E-Atria HMS — Modern Hospital Management System

E-Atria HMS is a 100% free and open-source Hospital Management System built on the modern, high-performance CodeIgniter 4 PHP framework. Designed for multispeciality hospitals, nursing homes, polyclinics, and diagnostic centres, E-Atria HMS provides end-to-end clinical workflow automation — from OPD registration, doctor e-prescriptions, and IPD bed management to NABH discharge summaries, digital radiology templates, automated pathology analyzers, pharmacy billing, and complete Ayushman Bharat Digital Mission (ABDM M1, M2, M3) milestone compliance.

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🌟 Key Features & Modules

• OPD Management: Token queue, biometric ABHA lookup, doctor clinical workspace, ICD-10 & SNOMED CT diagnoses, e-prescriptions, dynamic prescription print templates (A4/A5).
• IPD Inpatient Care: Bed management, nursing daily charts, vitals monitoring, OT scheduling, doctor rounds, bilingual legal consent forms (operative, high-risk, LAMA/DAMA).
• NABH Discharge Summaries: Speciality-wise clinical discharge templates (Medicine, Surgery, Cardiology, Ob/Gyn, Pediatrics, Orthopedics) with auto-calculated hospital stay and medication instructions.
• Pathology Laboratory (LIS): 37 clinical panels and 228 test parameters with LOINC codes, age/gender biological reference intervals, auto-differential calculation, and analyzer report printing.
• Radiology & Imaging (RIS): 59 master imaging templates across Ultrasound (USG: 27), 2D Echocardiography (ECHO: 9), Digital X-Ray (18), CT Scan (13), and MRI (14).
• Pharmacy & Inventory: Batch tracking, expiry alerts, GST invoices, vendor purchase orders, margin analysis, and Marg ERP item list compatibility.
• Billing & Ayushman Bharat (PM-JAY): 1,401 standardized Ayushman packages, corporate TPA claims, patient ledger, and detailed financial audits.
• ABDM National Health Stack: M1 (ABHA creation, Scan & Share), M2 (Care Context linking, OTP verification), and M3 (FHIR R4 clinical document bundle generation).

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📋 Table of Contents

1. Server Requirements
2. Quick Installation: Method A (Automated 1-Command Script)
3. Manual Installation: Method B (Step-by-Step)
4. Environment Configuration (.env)
5. Database Architecture & Starter Masters
6. Comprehensive Medical Templates Library Seeding
7. Web Server & SSL Configuration (Apache / Nginx)
8. File Permissions & Directory Hardening
9. Automated Background Cron Jobs
10. First Login & Hospital Customization
11. Updating an Existing Installation
12. Useful Spark CLI Commands
13. Official Documentation & Support

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1. Server Requirements

Component	Minimum	Recommended Production Spec
Operating System	Ubuntu 20.04 LTS / Debian 11	Ubuntu 24.04 LTS or Ubuntu 22.04 LTS
Hardware Resources	2 vCPU, 4 GB RAM, 25 GB SSD	4 vCPU, 8 GB RAM, 80 GB NVMe SSD (50+ clinical users)
PHP Version	PHP 8.2	PHP 8.3 (FPM or Apache mod-php)
Database	MySQL 5.7 / MariaDB 10.4	MySQL 8.0+ (UTF8MB4 charset, InnoDB)
Web Server	Apache 2.4 / Nginx 1.18+	Apache 2.4 with mod_rewrite, mod_ssl, mod_headers, mod_deflate
Package Managers	Composer 2.2+, Git 2.30+	Composer 2.7+, Git 2.34+

Required PHP Extensions:

php8.3-cli php8.3-fpm php8.3-mysql php8.3-curl php8.3-gd php8.3-mbstring php8.3-xml php8.3-intl php8.3-zip php8.3-bcmath

Recommended php.ini Settings:

memory_limit = 512M
upload_max_filesize = 50M
post_max_size = 50M
max_execution_time = 300
max_input_vars = 5000
date.timezone = Asia/Kolkata
display_errors = Off
expose_php = Off

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2. Quick Installation: Method A (Automated 1-Command Script)

For fresh Ubuntu servers (20.04, 22.04, or 24.04 LTS), the repository includes an automated installation script located at scripts/install_ubuntu.sh:

# 1. Clone repository to server
sudo mkdir -p /var/www/html/eatria_client
cd /var/www/html/eatria_client
sudo git clone https://git.e-atria.net/d_s_bisht/devsofttech_hms_ci4.git hospital

# 2. Run automated installation script
cd hospital
sudo bash scripts/install_ubuntu.sh <domain_name> <database_name> "<hospital_name>"

Real-World Example:

sudo bash scripts/install_ubuntu.sh hospital.yourdomain.com hms_live_db "City Multispeciality Hospital"

Interactive Prompt Mode: Running sudo bash scripts/install_ubuntu.sh without arguments will prompt for domain, database, hospital name, and MySQL credentials.

