E-Atria HMIS Module User & Operations Guide

01Recent Updates & Enhancements (Version 2.5)

The following features and certifications were recently developed and incorporated into the E-Atria HMIS platform:

02Hospital Roles & Permission Structure

E-Atria HMIS enforces strict Role-Based Access Control (RBAC). What each user sees in the sidebar and which action buttons are clickable depend on their assigned roles and permissions:

03Patient Management & Registration Module

Sidebar Menu: Billing → Patient List
Intended Users: Front Desk Receptionists, OPD Registration Staff, Admission Clerks.

This module serves as the primary master registry for all individuals receiving healthcare services at the facility. It provides comprehensive duplicate prevention, ABDM ABHA creation and verification, quick search, and direct launching of OPD, IPD, and Emergency encounters.

Screen 1: Search Tab

Purpose: Locate existing hospital patients within seconds and prevent duplicate file generation.

• Search by Patient Code (UHID) (e.g. P26091000018).
• Search by 10-Digit Mobile Number.
• Search by Patient Full Name (supports partial matching, e.g. "Rahul").
• Search by Aadhaar Number (12 digits) or 14-Digit ABHA ID.
• Search by ABHA Address Handle (e.g. rahul@sbx).
• Action: Clicking on any patient row opens their comprehensive Patient 360° Profile & Medical History.

Screen 2: New Person Registration Form

Purpose: Register a brand-new patient into the hospital master database. All fields are explained below:

Screen 3: ABHA Management Tab

Purpose: Seamless national Ayushman Bharat digital health identity integration directly at the registration desk:

Screen 4: Patient 360° Profile Hub

Once a patient is registered, their profile displays emergency and clinical shortcuts:

• Appointment For OPD — Generates OPD visit slip and assigns consulting doctor.
• Add Charge — Directly books diagnostic tests (Pathology, X-Ray, CT, MRI, USG) or procedures.
• Casualty — Emergency admission under ESI triage.
• Day Care — Short-stay procedure admission (<24 hours).
• IPD — Standard inpatient ward bed admission.
• Link Records to ABHA (HIP) — Initiates instant care context linking.

04Outpatient Department (OPD) Workflow

Sidebar Menus: Billing → OPD Invoice | Doctor's Work → OPD Appointment List

OPD Check-In & Token Generation

1. Reception Registration: Receptionist opens patient profile and clicks Appointment For OPD.
2. Consultation Parameters: Select Department (General Medicine, Orthopedics, Cardiology, etc.), Doctor, Fee Category (Normal, Revisit, Free, Camp), and Organization/Insurance case if applicable.
3. Receipt & Token: System generates OPD Slip with unique visit token (e.g. Token #14) and care context reference OPD-{PatientId}-S{OpdId}-{Date}.
4. ABDM OPD Queue: Patients scanning the hospital facility QR code via ABHA app appear automatically in the ABDM OPD Queue under Front Desk with pre-filled demographics for 1-click token creation.

Doctor OPD Consultation & Prescription Desk

Doctors access the consultation workspace from their daily appointment list. The screen contains dedicated clinical sections:

• Vitals & Physical Examination: BP (Systolic/Diastolic), Pulse, SpO2, Temperature, Respiratory Rate, Height, Weight, BMI, Waist circumference, and general examination tags (Pallor, Icterus, Cyanosis, Clubbing, Edema).
• Chief Complaints: Multi-select complaint box integrated with standard SNOMED-CT terminology. Allows entering duration and severity.
• Diagnosis: Provisional and Final diagnosis search powered by ICD-10 and SNOMED-CT clinical coding.
• Prescription (Medicines): Search by brand or generic name. Specify dosage (e.g. 500mg), frequency (e.g. 1-0-1, TID), timing (After food, Empty stomach), route (Oral, IV, IM), and duration in days. Automated drug interaction alerts activate if duplicate molecules are prescribed.
• Investigation Orders: Prescribe pathology tests or radiology imaging with 1 click. Automatically creates unbilled investigation requests at the diagnostic billing desk.
• Advice & Precautions: Standard diet, lifestyle, and recovery instructions. Supports inserting pre-defined advice snippets.
• Next Visit / Follow-up: Set scheduled review date (e.g. "After 7 Days" or specific calendar date).
• ABDM Push: When saving, clicking Share to ABHA automatically generates the HL7 FHIR R4 OPConsultRecord bundle and makes it available to the patient's ABHA app.

