The System Learns to Breathe

After the Applause

A presidential visit is a peak moment. It gives you a photograph, a memory, and a brief surge of pride. But the next morning, the hospital returns to its old truth.

Patients still crowd the OPD.
The wards still overflow.
The emergencies still arrive without warning.

If the HIS had to prove itself, it would not be in front of the President. It would have to prove itself on ordinary days, when nobody clapped, when nobody cared about “innovation,” and when the only thing that mattered was whether the patient’s report could be found at the right time.

In those ordinary days, the system began to mature.

Not dramatically. Not like a miracle.
It matured the way institutions mature: through repetition, irritation, small fixes, and reluctant acceptance.

The First Trust: Retrieval

One of the earliest moments when I felt the HIS had truly begun to matter was not during office hours. It was at night.

A patient with chest pain arrives at midnight. The resident is sweating, trying to decide quickly: is this an old patient? Has he been admitted before? What were his previous ECGs? Did he have diabetes? Was he already on aspirin? Did he have renal failure?

In the paper era, the answer depended on memory, luck, or a relative who carried a torn discharge card from a past admission. Many times, the information simply did not exist when it was needed most.

With the HIS, the resident could search by first name, last name, CR number, or village. Within a minute or two, the past record would surface on the screen. Not perfectly, not always complete, but far better than the old fog.

That change did something subtle. It gave young doctors confidence. It reduced guesswork. It made the hospital feel safer.

The Patient Learns the System

Our patients are mostly villagers. Many of them have lived lives that require endurance. They know how to wait. They know how to manage scarcity. They also know how systems fail.

What surprised me was how quickly many rural women understood the logic of the HIS.

Often, when we asked for old paper reports, they would point not to their bags, but to the desktop, the iPad, or the monitor near the nursing station. Their gesture seemed to say, almost teasingly, “Why are you asking me? It is all there.”

Many of these women had not studied beyond middle school. Some had never written a full sentence in English. Yet they trusted the screen because it gave them something paper never gave: security.

Paper gets lost. Paper gets wet. Paper tears. Paper disappears in the chaos of life.

The screen stayed.

The HIS did not just digitise the hospital. It changed patient behaviour. It changed expectations. It created a new kind of confidence: the belief that the hospital would remember.

The Cost of Change

None of this came without cost.

Change in a hospital is never neutral. Every new system steals time from someone. The question is always: whose time?

In our case, it was often the juniors. It was the interns filling both paper slips and digital orders. It was the nurses learning to type when their hands were already full. It was the lab technicians asked to trust machine-to-server transfers when they had lived their entire professional life signing registers.

The system also demanded emotional labour.

When I was in Berkeley, Bhavana carried a particular burden that few people noticed. She had to face department heads who were frustrated, cynical, and sometimes openly hostile. Many of them respected me, and some fell in line simply because the “Kalantri name” was attached to the project. That shield was absent when I was 13,000 kilometres away.

If a report got wrongly mapped to multiple patients, the Pathology Head would not write a gentle note. He would write an angry one. If ten consecutive patients showed malaria positive due to a bug, it was not seen as a “software issue.” It was seen as an insult to the department’s competence.

Bhavana would absorb those blows, and then she would call or email me, often at the end of a long day, when she was tired and still had a home to run.

She was not asking for sympathy. She was asking for partnership.

The Quiet Wins

The HIS did not win people over through speeches. It won them over through small reliefs.

A biochemistry attendant once had a job that sounded simple but consumed his life. He would carry reports to thirty-odd wards every day. Sugar, creatinine, liver function tests, electrolytes. Bundles and bundles. It took him three hours daily, walking, climbing, searching for the right bed, the right patient, the right file.

When reports became available on the system, that daily marathon shrank. The attendant still worked hard, but his work changed shape. He stopped being a courier and became a support worker in a different way.

In Pathology, residents who used to stay up till 2 a.m. copying sixteen parameters of a CBC for hundreds of patients began finishing earlier. Not because their workload reduced, but because the most mindless part of it disappeared.

Radiologists began using templates. Their reports became more legible, more consistent, and less dependent on handwriting that could be misread at the bedside.

These were not glamorous victories. Nobody cut a ribbon for them. But these were the wins that mattered because they returned time to the hospital.

And time is the most expensive currency in healthcare.

Transparency: The Bill That Could Be Read

One of the most powerful changes the HIS brought was not clinical. It was moral.

In many hospitals, the bill is a mystery. Families pay because they are afraid to argue. They do not know what they are paying for. They cannot separate necessity from padding.

With the HIS, our patients began receiving itemised, system-generated bills. The details were there. The numbers were visible. Even if the patient could not read every line, the family could. And the very fact that it was printed and structured created trust.

More importantly, it allowed patients to see something we had always believed in but could not always demonstrate: that MGIMS charged procurement cost plus a modest margin, not market price.

Families began noticing the difference. They began comparing. They began realising they were saving money without being short-changed on care.

This was not charity.
It was fairness, made visible.

The Hospital Becomes One Map

Before the HIS, the hospital functioned like islands.

The ward did not know what the lab was doing until the report physically arrived.
The pharmacy did not know the real-time consumption pattern until the stock ran out.
The administration relied on anecdotes, not data.

The HIS began connecting these islands.

Nurses could check whether an X-ray was ready without sending someone running. Residents could see whether blood was cross-matched without making ten phone calls. Departments began speaking through the system, not through messengers.

It did not make the hospital quiet. Hospitals are never quiet.
But it made the chaos more organised.

And slowly, the HIS stopped being a project and started becoming an atmosphere.

---