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3. Manual Installation: Method B (Step-by-Step)

Step 1: Install System Packages

sudo apt update && sudo apt upgrade -y
sudo apt install -y apache2 mysql-server git unzip curl ca-certificates certbot python3-certbot-apache

# Install PHP 8.3 & extensions
sudo apt install -y \
  php8.3 php8.3-cli php8.3-fpm php8.3-mysql php8.3-curl \
  php8.3-gd php8.3-mbstring php8.3-xml php8.3-intl php8.3-zip php8.3-bcmath libapache2-mod-php8.3

# Enable Apache modules
sudo a2enmod rewrite ssl headers deflate
sudo systemctl restart apache2

Step 2: Clone Repository & Install Dependencies

sudo mkdir -p /var/www/html/eatria_client/hospital
sudo git clone https://git.e-atria.net/d_s_bisht/devsofttech_hms_ci4.git /var/www/html/eatria_client/hospital

cd /var/www/html/eatria_client/hospital
composer install --no-dev --optimize-autoloader

Step 3: Create MySQL Database

CREATE DATABASE IF NOT EXISTS `hms_hospital_db` CHARACTER SET utf8mb4 COLLATE utf8mb4_general_ci;
CREATE USER 'hms_user'@'localhost' IDENTIFIED BY 'YourStrongPassword123!';
GRANT ALL PRIVILEGES ON `hms_hospital_db`.* TO 'hms_user'@'localhost';
FLUSH PRIVILEGES;

Step 4: Configure Environment File (.env)

cp env .env
nano .env
# Edit database and app.baseURL (see Section 4)

Step 5: Initialize Schema & Superadmin User

Execute the built-in Spark CLI installer:

php spark hms:install \
  --hospital-name="City Multispeciality Hospital" \
  --admin-user="admin" \
  --admin-email="admin@hospital.com" \
  --admin-password="YourStrongPassword"

Or import clean starter schema directly:

mysql -u root -p hms_hospital_db < database/hms_starter_schema_and_masters.sql

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4. Environment Configuration (.env)

Edit .env inside the project root:

#--------------------------------------------------------------------
# ENVIRONMENT
#--------------------------------------------------------------------
CI_ENVIRONMENT = production

#--------------------------------------------------------------------
# APPLICATION
#--------------------------------------------------------------------
app.baseURL = 'https://hospital.yourdomain.com/'
app.appTimezone = 'Asia/Kolkata'

#--------------------------------------------------------------------
# DATABASE
#--------------------------------------------------------------------
database.default.hostname = 127.0.0.1
database.default.database = hms_hospital_db
database.default.username = hms_user
database.default.password = YourStrongPassword123!
database.default.DBDriver = MySQLi
database.default.port     = 3306
database.default.DBDebug  = false

# Database Maintenance Key
setup.dbToolsKey = yourSecureKey2026

#--------------------------------------------------------------------
# SNOMED CT CSNOTK TERMINOLOGY SERVICE
#--------------------------------------------------------------------
snomed.csnotk.baseUrl = https://csnotk.e-atria.in/csnoserv
snomed.csnotk.enabled = true
snomed.csnotk.timeoutSec = 10

#--------------------------------------------------------------------
# ABDM BRIDGE GATEWAY CONNECTOR
#--------------------------------------------------------------------
ABDM_BRIDGE_PUBLIC_URL = https://abdm-bridge.e-atria.in
abdm.connector = dreamsoft
abdm.directBaseUrl = https://dev.abdm.gov.in/api/v3
abdm.directTimeoutSec = 30
BRIDGE_SYNC_URL = https://csnotk.e-atria.in/api/bridge
ABDM_BRIDGE_URL = https://abdm-bridge.e-atria.in/api/v1/bridge
BRIDGE_SYNC_TIMEOUT = 20
BRIDGE_SYNC_PROVIDER = bridge

Generate application encryption key:

php spark key:generate

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5. Database Architecture & Starter Masters

The pre-built database (database/hms_starter_schema_and_masters.sql):