05In-Patient (IPD), Day Care & Emergency (Casualty)

Sidebar Menus: In-Patient & Nursing Care → IPD Patient List | Billing → IPD Billing
Compliant Standards: NABH 5th Edition, ESI Triage Levels 1–5, PADSS Criteria, HL7 FHIR R4.

1. Admission Categories & Key Identifiers

2. Emergency / Casualty Admission & ESI Triage

Casualty staff immediately triage arriving patients into 5 international Emergency Severity Index (ESI) tiers:

• ESI 1 (Resuscitation) — Immediate life-threat (cardiac arrest, severe shock). 0 min door-to-doctor.
• ESI 2 (Emergent) — High risk, danger vitals, acute chest pain. ≤10 min door-to-doctor.
• ESI 3 (Urgent) — Stable vitals needing multiple resources (IV fluids, Labs, X-Ray). ≤30 min.
• ESI 4 (Less Urgent) — 1 resource needed (simple suture, uncomplicated UTI). ≤60 min.
• ESI 5 (Non-Urgent) — Medication refill, minor rash. ≤120 min.

3. Clinical Escalation: Convert to IPD with SBAR Handover

When a Casualty or Day Care patient deteriorates or requires prolonged admission, click "Convert to IPD". The system enforces the SBAR clinical handover protocol:

4. Day Care Discharge & PADSS Scoring

Before discharge from Day Care, patients must be evaluated against the Post-Anaesthetic Discharge Scoring System (PADSS) across 5 clinical parameters (Vital signs, Ambulation, Nausea/vomiting, Pain control, Surgical bleeding). A score of ≥ 9 out of 10 is mandatory for home discharge.

06Operation Theatre (OT) Management

Sidebar Menu: In-Patient & Nursing Care → OT Surgery Queue

1. Surgery Request: Treating surgeon submits surgery request specifying procedure name, operating surgeon, assistant, anaesthetist, required OT room, priority (Elective / Emergency), and requested date/time.
2. Pre-Operative Assessment: Pre-anaesthetic checkup (PAC) recording airway grading (Mallampati), ASA physical status score (I–V), blood cross-match confirmation, and NPO status.
3. OT Scheduling: OT supervisor allocates OT Table and timing, checking for equipment or instrument tray conflicts.
4. Patient Call: Ward nurse updates patient status to Called to OT and performs pre-op surgical checklist (consent signed, jewellery removed, dentures removed, surgical site marked).
5. WHO Surgical Safety Checklist Gates:
   • Sign-In (Before Induction): Confirm patient identity, procedure, site marking, pulse oximeter attached, allergy checks, difficult airway risk, anticipated blood loss.
   • Time-Out (Before Skin Incision): Entire team introduces themselves; surgeon, anaesthetist, and nurse confirm patient name, procedure, antibiotic prophylaxis given ≤60 min prior, essential imaging displayed.
   • Sign-Out (Before Patient Leaves OT): Nurse verbally confirms instrument and sponge counts, specimen labeling, equipment malfunctions, post-op recovery plan.
6. Operative & Anaesthesia Notes: Surgeon logs operative findings, implants used (with serial/lot numbers for tracking), sutures, drainage tubes, and post-op recovery orders.

07Doctor's Work & Clinical Masters

Sidebar Menu: Doctor's Work (Appointments, Rx-Group, OPD Medicine, Clinical Masters, Clinical Templates, Document Issue, Immunization)

1. Rx-Group Master (Prescription Protocol Sets)

Purpose: Build reusable multi-medicine prescription sets for 1-click prescribing during busy OPD hours.

• Create groups such as "Acute Gastroenteritis Kit", "Hypertension Starter", or "Viral Fever Pack".
• Each group contains pre-configured dosages, frequencies, and instructions. During consultation, picking one group populates all medicines instantly.

