Hospital management software for small hospitals and nursing homes in India

Most of India’s in-patient care happens in hospitals of 20 to 100 beds: nursing homes run by a surgeon and an anaesthetist, single-specialty hospitals for eyes, orthopaedics or maternity, and multi-specialty hospitals in district towns. These hospitals rarely have an IT department. They need hospital management software that the front desk, the nurses and the billing clerk can run themselves, and that the owner can read at the end of the day.

This guide sets out what hospital management software (HMS, also called HIS or HMIS) has to cover in a hospital of that size, and ends with questions to ask in any demo.

1. One patient record, OPD to IPD

The out-patient department is where most patients first arrive, and some of them are admitted the same day. If the OPD and the wards run on different systems, the admission starts with re-typing the history, the allergies and the investigations. The first thing to check is that an OP patient admitted keeps one chart and one number.

2. Admission and beds

• Admission into a bed from a view of the wards, with the free beds shown.
• The admission number and the MRN issued at admission, on the wristband and the file.
• Transfers between wards, and every state of the stay recorded on the admission.
• Consent recorded against the admission, with who signed and when.

3. Nursing

The nursing station is where errors are caught or missed. Look for vitals with abnormal values flagged, the medication administration record (each dose given, held or refused, with who and when), intake and output, nursing notes, and shift handovers that the incoming nurse reads before the outgoing one leaves.

4. The operation theatre

For a surgical hospital the theatre list is the day’s plan. The software should put theatres on a calendar that refuses double bookings, walk each case through the WHO surgical safety checklist, and keep the pre-operative, operative, post-operative and anaesthesia notes on the case. Charges for the theatre, the surgeon, the anaesthetist and the consumables should reach the bill when the case closes.

5. Emergency and the ICU

Even a small hospital takes emergencies. Triage, re-assessment while the patient waits, and an outcome for every visit (discharged, admitted, transferred, or left against medical advice) protect the patient and the hospital. A hospital with an ICU needs an observation chart, blood gas results with critical values flagged, drips and ventilator settings, and severity scores such as APACHE II or SOFA.

6. Pharmacy and lab charges that post themselves

Medicines dispensed and tests done for an admitted patient should post to the admission’s bill as they happen. When they are written on a slip and typed in at discharge, some are always missed, and the hospital loses the money.

7. Billing, deposits and insurance

The bill is where the owner looks first. Check for:

• A running ledger on every admission, with interim bills during a long stay and a final bill at discharge.
• Deposits and advances netted off the final bill.
• Cashless insurance: the policy, the pre-authorisation, the insurer’s decision, the final claim and settlement, with the patient’s share (co-pay and items the insurer will not pay) billed separately.
• State scheme cases. In many district towns a large share of admissions come under a government scheme such as CMCHIS in Tamil Nadu, NTR Vaidya Seva in Andhra Pradesh or PM-JAY. Ask how the software records the scheme, the package and the patient’s share.
• Changes to a final bill held for approval, with a log of who approved what.

8. Discharge and medical records

The discharge summary should be built from what was recorded during the stay, signed only when the required parts are filled, and handed to the patient with the medicines as a schedule they can follow. Medical records then keeps the file: ICD coding of the stay, requests to retrieve it, and how long it is retained.

9. Quality and NABH

Hospitals working towards NABH accreditation need incident reporting, root cause analysis and corrective actions followed to the end, infection control and medication safety registers, and a view of which standards are met. Software that records these as part of the day’s work is easier to keep up than a separate quality binder.

10. Reports for the owner

At the end of the day the owner wants a short list of numbers: admissions and discharges, bed occupancy, collections by mode, insurance claims pending and their age, and what the pharmacy sold. These should come from the same records the staff work on, not from a spreadsheet someone fills in.

Questions to ask in any hospital software demo

1. Admit an OP patient into a bed and show that the OP history is on the chart.
2. Record a dose held by a nurse and show where the doctor sees it.
3. Book two cases into the same theatre at the same time and see what happens.
4. Dispense a medicine to an admitted patient and show it on the bill without re-typing.
5. Take a deposit, raise an interim bill, and show the final bill with the deposit netted.
6. Run a cashless admission from pre-authorisation to settlement, with the patient’s share billed.
7. Sign a discharge summary with a required field empty and see what happens.

Where 92health fits

92health runs a hospital’s in-patient side on the same record as its OPD, pharmacy and lab:

• admission into a bed with the MRN and admission number, transfers, and consent;
• a nursing station with abnormal vitals, the medication administration record, intake and output, notes and handovers;
• theatres on a calendar that checks for clashes, with the WHO checklist and the operative and anaesthesia notes;
• emergency triage with an ESI suggestion and every outcome recorded, and an ICU chart with blood gases, drips, a ventilator log and APACHE II, SOFA and qSOFA scores;
• charges from the pharmacy and lab posting to the admission, interim and final bills paid by cash, card, UPI or a TPA, with pre-authorisation, claims and settlement run from the admission;
• the discharge summary, medical records with ICD coding and retention, and incident reporting with root cause analysis and the NABH checklist.

Hospitals can start with the OPD and the pharmacy and switch on the rest as they are ready. If you run a hospital or nursing home in Chennai, Coimbatore, Madurai, Visakhapatnam, Vijayawada or anywhere else in India, book a demo and bring the questions above.