• 399 Total Tables: Complete enterprise schema with relational constraints and composite indexes.
• Zero-Patient Clean State: All clinical and transactional tables start empty (patient_master = 0 rows, opd_master = 0 rows, ipd_master = 0 rows, invoice_master = 0 rows).
• 83,000+ Preloaded Master Records:
  • Ayushman Packages: 1,401 standardized PM-JAY packages (ayushman_package_master).
  • Drug Timings & Frequencies: opd_dose_frequency, opd_dose_when, opd_dose_where, opd_dose_duration.
  • Charge Items & Departments: hc_department, hc_items, ipd_item_type.
  • Reference Catalogues: blood_group, color, india_state, med_company, med_formulation.
  • Security & RBAC: CodeIgniter Shield auth with Superadmin account pre-configured.

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6. Comprehensive Medical Templates Library Seeding

E-Atria HMS includes a hospital-wide Medical Templates Library that populates out-of-the-box clinical templates:

php spark db:seed MedicalTemplatesLibrarySeeder

🛡️ Insert-If-Not-Exists Safety Guarantee:
The seeder runs in Safe Mode. It checks whether each template or test parameter already exists in your database. If a record exists, it is NEVER overwritten or updated, preserving all custom test rates, personalized normal reference intervals, and doctor notes. Only missing or newly added templates are inserted.

What Gets Seeded Out-of-the-Box:

• 🩺 37 Pathology Panels & 228 Test Parameters: Complete Blood Count (CBC with ESR), LFT, KFT/RFT, Lipid Profile, Thyroid Profile (Total & Free), Urine Routine & Microscopic, HbA1c, Coagulation Profile (PT/INR/APTT), Semen Analysis, CSF Analysis, Dengue Serology, Sputum AFB, Widal, and Stool Routine. Includes standardized LOINC codes, adult male/female reference intervals, units, and HTML table formats.
• 🩻 59 Radiology Master Templates across 5 Modalities:
  • Ultrasound (USG - 27 templates): Whole Abdomen & Pelvis, KUB, TVS, Obstetric (Early dating, Growth, Anomaly Level-II / TIFFA, Color Doppler), Scrotum, Thyroid, Breast, Musculoskeletal.
  • Echocardiography (ECHO - 9 templates): 2D Echocardiography with Color Doppler, Stress Echo, Pediatric Congenital Echo.
  • Digital X-Ray (18 templates): Chest PA/AP, KUB, Cervical Spine, Lumbar Spine, Skull, Pelvis with Hip, Extremities.
  • CT Scan (13 templates): NCCT / CECT Brain, HRCT Chest, CT Abdomen & Pelvis, CT KUB, CT Angiography.
  • MRI (14 templates): MRI Brain with DWI, MRI Cervical/Lumbar Spine, MRI Knee Joint, MRI Shoulder Joint, MRCP.
• 📄 7 NABH/ABDM IPD Discharge Summaries: General Medicine, General Surgery, Cardiology, Obstetrics & Gynaecology, Pediatrics & Neonatology, Orthopedics, and Day Care Surgeries.
• ✍️ 36 Master Clinical Narratives: Pre-written standardized medical narratives for Diagnosis Remarks, Hospital Course, In-Hospital Treatment, and Post-Discharge Instructions.
• 📋 13 Bilingual IPD Document Forms: High-Risk Operative Consent, General Inpatient Admission Consent, LAMA/DAMA Refusal, Blood Transfusion Consent, Patient Property Handover, and Financial Clearance.
• 🩺 29 OPD Doctor Clinical Templates: Speciality-wise examination findings, provisional diagnoses, final diagnoses, prescriber remarks, and follow-up advice.
• 🖨️ 3 OPD Prescription Print Layouts: Standard Header/Footer, Compact A5, and Pediatric specialized formats.

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7. Web Server & SSL Configuration (Apache / Nginx)

Point your virtual host DocumentRoot strictly to the public/ folder — not the project root.

