Arrived" on worklist
Radiographer/technician performs imaging:
→ Patient positioned, image taken
→ DICOM images automatically sent to
PACS server from modality (X-Ray machine, CT,
MRI)
→ Images tagged with patient MRN (worklist pre-loaded via
RIS-PACS interface)
→ No mis-tagging: patient MRN from order →
confirmed on machine → image sent to PACS
→ Technician marks "Images Acquired" on system
Radiologist opens PACS viewer on their workstation (or
remote/teleradiology):
→ Sees patient history and clinical indication alongside
images
→ Dictates report (voice recognition software
types it) or types directly
→ Report structured: Technique → Findings → Impression →
Recommendation
→ Radiologist digitally signs report → status changes to
"Reported"
→ Urgent/critical findings (pneumothorax,
aortic aneurysm etc.) → immediate phone call to referring doctor
+ documented
→ Doctor notified on their screen — can view report AND images
from OPD/IPD station via PACS viewer
→ Patient gets printed report + CD/DVD with DICOM images (or
soft copy QR link)
→ Images archived in PACS for
5–10 years (medicolegal requirement)
→ Previous imaging available for comparison automatically when
same patient returns
→ ABHA-linked patients: report + images pushed to ABHA health
locker
Blood Bank is the most critically regulated department. Every unit of blood must be fully traceable — from donor to recipient. A single transfusion error can be fatal. The software must enforce every safety check and maintain complete chain-of-custody records mandated by the Drug Controller General of India (DCGI).
→ Donor registration: Name, Age, Address, Blood Group, previous
donations
→ Donor screening: Weight, Hb, BP, pulse —
system enforces eligibility (Hb ≥ 12.5g, Weight ≥ 45 kg, BP
normal, no donation in last 90 days)
→ Medical history questionnaire: HIV risk,
jaundice, malaria, tattoo, travel history
→ Donation done → unit labelled with
unique Donation ID (barcode)
→ Donor certificate auto-generated + refreshment coupon issued
Every donated unit must be tested before use —
mandatory by law (Drugs & Cosmetics Act):
→ HIV (ELISA + NAT) →
Hepatitis B (HBsAg) →
Hepatitis C (Anti-HCV) →
Syphilis (VDRL) → Malaria (MP
antigen)
→ ABO & Rh typing of donor unit (confirmed
twice)
→ Results entered in system → Reactive unit:
quarantined, destroyed, donor notified confidentially
→ Non-reactive unit: label updated to "Safe" →
moved to approved inventory
One whole blood unit is processed into components (maximizes
utility):
→ PRBC (Packed Red Blood Cells) — for anaemia,
surgery bleeding
→ FFP (Fresh Frozen Plasma) — for clotting
disorders
→ Platelets (Random Donor Platelet / Single
Donor Platelet) — for dengue, chemo patients
→ Cryoprecipitate — for haemophilia
Each component gets its own barcode label + expiry date. Stored
at specific temperatures (PRBC at 2–6°C, FFP at −18°C, Platelets
at 22°C with agitation).
Doctor/nurse sends blood request from patient's IPD screen:
→ Request includes: Patient MRN, blood group,
component needed, quantity, urgency (ROUTINE/URGENT/EMERGENCY),
clinical indication
→ Blood Bank receives request → system checks patient's blood
group in EMR
→
Maximum Surgical Blood Order Schedule (MSBOS):
system suggests how many units typically needed for that surgery
type
This is where transfusion errors are prevented:
→ Blood Bank receives patient's blood sample (fresh sample —
collected within 72 hours)
→ Technician performs
ABO/Rh typing of patient (re-confirmed, not
just from record)
→ Cross-match test: patient's serum + donor's
red cells → if no reaction → COMPATIBLE
→ System records: which unit was cross-matched against which
patient
→ Incompatible result: unit rejected, new unit
selected, re-tested
→ Compatible unit: cross-match tag issued, unit reserved for
patient for 24 hrs
→ Blood Bank issues unit with Issue Slip to
ward/OT
→ Nurse receives: performs
bedside verification (patient name + blood
group on label vs wristband — checked by TWO nurses)
→ Transfusion started → Transfusion record in
system: start time, end time, vitals during transfusion, any
reactions
→ Transfusion reaction: if
fever/chills/urticaria → stop transfusion → report to Blood Bank
+ doctor → investigation
→ Completed: "Transfused" status in system.