2. Clinical Master Workspace (Complaints, Profiles & Advice)

Purpose: Maintain hospital-wide clinical dictionaries:

• Chief Complaints Master: Frequently presenting symptoms mapped to standard clinical concepts.
• Investigation Master: Master catalog of diagnostic tests and individual laboratory parameters.
• Investigation Profile Master: Grouping individual tests into test batteries (e.g. Lipid Profile containing Total Cholesterol, Triglycerides, HDL, LDL, VLDL).
• OPD Advice Master: Standard dietary, physical therapy, and medication precautions.

3. Doctor Document & Certificate Issuance Desk

Purpose: Issue legal and clinical certificates directly from the patient encounter:

• Medical Leave & Fitness Certificates
• Referral Slips to higher tertiary centers
• Birth Intimation and Death Audit Slips
• Emergency Travel Medical Clearance

4. Pediatric Immunization Tracker

Purpose: Track national vaccine schedules for infants and children:

• Pre-configured national immunization schedule (BCG, OPV, Hepatitis B, Pentavalent, Rotavirus, Measles, MMR).
• Record administered date, batch number, manufacturer, and injection site.
• System automatically schedules and alerts next due dates.

08Diagnosis, Laboratory & Imaging Modules

Sidebar Menu: Diagnosis (Pathology, Biopsy, X-Ray, MRI, CT-Scan, Ultrasound, Echo)

1. Pathology & Biopsy Workflow

1. Sample Collection & Accession: Phlebotomist collects sample, assigns unique Lab Accession Number / Barcode, and records collection time.
2. Result Entry: Laboratory technician enters quantitative parameter readings. Values outside normal reference intervals automatically highlight in bold red.
3. Pathologist Verification: Pathologist reviews values, adds clinical microscopic comments, and clicks Verify & Sign. Finalized reports are locked against accidental modification.
4. Digital Delivery: Reports can be printed on hospital letterhead, downloaded as PDF, or transmitted to ABDM.

2. Radiology & Diagnostic Imaging Workflow

Covers all major modalities: X-Ray, Ultrasound (USG), CT-Scan, MRI, and 2D Echocardiography.

• Image / DICOM Upload: Attach patient scan images, high-resolution snapshots, or multi-frame study files directly to the examination entry.
• Template-Driven Reporting: Load pre-designed normal or pathological reporting templates with 1 click to draft standardized reports.
• Radiologist Sign-off: Consultant radiologist enters clinical findings and final impression, then signs off.
• ABDM DiagnosticReportRecord Push: Pushes verified imaging reports to ABDM Gateway for immediate viewing in the patient's ABHA app.

09Template Design & Configuration Guide

Sidebar Menu: Admin & Settings → Template
Intended Users: Radiologists, Pathologists, Chief Medical Officers, Hospital Administrators.

Standardized templates ensure clinical precision, reduce reporting turnaround time by over 70%, and ensure medico-legal compliance across all imaging and diagnostic disciplines.

1. Diagnostic Modality Navigation & Scope

In E-Atria HMIS, pre-configured diagnostic report templates are organized into dedicated modality tabs under Admin & Settings → Template:

2. How to Design a New Radiology Template (Step-by-Step)

1. Open Modality Template Workspace: Go to Admin & Settings → Template and click on the desired modality tab (e.g. X-Ray, CT-Scan, MRI, or Ultrasound).
2. Click "+ Add Template": Opens the rich-text template builder.
3. Specify Template Title: Enter a clear, standardized name (e.g. X-RAY CHEST PA VIEW - NORMAL STUDY or CT HEAD - NORMAL BRAIN STUDY).
4. Link Hospital Service / Billing Test:
   Automatic Template Loading: In the "Linked Charge / Test Item" dropdown, select the corresponding test name from the Hospital Charges Master. When reception bills this service on an OPD or IPD slip, the system will automatically inject this template into the doctor's report editor without requiring manual search!
5. Structure the Clinical Content: Adhere to professional NABH reporting standards by dividing the template into 4 standard sections:
   Recommended Clinical Template Anatomy

   CLINICAL INDICATION:
   Suspected chest pathology / Routine pre-operative medical evaluation.
   