Apache Configuration (/etc/apache2/sites-available/hospital.conf):

<VirtualHost *:80>
    ServerName hospital.yourdomain.com
    ServerAdmin webmaster@yourdomain.com

    DocumentRoot /var/www/html/eatria_client/hospital/public

    <Directory /var/www/html/eatria_client/hospital/public>
        Options -Indexes +FollowSymLinks
        AllowOverride All
        Require all granted
        DirectoryIndex index.php index.html

        <IfModule mod_rewrite.c>
            RewriteEngine On
            RewriteBase /
            RewriteCond %{REQUEST_FILENAME} !-f
            RewriteCond %{REQUEST_FILENAME} !-d
            RewriteRule ^(.*)$ index.php/$1 [L]
        </IfModule>
    </Directory>

    <IfModule mod_headers.c>
        Header always set Strict-Transport-Security "max-age=31536000; includeSubDomains; preload"
        Header always set X-Frame-Options "SAMEORIGIN"
        Header always set X-Content-Type-Options "nosniff"
        Header always set Referrer-Policy "strict-origin-when-cross-origin"
        Header always set X-XSS-Protection "1; mode=block"
    </IfModule>

    ErrorLog ${APACHE_LOG_DIR}/hospital_error.log
    CustomLog ${APACHE_LOG_DIR}/hospital_access.log combined
</VirtualHost>

Enable site and install free SSL certificate:

sudo a2ensite hospital.conf
sudo apache2ctl configtest
sudo systemctl reload apache2
sudo certbot --apache -d hospital.yourdomain.com

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8. File Permissions & Directory Hardening

The web server user (www-data) must have write access only to writable/ and public/assets/images:

cd /var/www/html/eatria_client/hospital

# Ensure subdirectories exist
sudo mkdir -p \
  writable/cache \
  writable/logs \
  writable/session \
  writable/uploads \
  writable/debugbar \
  public/assets/images

# Assign ownership
sudo chown -R www-data:www-data /var/www/html/eatria_client/hospital

# Secure permissions
sudo chmod -R 755 /var/www/html/eatria_client/hospital
sudo chmod -R 775 writable public/assets/images

# Lock down .env file
sudo chmod 640 .env
sudo chown www-data:www-data .env

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9. Automated Background Cron Jobs

Add the following background tasks using sudo crontab -e:

# Process ABDM Work Task Board Care Context Linking every 2 minutes
*/2 * * * * cd /var/www/html/eatria_client/hospital && php spark abdm:taskboard-sync > /dev/null 2>&1

# Push stored health records to ABDM Bridge every 5 minutes
*/5 * * * * cd /var/www/html/eatria_client/hospital && php spark abdm:push-sync > /dev/null 2>&1

# Prune old ABDM logs daily at 02:00 AM
0 2 * * * cd /var/www/html/eatria_client/hospital && php spark abdm:prune-logs > /dev/null 2>&1

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10. First Login & Hospital Customization

1. Open your browser: https://hospital.yourdomain.com/login
2. Sign in with your administrator credentials:
   • Username / Email: admin (or configured email)
   • Password: Admin@12345 (or configured password)
   • CAPTCHA: Enter the 4-digit code displayed on screen.
3. Once logged in:
   • Go to Setting → Hospital Profile (/setting/admin/hospital-profile) to customize your Hospital Name, Address, Contact details, GSTIN, and upload your high-resolution Hospital Logo and branded Login Wallpaper.
   • Go to Setting → Medical Templates (/setting/template) to review or customize your pre-loaded Pathology, Radiology, and Discharge layouts.

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11. Updating an Existing Installation

# 1. Navigate to project root
cd /var/www/html/eatria_client/hospital

# 2. Pull latest code from official repository
git pull origin main

# 3. Update Composer packages
composer install --no-dev --optimize-autoloader

# 4. Run database migrations (safe - skips already applied migrations)
php spark migrate

# 5. Seed newly added clinical templates (preserves existing hospital data)
php spark db:seed MedicalTemplatesLibrarySeeder

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12. Useful Spark CLI Commands

# Show all CLI commands
php spark list

# Run interactive automated installer
php spark hms:install

# Seed Medical Templates Library (Safe Mode)
php spark db:seed MedicalTemplatesLibrarySeeder

# Run pending database migrations
php spark migrate

# Rollback last migration batch
php spark migrate:rollback

# Synchronize ABDM Care Contexts & Health Records
php spark abdm:taskboard-sync
php spark abdm:push-sync

# Check database tables
php spark db:table hospital_setting

# Built-in development server (local only)
php spark serve --host 0.0.0.0 --port 8080

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13. Official Documentation & Support

• Ubuntu Installation Guide: docs/UBUNTU_INSTALLATION_GUIDE.md
• ABDM Care Context & FHIR Standards: docs/abdm/CARE_CONTEXT_AND_FHIR_STANDARDS.md
• Online Documentation Portal: https://www.e-atria.net/docs
• Website & Cloud Services: https://www.e-atria.net
• Software License: SOFTWARE_USE_LICENSE.md
• Technical Support & Turnkey Deployments: info@e-atria.net