Full traceability: donor→ unit → patient
MHRD (Medical Records Department) is the hospital's memory. Every patient file, every discharge summary, every death certificate is stored and managed here. For digital HMIS, MHRD is the EMR management team — they ensure records are complete, coded, and retrievable. They also handle medicolegal cases.
After IPD patient is discharged:
→ MHRD staff receives notification → opens patient's digital
record
→ Checks for completeness: Is discharge summary
signed? Are nursing notes complete? Lab reports attached?
Consent forms scanned?
→ Incomplete record alert: sent to treating
doctor to complete within 24 hours (NABH standard)
→ Once complete → record "Locked" (no further
edits without medical superintendent approval)
Every discharge diagnosis must be coded using
ICD-10-CM (International Classification of
Diseases):
→ Coder reads discharge summary → assigns ICD codes for
principal diagnosis + co-morbidities
→ Procedure coding: ICD-10-PCS or
CPT codes for insurance claims
→ Software has ICD-10 lookup with search → coder selects → code
linked to episode
→ Why this matters: insurance reimbursement
(TPA), government schemes (Ayushman Bharat), epidemiology data,
hospital performance reports
When patient comes due to accident, assault, rape, suspicious
death:
→ Case tagged as MLC at registration
→ Police intimation mandatory (system generates MLC
form/report)
→ Special documentation: Injury description, time of
examination, clothing condition, seizure of exhibits
→ Record cannot be shared without court order
(access restricted in system)
→ Forensic reports, death certificate, post-mortem referral
tracked
When a patient dies in hospital:
→ Doctor records death in system with
Cause of Death (ICD coded)
→ Death Summary generated (required for
burial/cremation permission)
→ Death Certificate issued — linked to Aadhaar,
ABHA, Civil Registration System
→ For medico-legal deaths: police intimation +
post-mortem referral auto-triggered
→ Maternal/Neonatal deaths flagged separately
for CMO/government reporting
Patients / lawyers / insurance / other hospitals may request
records:
→ Request registered in system with purpose and requester
details
→ Patient/guardian consent mandatory before
release
→ Records released only as
certified copies (not originals) — watermarked,
stamped
→ All releases logged: who requested, what was provided, when,
authorised by whom
→ Third party requests (insurance, court):
formal letter + processing fee required
HRMS manages all hospital staff — from doctor to housekeeping. Attendance, shifts, leave, payroll, PF, ESI, TDS — all automated. In a hospital, wrong shift management = patient safety risk, so this module is directly linked to operations.
When a new staff member joins:
→ Profile created: Personal details, Qualifications
(MBBS/MD/GNM/Diploma), Registrations (MCI/NMC/State Nursing
Council number)
→ Credential verification: system tracks if
registration is valid/expired (important for doctors — MCI/NMC
renewal mandatory)
→ Department, Designation, Grade, Reporting Manager assigned
→ System account created automatically (HMIS login, email, ID
card) → role assigned = access control activated
→ Joining documents scanned and stored:
Aadhaar, PAN, degree certificates, experience letters
Critical for hospital operations — ICU,
Emergency, and wards must have staff 24×7:
→ Shift templates: Morning (8am–2pm), Evening (2pm–8pm), Night
(8pm–8am), 24hr
→ Roster created monthly by head nurse/admin → published 7 days
in advance
→ Understaffing alert: system warns if below
minimum staffing per ward
→ Overtime tracking: if >8hrs or called on
off-day → overtime rate applied in payroll
→ Swap requests: staff can request shift swaps → supervisor
approval in app → roster auto-updated
→ Biometric devices (fingerprint/face) at
entry/exit points → attendance auto-recorded
→ Mobile app check-in with GPS for field staff
or WFH cases
→ Late arrival / early departure flagged automatically
→ Absenteeism triggers: if nurse doesn't check
in for shift → head nurse notified immediately → emergency
replacement arranged
→ Monthly attendance report for payroll processing
