From Paper to Screens

The Seed from Lucknow

In 1999, I travelled to Lucknow to see a health informatics system developed by C-DAC at Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGI). Until then, I had read about hospital information systems, but seeing one in action was different. The speed, the order, the clarity of information, and the way it reduced confusion in the hospital impressed me deeply.

When I returned to Sevagram, the idea stayed with me. MGIMS was not a large metropolitan institute, and we did not have the luxury of unlimited resources. Yet I kept wondering why efficiency and accuracy should remain the privilege of big cities. If a hospital runs on discipline, then information should run on discipline too.

A Delhi Evening

Mr. S.R. Halbe played a pivotal role in turning this idea into something real. He arrived in Sevagram in the mid-1990s and quickly became someone who understood not only accounts and systems, but also people. In the winter of 2003, he called me to Delhi and took me to meet Arun Shourie, then the minister responsible for information technology.

We met him in his library, a room that looked as if it had been built for long conversations and difficult decisions. Although he was in the middle of a meeting, he gave us time. I spoke about MGIMS, about our hospital, and about our plan to implement a Hospital Information System. He listened with interest and promised support.

On 12 February 2004, Mr. P. Soreng from the ministry formally tasked C-DAC Noida with designing and implementing an HIS for MGIMS.

The paperwork moved quickly. The hospital did not.

The Year I Left, and the Year It Began

In August 2004, I left for Berkeley for my MPH. Before leaving, I handed over responsibility to Dr. Rajnish Joshi with a brief that sounded simple when spoken aloud: get HIS on hospital desktops by August 2005.

Bhavana was at the centre of this work. She also brought in Yogesh Khond, a young man who had lost his father to oral cancer and had started as an attendant in the Dean’s office. He had talent and hunger, and Bhavana recognised it early. In a project like HIS, the most valuable people are often not those with impressive degrees, but those who can learn quickly and stay steady when the system collapses.

Servers, Snails, and Small Humiliations

C-DAC selected a Java-based server that was said to be used by top banks. On paper, it sounded reassuring. On our campus, it behaved like an exhausted creature. It froze, slowed down, and sometimes refused to respond. Transactions failed. Screens hung. Printers jammed. The network crawled.

For interns and residents, ordering a test began to feel like waiting for a slow train that never arrives. In a busy hospital, delays are not just irritating. They become dangerous, because every delay adds pressure to a system already running at full capacity.

We were learning this the hard way.

On 11 August 2006, I wrote to C-DAC in frustration:
“We at MGIMS look forward to the server that would run, not crawl. Indeed, if the speed issue is set right, we will heave a huge sigh of relief!”

It was not a clever line. It was an exhausted one.

The Work Nobody Saw

In the early days, residents had to do double work. They filled the paper requisition forms as usual and also entered the same orders digitally, because the system needed testing. This meant extra time, extra fatigue, and extra resentment, especially during night duties.

C-DAC sent system analysts who stayed in Sevagram for two months. Our team took them to department after department, nearly fifteen of them, and patiently explained workflows. Some heads of departments were supportive. Some were cynical. Some became defensive and found faults in every screen. A few simply pushed the job onto the junior-most person, who did not fully understand how the department actually functioned.

After three months, a blow arrived that felt almost absurd. C-DAC informed us that the system analysts had resigned and left without submitting their report. The entire system analysis had to be repeated.

Bhavana had to face this at a time when I was away in Berkeley. She was not only dealing with software and servers. She was dealing with disappointment, anger, and the tiredness of repeating work that should never have been lost.

Bugs That Could Start a Riot

The bugs were many, and some were frightening. Once, the same lab report appeared in multiple patient records. In one ward, ten consecutive patients were shown as positive for malaria. The Pathology head wrote an angry letter. It was embarrassing, but more than that, it was alarming. A hospital information system cannot afford to be casually wrong. It has to be boringly reliable.

At that stage, we did not have a trained in-house technology expert. The C-DAC engineers were learning too. We were all learning while the hospital kept running, and that is what made it exhausting.

The First Resistance

The strongest resistance came from Pathology. They felt the system was a waste of time and energy. They demanded data entry operators, arguing that doctors and technicians should not waste time entering data. The institute refused, because the truth was simple: if a system is built on outsourced data entry, it never becomes part of hospital culture. It remains someone else’s burden.

Not everyone resisted. Dr. MVR Reddy in Biochemistry supported the system fully. Dr. Deepak Kumar Mendiratta, the Microbiology head, also stood by it and tolerated the teething troubles. The surgical departments were mostly indifferent. They did not fight the system, but they did not champion it either.

For Bhavana, the resistance was emotionally taxing. The system was slow and error-prone, and she had to face senior colleagues who were cynical and impatient. She was managing the home and the children, while carrying a project that had begun to feel like a test of endurance.

The Mouse on the Screen

C-DAC began with registration and insurance. For many clerks, it was their first encounter with a computer. They were nervous, curious, and eager.

During training, someone asked Prem Das, one of the clerks, to “click an icon.” He lifted the mouse and held it against the screen. For a second, everyone froze. Then the room erupted in laughter, Prem Das included. He laughed, then he learned. Within a week, the staff were comfortable with the keyboard and mouse.

And something quietly remarkable happened. Registering 1,500 patients took no more than three hours. In a hospital that had lived on paper, this felt like a new kind of order.

The Cost Everyone Paid

The cost of the HIS was not only financial. It was time, fatigue, and the strain of change in a hospital that was already stretched. Yet the hospital’s lowest rung, the people who actually do the work, stood by the system. Residents, technicians, pharmacists, nurses, ward staff, OPD staff, lab staff, kitchen staff, accounts staff, and administrative staff kept going, even when many wondered if the project was worth it.

We involved them because they understood how the hospital really functioned. When they felt included, the system slowly became theirs, not ours. That sense of belonging saved the project more than any server upgrade ever could.

Chalti Ka Naam Gaadi

Over the years, the HIS entered our lives in an intimate way. It followed us home, entered our conversations, and occupied our weekends. Like the film Chalti Ka Naam Gaadi, it began to feel like a family enterprise, full of teamwork, breakdowns, repairs, arguments, and strange humour.

Even today, when our Honda Jazz approaches the blind turn at the railway underpass between Sevagram and Pavnar, my granddaughters shout, “Baaju!” They are warning the car.

In our lives, the HIS was also a sharp turn. Once we took it, there was no going back.

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