   TECHNIQUE:
   Standard plain radiograph of the chest was obtained in the postero-anterior (PA) erect position at full inspiration.
   
   FINDINGS:
   • Trachea is central in position.
   • Cardiothoracic ratio is within normal limits. Cardiac size, shape, and contours appear normal.
   • Both lung fields are clear with normal vascularity. No focal parenchymal consolidation, infiltrate, mass, or cavitation detected.
   • Both costophrenic and cardiophrenic angles are sharp and clear. No pleural effusion seen.
   • Mediastinal and hilar contours appear normal with no lymphadenopathy.
   • The visualised thoracic cage, ribs, clavicles, and soft tissues appear unremarkable.
   • Both diaphragmatic domes are smooth and normal in position.
   
   IMPRESSION:
   NO SIGNIFICANT ABNORMALITY DETECTED ON CHEST RADIOGRAPH.
   NORMAL STUDY.
   

6. Save & Test Template: Click Save Template. The template is immediately active across all diagnostic report editors.

3. Pathology Parameter & Reference Interval Design

Pathology templates configure individual analytical parameters:

• Parameter Name: e.g. Fasting Blood Glucose, Serum Creatinine, Platelet Count.
• Unit of Measure: e.g. mg/dL, g/dL, /cumm, mmol/L.
• Reference Ranges: Age and gender specific normal minimum and maximum thresholds. Readings outside these limits automatically flag as LOW or HIGH in red text.

10Pharmacy & Medical Store Module

Sidebar Menu: Pharmacy → Medical Store

1. Point of Sale (POS) Dispensing

1. Search Patient / Prescription: Enter patient UHID or fetch active doctor e-Prescription.
2. Batch & Expiry Selection: Scan barcode or search drug. The system enforces FEFO (First Expiry, First Out) by automatically suggesting the earliest expiring batch.
3. Pricing & Discounts: Calculates MRP, discounted rate, CGST/SGST taxes, and net amount payable.
4. Receipt & Label: Prints tax invoice with dosage frequency labels and Schedule H warnings.

2. Medicine Returns & Credit Notes

Unopened and non-expired medications returned by patients are processed with credit notes or cash refunds. Returned stock instantly increments the active batch inventory.

3. Pharmacy Credit Payout Workflow

For corporate and insurance empanelled credit dispensing:

• Open Credit Payout Request to review outstanding credit pool lines.
• Select approved credit accounts, enter remarks, and submit request to Accounts & Finance for reimbursement.

11Hospital Stock & Inventory Management

Sidebar Menu: Hospital Stock → Hospital Stock

1. Stock Indent & Issue Workflow

1. Department Indent: Ward nurses, OT, or lab staff submit an electronic indent specifying required consumables (syringes, gloves, IV sets, gauze).
2. Store Approval: Store manager reviews current stock levels and approves/adjusts requested quantities.
3. Stock Issue: Storekeeper issues approved batches. Main store inventory automatically deducts, and sub-store/ward inventory increases.

2. Purchase Orders (PO) & Goods Receipt Note (GRN)

• Purchase Order: Generate supplier PO based on minimum reorder levels.
• GRN & Inward Inspection: Upon delivery, record received batch numbers, manufacturer, expiry dates, purchase rates, and GST. Discrepancies generate vendor debit notes.

12Billing, Invoices & Cashier Workflows

Sidebar Menu: Billing (OPD Invoice, Charges Invoice, IPD Billing, Org Packing, Cash Submission)

1. Invoicing Types

• OPD Invoice: Consultation fee collection and receipt generation.
• Charges Invoice: Invoicing for diagnostic tests, day-care procedures, dressing, physiotherapy, and dental work. Supports split payments (Cash, Card, UPI, Cheque).
• IPD Billing: Running patient ledger tracking room rents, doctor visits, surgery fees, bedside medicines, and advance receipts. Supports interim provisional billing and final discharge invoice.

2. Shift-End Cash Statement Submission

Purpose: Guarantee 100% financial accountability at the end of every cashier's work shift.