Leave types configured: CL (Casual Leave), SL (Sick Leave), EL
(Earned Leave), Maternity, Paternity, Compensatory Off
→ Employee applies via app → Supervisor approves/rejects
→ Leave balance auto-updated → accrual
calculated monthly
→ Leave encashment: at year-end or resignation
→ calculated automatically
→ Leave calendar visible to team → helps with roster planning
→ LWP (Leave Without Pay): auto-deducted from
salary when leave balance zero
At month-end, payroll is processed automatically:
Gross Salary = Basic + HRA + Allowances
(Transport, Medical, Special)
Deductions = PF (12% of Basic) + ESI (if salary
≤ ₹21,000: 0.75%) + TDS (Income Tax) + Professional Tax + LWP
deductions
Net Salary = Gross − Deductions
→ Payslip auto-generated as PDF → emailed to
employee
→ Bank transfer file generated (NEFT/IMPS
format) for finance team
→ PF challan auto-generated for EPFO portal
submission
→ ESI challan auto-generated for ESIC portal
Software auto-generates all mandatory government filings:
→ Form 24Q: Quarterly TDS return to Income Tax
dept (salary TDS)
→ Form 16: Annual TDS certificate to each
employee (for their IT return)
→ ECR (Electronic Challan cum Return): Monthly
PF return to EPFO
→ ESI Return: Half-yearly return to ESIC
→ Professional Tax return (state-specific)
→
Appointment letters, increment letters, experience
letters: auto-generated from templates
Accounts module is the financial backbone. Every transaction in the hospital — OPD fee, IPD bill, pharmacy sale, salary, supplier payment — flows into the accounts module as a journal entry. The system maintains the complete General Ledger and generates P&L, Balance Sheet, and cash flow reports.
One-time setup by the accountant — defines all account heads:
Income heads: OPD Revenue, IPD Revenue,
Pharmacy Sales, Lab Revenue, Radiology Revenue, Blood Bank
Revenue
Expense heads: Salaries, Medicine Purchase,
Utilities, Maintenance, Equipment, Consumables
Asset heads: Equipment, Building, Bank,
Accounts Receivable (TPA pending)
Liability heads: Accounts Payable (supplier
dues), TDS Payable, GST Payable, Loans
Every transaction in HMIS auto-creates a journal entry —
accountant never enters manually:
→ Patient pays OPD bill → Dr Cash / Bank, Cr OPD Revenue
→ Pharmacy buys medicines → Dr Medicine Stock, Cr Accounts
Payable (Supplier)
→ Supplier paid → Dr Accounts Payable, Cr Bank
→ Salary processed → Dr Salary Expense, Cr Staff Payable, Cr TDS
Payable
→ TDS deposited → Dr TDS Payable, Cr Bank
→ TPA settles insurance → Dr Bank (TPA), Cr Accounts Receivable
(TPA)
Tracks all money owed to the hospital:
→ TPA/Insurance pending: IPD bills submitted to
TPA → claim under process → aging report shows how long
pending
→ Government scheme pending: PMJAY/Ayushman
claims submitted → waiting for settlement
→ Corporate/credit patients: Companies with
tie-up — monthly invoice raised
→ Dunning alerts: automatic reminders for
overdue TPA payments > 30 / 60 / 90 days
Tracks all amounts owed to suppliers:
→ Medicine supplier invoice received → GRN matched → payable
created
→ 3-way matching: PO vs GRN vs Invoice → only
then payment approved
→ Payment terms tracked (Net 30, Net 60) → alert before due
date
→ Cheque/NEFT payment processed → supplier ledger updated → GST
ITC booking done
→ Monthly supplier outstanding report → reconciliation with
supplier's statement
End of day / month / year — reports generated with one click:
→ Daily Collection Report: Cash + Card + UPI +
Insurance received today per department
→ P&L Statement: Revenue − Expenses = Net
Profit (by month, quarter, year)
→ Balance Sheet: Assets = Liabilities + Equity
(as of any date)
→ Cash Flow Statement: Operating + Investing +
Financing cash flows
→ Department-wise Revenue: Which dept earns
most? (OPD, Pharmacy, Lab, IPD)
→ Doctor-wise Revenue: Contribution of each
doctor (for incentive calculation)
Insurance/TPA module manages cashless hospitalization and reimbursement claims. The hospital empanels with insurance companies through TPAs (Third Party Administrators). When an insured patient gets admitted, the hospital can claim the bill directly from TPA — patient pays only non-covered amounts.
