A zero licence fee does not keep a hospital running at 2 a.m. Someone still owns registration, wards, lab and radiology handoffs, pharmacy stock, bills, claims, backups, upgrades, and incident response.
India has credible public and open-source hospital systems. They are not interchangeable free downloads. The first filter is eligibility; the second is operating ownership.
Decision summary
- NIC e-Hospital is described for government hospitals; do not infer private eligibility.
- eSushrut’s programme, version, deployment, and support route require facility-level confirmation.
- Bahmni removes a proprietary licence but leaves implementation and continuity work to the hospital or a partner.
- Hospital Copilot is a separate, demo-priced product rather than a free HMS.
The three routes buyers often mix together
| Route | What it is | First question |
|---|---|---|
| NIC e-Hospital | An as-is SaaS product described by NIC for government hospitals | Is this facility eligible, and what rollout and support are provided? |
| C-DAC eSushrut | A government-developed hospital-management system used in public health settings | What programme, deployment, support, and version is available to this facility? |
| Bahmni | An open-source hospital system combining clinical and operational components | Who will implement, host, secure, support, upgrade, and recover it? |
These routes can reduce proprietary licence cost. Only an answered operating model makes one usable.
What the official pages establish
NIC calls e-Hospital a cloud-based, as-is SaaS product for government hospitals. Its current module list includes registration, admission-discharge-transfer, billing, clinic, laboratory, radiology, store and pharmacy, operation theatre, dietary, laundry, and queue management. That is meaningful scope. It is not a promise that any private facility can sign up, receive every module, or avoid local rollout work.
C-DAC’s official health-informatics page describes eSushrut as a hospital-management system deployed across government health settings. A buyer should confirm the exact access path, current version, modules, implementation partner, hosting, and support for its institution. Public-sector use is not a private-hospital commercial contract.
Bahmni’s official site describes an open-source system built from multiple components for hospitals and clinics. It can be hosted on site without dependence on the Internet. That feature is useful in a low-connectivity setting, but the hospital owns local infrastructure and continuity unless a partner contract says otherwise.
Eligibility and ownership matrix
Fill this before a feature comparison.
| Decision | e-Hospital | eSushrut | Bahmni or other open source |
|---|---|---|---|
| Facility eligible | Licence permits intended use | ||
| Contract or programme owner | |||
| Implementation owner | |||
| Hosting and infrastructure owner | |||
| Security and patch owner | |||
| Interface owner | |||
| Migration owner | |||
| Training and go-live owner | |||
| Day and night support owner | |||
| Backup and restore owner | |||
| Upgrade and regression-test owner | |||
| Data-export and exit owner |
An empty cell is a deployment risk. It is not a saving.
Price the work that the licence omits
Build two totals: year one and a normal operating year. Keep unknown costs blank until the programme, implementation partner, or hospital supplies a figure.
| Cost row | Quantity and unit | Year one | Later annual | Owner | Evidence |
|---|---|---|---|---|---|
| Discovery, workflow mapping, governance | |||||
| Infrastructure, network, devices, power, hosting | |||||
| Configuration, approved customisation, master data | |||||
| Patient, clinical, billing, stock, document migration | |||||
| Lab, PACS, payment, accounting, payer interfaces | |||||
| Security testing, logging, incident handling | |||||
| Backup, restore tests, redundancy, recovery | |||||
| Training, super-users, floor support, downtime drills | |||||
| Upgrades, regression tests, release support | |||||
| Internal clinical, finance, quality, IT labour | |||||
| Complete export, archive, termination, transition | |||||
| GST and other applicable tax |
The HMS cost breakdown has a more detailed workbook. Put zero in a row only when someone has accepted the work and its cost.
Test a hospital journey, not a module menu
NABH’s hospital digital toolkit separates readiness, RFP, vendor evaluation, migration, UAT, SLA, infrastructure, backup, and go-live. That structure is more useful than asking whether a product “has pharmacy.”
Use one synthetic journey:
- Register a patient and resolve a possible duplicate.
- Move the patient from OPD to admission and then another bed.
- Place a lab and imaging order; process a corrected result.
- Prescribe, dispense, return, and trace a batch.
- Add services, cancel one charge, and reconcile the bill.
- Prepare discharge and the applicable payer or claim packet.
- Correct a signed record without erasing the original.
- Interrupt an interface or the network and show recovery.
- Export the complete encounter and audit evidence.
The test should identify the owner at each handoff. If two systems participate, the interface and its failure queue are part of the product decision.
Run a recovery drill
The normal demo proves the happy path. A hospital also needs evidence for the bad hour.
- Stop the application or network during registration.
- Record the local downtime workflow and temporary identifier rule.
- Restore service and reconcile duplicate or delayed entries.
- Restore a backup into an isolated environment.
- Compare patient counts, recent encounters, stock, bills, and audit events.
- Record the recovery time, data-loss window, decision owner, and unresolved differences.
Do not accept “backups are included” as the result. A restore log and reconciliation record are the evidence.
Turn modules into contractual questions
| Module or handoff | Contract question |
|---|---|
| Registration and ADT | Who resolves duplicates, merges, transfers, and downtime identities? |
| Laboratory | Who owns analyzer interfaces, corrected results, acknowledgment, and queues? |
| Radiology and PACS | Who owns worklists, report addenda, image links, and failed messages? |
| Pharmacy and stores | Who validates formulary, batches, expiry, returns, and stock reconciliation? |
| Billing and payer | Who configures packages, refunds, deposits, claims, and financial reconciliation? |
| Backup and recovery | What recovery time and data-loss window are contractual? |
| Support | Which hours, channels, severity rules, and escalation contacts are contracted? |
| Exit | Which complete exports, formats, delivery times, and transition services are included? |
Each answer should name the programme, hospital team, implementation partner, or vendor. Shared responsibility without named handoffs is an empty cell in a different form.
Open source is strongest with a real operating team
Bahmni can be a sound choice for a hospital that wants deployment control, can fund implementation, and has an accountable technical team or partner. It is risky when “community supported” substitutes for a named service owner.
The same principle applies to customisation. Every local change creates something the hospital must retest when upstream software or a connected system changes. Tie each change to a documented clinical or operational need.
ABDM does not fill the missing HMS modules
ABDM’s official FAQ says it does not recommend a particular HIS, HIMS, or HMIS. Its model is federated and consent based; providers retain their own records. ABDM can be an exchange requirement for a local hospital system. It is not the local registration, ward, lab, radiology, pharmacy, billing, or finance system.
Ask any programme or implementation partner to demonstrate the exact ABDM transaction needed, including consent, refusal, failure, and audit. Do not assume open-source code is production-integrated because a connector exists somewhere.
Patient Square’s hospital boundary
Patient Square is not a free HMS. Hospital Copilot is separately demo-priced. A hospital can deploy the complete Patient Square HIS/EHR or retain its existing HIS/EHR and define Hospital Copilot workflows during discovery. Neither path promises automatic filing or write-back into a named third-party system.
Registration, ADT, CPOE, eMAR, LIS, RIS, PACS, pharmacy, billing, interfaces, and other specialist workflows are requirements to scope and acceptance-test, not universal shipped claims.