1. At the end of the shift, the billing cashier opens Cash Submission.
2. System calculates total cash collections recorded under that cashier's user ID for the active shift.
3. Cashier enters physical currency breakdown (e.g. 500x10, 200x5, 100x20).
4. Click Submit Cash Statement to lock the shift and handover cash to the Accounts Department.

13Accounts & Finance Management

Sidebar Menu: Accounts And Finance (Finance Dashboard, Accounts Verify Payment, Payment Edit, Bank Audit, Payouts)

14Insurance, TPA & Ayushman Bharat (PM-JAY)

Sidebar Menus: Billing → Org. OPD's Invoice | Billing → Org Packing | Report → Insurance Credit

1. Case Registration: Patient admission is linked to an empanelled Corporate, TPA (e.g. Star Health, Medi Assist), or Ayushman Bharat scheme. Enter pre-authorization request number and approved initial amount.
2. Tariff Packages: Pre-agreed package tariffs are applied automatically to line items, preventing unapproved billing.
3. Org Packing: Consolidates invoices, diagnostic reports, discharge summary, and pharmacy slips into a single verified claim docket for physical or portal submission.
4. Settlement & Deductions: When the TPA settles the claim, record the approved amount, write off approved TDS/deductions, and reconcile outstanding patient co-pays.

15ABDM (Ayushman Bharat Digital Mission) Ecosystem

Sidebar Menu: ABDM (ABDM Task Board, ABHA Patient Request List, ABDM OPD Queue, ABDM Bridge Log)
Compliant Standard: ABDM HIECM V3 Standard, FHIR R4 Bundle Specifications.

1. Milestone 1 (M1): ABHA Creation & Verification

• Aadhaar OTP Creation: Enter 12-digit Aadhaar → healthcare worker and beneficiary declarations are collected → OTP verified → ABHA Number & Address generated.
• ABHA Verification: Retrieve verified demographic profile and photograph from ABDM via mobile OTP or ABHA number.
• Facility Scan & Share: Generates hospital QR code displayed at reception. Patients scan QR via their ABHA app, populating their details directly in the ABDM OPD Queue for 1-click token creation.

2. Milestone 2 (M2): Health Information Provider (HIP) Linking

3. Milestone 2 (M2): Health Information Exchange (FHIR R4 Data Transfer)

When the patient requests their health records in their ABHA app, the HMS generates and transfers encrypted FHIR R4 bundles:

4. Milestone 3 (M3): Health Information User (HIU)

Allows hospital doctors to request digital consent from arriving patients to view their previous medical history and diagnostic reports from other hospitals across India via the ABHA Patient Request List (Digital Consent Management).

16Reports, Analytics & NABH Quality Audits

Sidebar Menu: Reports (Collection Report, Old Payment Received, OPD Total, Diagnosis Report, Insurance Credit, NABH Audit)

17Admin, System Settings & Master Configuration

Sidebar Menu: Admin & Settings (Admin Panel, Template, Charges Master, Bed Status)

1. Bed Status & Ward Configuration (`setting/admin/bed-status`)

• Configure hospital physical departments, wards (e.g. General, ICU, NICU, Day Care, Casualty), and rooms.
• Define bed numbers, daily per-diem room tariff rates, and room amenities (Oxygen, Ventilator, AC).
• Live real-time graphical bed census showing Occupied, Vacant, Cleaning, and Maintenance beds.

2. User Management & Access Permissions

• Create system users with individual usernames and secure passwords.
• Assign users to system groups (Doctor, Reception, Nursing, Accounts, Pharmacy, Admin).
• Grant granular operational privileges (e.g. Payment Adjustments, Radiology Template Setup, Bill Cancellation, Pharmacy Dispensing).

3. Hospital Charges & Tariff Master

• Configure hospital master rate list for consultations, investigations, surgical procedures, nursing care, and consumables.
• Set differential pricing tiers for Private, General, and Empanelled Corporate/TPA patients.

4. Hospital Profile & Letterhead Customization

• Configure official hospital name, HFR ID (Health Facility Registry ID), registration number, and address.
• Upload hospital logo and configure print letterhead modes (Printed Paper mode vs Blank Paper mode with auto-header).

18Troubleshooting Common Operational Issues