When patient presents insurance card at admission:
→ Enter policy number or scan e-card → system calls TPA API to
verify in real time
→ Checks: Is policy active? →
Sum Insured remaining? →
Is this hospital empanelled? →
Is this condition covered? (e.g., pre-existing
conditions may have waiting period)
→ Co-pay percentage identified (patient bears
this %)
→ Maternity benefits, room rent limits, sub-limits noted
→ Patient and attender briefed on what is covered vs what they
pay
For planned procedures and IPD admissions —
pre-auth is mandatory:
→ Billing staff fills pre-auth form: Patient details + Policy
details + Diagnosis + Proposed treatment + Estimated cost
→ Sent to TPA via system integration (API or email)
→ TPA responds within 2–24 hours with: Approved
amount + Conditions (specific room type, excluded items)
→ Approved amount displayed on patient's billing screen — guides
treatment planning
→ For emergency: provisional approval taken, detailed pre-auth
follows within 24 hrs
If during treatment the bill is likely to exceed approved
amount:
→ Billing staff submits
enhancement request with justification
(complication occurred, longer stay needed)
→ TPA reviews and approves additional amount or declines
→ Interim billing: for long stays (>7 days),
TPA may request interim bill to process partial payment
→ System tracks approved vs actual bill in real time → alerts
when 80% of approved amount used
At discharge, claim package assembled by system:
→ Claim form (TPA-specific format)
→ Discharge summary (doctor signed)
→ All bills (itemized: bed, medicine, lab, OT
etc.)
→ Investigation reports (lab, X-ray)
→ Pre-auth approval letter
→ KYC documents (Aadhaar, policy card)
→ Submitted digitally via TPA portal or API →
Claim ID received
→ Patient pays co-pay + any non-covered items → exits hospital
After submission, track claim status in system:
→ Query raised: TPA asks for missing document →
system alerts billing team → documents submitted
→ Approved: settlement amount confirmed → TPA
pays to hospital bank account
→ Partially approved: TPA disallows certain
items (e.g., excluded consumables) → difference charged to
patient or written off
→ Rejected: full claim denied → hospital may
contest or charge patient
→ Settled amounts auto-reconciled with Accounts module → AR
closed
→ Aging report: claims pending >30/60/90 days →
escalation triggered
| Scheme | Type | Process Difference | Who Pays Hospital |
|---|---|---|---|
| Private Insurance (Mediclaim) | Cashless or Reimbursement | Pre-auth via TPA portal/API | TPA (within 15–45 days) |
| Ayushman Bharat / PMJAY | Cashless (Govt scheme) | PMJAY portal pre-auth, package rates fixed | State Health Agency (45–60 days) |
| CGHS (Central Govt) | Cashless or Reimbursement | CGHS referral letter needed, rate card fixed | CGHS office (60–90 days) |
| ESI (Employee State Insurance) | Cashless | ESI card, treatment only at empanelled hospitals | ESIC regional office |
| Corporate Tie-up | Credit (monthly billing) | Company ID verified, monthly invoice to company | Company HR/Finance (30 days) |
ABHA (Ayushman Bharat Health Account) is India's national health ID — like Aadhaar but for health records. ABDM (Ayushman Bharat Digital Mission) is the platform that lets patients link their health records from ANY hospital to their ABHA ID. Your HMIS must connect to ABDM to be compliant with NHA guidelines.
When patient registers:
→ Receptionist asks: "Do you have an ABHA ID?"
