Hospital Management

HL7 FHIR (Fast Healthcare Interoperability Resources) is the modern standard for healthcare data exchange. It defines Resources (standardised data models) like Patient, Observation, Condition, Medication, DiagnosticReport — and RESTful APIs to exchange them. Why it matters: Previously, every HMS stored data differently. A patient's records at Apollo couldn't be read by Fortis. HL7 v2 (older standard) used pipe-delimited messages — hard to work with. FHIR uses JSON/XML + REST — modern developers can build with it easily. In India: ABDM (Ayushman Bharat Digital Mission) mandates FHIR R4 for all health record exchange. When a patient shares their ABHA health records, those are FHIR Bundles. Key resources: Patient, Encounter (visit), Observation (vitals/lab results), DiagnosticReport, MedicationRequest (prescription), Condition (diagnosis), AllergyIntolerance. FHIR Terminology: HIP (Health Information Provider) = hospital creating records; HIU (Health Information User) = entity requesting records (doctor, insurer); ABHA (Ayushman Bharat Health Account) = patient's digital health ID.

HMS (Hospital Management System): Comprehensive operational system managing the entire hospital — patient flow, bed management, billing, pharmacy, inventory, HR, finance. Primarily focused on hospital operations. EMR (Electronic Medical Record): Digital version of a patient's medical record within one provider/hospital. Contains clinical data from that institution — diagnoses, medications, lab results, notes. Provider-centric — not easily shared outside. EHR (Electronic Health Record): Broader than EMR — designed for cross-institutional sharing. Contains longitudinal health record across multiple providers. Interoperable by design (FHIR, HL7). In India, ABDM's PHR (Personal Health Record) is the government's EHR initiative — patients own their records in their ABHA account. Hierarchy: HMS contains an EMR module → EMR data can be shared as EHR via ABDM/FHIR. In practice, many people use EMR and EHR interchangeably in India. Technically: EMR = single facility, EHR = shareable across facilities.

Requirements: Live bed availability, bed assignment for admissions, housekeeping status tracking, ICU vs ward differentiation. Data model: Bed (id, ward, type, features), BedStatus (AVAILABLE/OCCUPIED/CLEANING/MAINTENANCE), Patient-Bed Assignment (patientId, bedId, admissionTime, dischargeTime). Real-time updates needed: 1) Admission: Bed status → OCCUPIED. 2) Discharge: Bed status → CLEANING (housekeeping notified). 3) Housekeeping completes: Bed status → AVAILABLE. 4) Maintenance issue: → MAINTENANCE. Tech: WebSocket / SSE for real-time dashboard push to nurses and admissions desk. Redis for live bed status cache — sub-second reads. PostgreSQL for historical occupancy data. API: GET /api/v1/beds/availability returns live bed count by ward and type. Allocation algorithm: When bed requested, find best match: requested type (ICU/private/general) → nearest to nursing station → recently cleaned preference. Dashboard: Colour-coded floor plan — green (available), red (occupied), yellow (cleaning). Integration: Housekeeping app for status updates, nurse station for patient monitoring, billing for room charge calculation, ADT triggers for ABHA PHR update.

India-specific: 1) IT Act 2000 / DPDP Act 2023: Patient data is sensitive personal data — requires explicit consent for collection and processing. 2) Clinical Establishments Act: Mandates record keeping for minimum periods (typically 5 years for clinical records). 3) ABDM Health Data Management Policy: ABHA-linked data must follow consent-based sharing via ABDM framework — patients control their records. 4) Drug and Cosmetics Act: Pharmacy records must be maintained per Schedule A. Security requirements: 1) Role-based access control (RBAC): Doctor sees only assigned patients; billing can't see clinical notes; pharmacist sees only prescriptions. 2) Audit trail: Every record access/modification logged with user, timestamp, IP — immutable audit log. 3) Encryption: PHI encrypted at rest (AES-256) and in transit (TLS 1.3). 4) Consent management: ABDM mandates patient consent before any 3rd party can access records — logged and revocable. 5) Data residency: Health data must be stored in India (per MeitY guidelines). In US: HIPAA (Health Insurance Portability and Accountability Act) — strict penalties for PHI breach. 21 CFR Part 11: FDA requirement for electronic records in pharma/clinical trials — audit trails, electronic signatures.

ABDM (now NHA — National Health Authority) is India's digital health infrastructure. Key components: 1) ABHA (Ayushman Bharat Health Account): 14-digit unique health ID for every Indian. Created via Aadhaar OTP or driving license. Like UPI ID but for health. Currently 50Cr+ IDs created. 2) Health Facility Registry (HFR): Database of all hospitals, clinics, labs in India — each with unique facility ID. 3) Healthcare Professional Registry (HPR): All doctors and healthcare workers with unique ID. 4) PHR (Personal Health Record) App: Health Locker where patients store their records — linked to ABHA. (Like DigiLocker but for health records). 5) ABDM Gateway: Middleware connecting Health Information Providers (HIPs = hospitals creating records) and Health Information Users (HIUs = entities requesting records). Technical flow: Doctor orders discharge summary → HMS creates FHIR Bundle → uploads to ABDM as HIP → Patient notified in PHR app → Patient consents to share with another hospital (HIU) → ABDM Gateway facilitates transfer. Integration for developers: 1) HIP APIs to push FHIR records. 2) ABHA verification API for patient identity. 3) Consent Manager APIs for patient consent workflows. 4) Discovery APIs to find records for a patient across facilities.