→ New ABHA ID: Patient gives Aadhaar → OTP sent
to Aadhaar-linked mobile → ABHA ID created (14-digit number like
12-3456-7890-1234) → stored against MRN
→ Existing ABHA ID: Enter ABHA ID/mobile → OTP
verified → linked to hospital MRN
→ Voluntary — cannot be forced, but incentivized (faster claim
processing, no repeat history-telling)
→ ABHA Address: Custom address like
"ramesh@sbx" (like email for health data)
One-time setup — hospital registers with ABDM as a
Health Information Provider (HIP):
→ Hospital gets HIP ID on ABDM
sandbox/production
→ HMIS integrates with ABDM gateway via APIs
(NHA provides API documentation)
→ Linked facilities (branches) registered separately
→ Certificate installed (ABDM uses mutual TLS)
→ HMIS now becomes part of the national health network — can
send AND receive patient records
Before any health record is shared — patient must give
consent:
→ Patient receives consent request on
ABHA mobile app (or PHR app)
→ Patient reviews: which hospital is asking, what records, for
what purpose, for how long
→ Patient approves → Consent Artefact created
(digitally signed, time-limited)
→ Hospital can now share only the records specified in the
consent
→ Patient can revoke consent any time → records
access immediately blocked
→ All consents logged — audit trail maintained
After patient consents, HMIS pushes records as FHIR R4
resources:
→ OPD Visit → FHIR Encounter + Condition
(diagnosis) + Observation (vitals)
→ Prescription → FHIR MedicationRequest
→ Lab Report → FHIR DiagnosticReport +
Observation (each result value)
→ Radiology Report → FHIR DiagnosticReport +
ImagingStudy
→ Discharge Summary → FHIR Composition
(document bundle)
→ Immunisation records → FHIR Immunization
Records available in patient's ABHA health locker — accessible
from any ABDM-connected hospital
Your hospital can also act as HIU (Health Information User) —
fetch patient's records from OTHER hospitals:
→ Patient from another city comes for second opinion → doctor
wants previous records
→ Doctor requests record access via HMIS → consent request sent
to patient's ABHA app
→ Patient approves → FHIR records fetched from previous
hospital's HMIS
→ Records displayed in doctor's screen alongside current
visit
→ No fax, no CD, no carrying physical reports —
digital, instant, standardized
For Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
patients:
→ Patient verified via ABHA ID + biometric (Aadhaar
authentication at bedside)
→ Hospital raises claim on
PMJAY portal / BIS (Beneficiary Identification
System)
→ Claim includes: ICD codes + procedure codes + package code
(PMJAY has fixed package rates for ~1,500+ procedures)
→ State Health Agency reviews and approves
→ Settlement via PFMS (Public Finance Management System) to
hospital bank account
→ Complete claim journey tracked in Insurance module
| When this happens... | These modules are triggered automatically |
|---|---|
| Patient registers | Reception → ABHA Linking → Patient Profile in EMR |
| Doctor writes prescription | OPD → Pharmacy (prescription visible) → ABHA (record pushed) |
| Doctor orders lab test | OPD/IPD → Lab worklist → Billing (charge added) → ABHA (result pushed on release) |
| Doctor orders X-ray | OPD/IPD → Radiology worklist → PACS → Billing (charge added) → ABHA |
| Patient admitted to IPD | OPD → IPD Admission → Bed Management → Billing (running bill starts) → Insurance (pre-auth triggered) |
| Doctor orders blood | IPD → Blood Bank (request) → Cross-match → Issue → Transfusion record → Billing |
| Medicine dispensed (OPD) | Pharmacy → Stock deducted → GST ledger entry → Billing receipt |
| Medicine dispensed (IPD ward) | Pharmacy → Ward indent → MAR in nursing → Running bill updated → GST ledger |
| Patient discharged | IPD → Discharge summary (doctor) → Final bill (billing) → Insurance claim → ABHA discharge record → MRD assembly → Bed freed |
| Salary processed | HRMS Payroll → Accounts (journal entry) → Bank transfer file → PF/ESI challan → TDS deducted |
| Supplier invoice received | Pharmacy/Purchase → GRN → Accounts Payable → GST ITC booking → Payment due date set |
| Month end | Accounts → GSTR-1 generated → GSTR-3B computed → P&L report → PF challan → ESI return |