Policy Update
Fatima Firdaus
Introduction
Against the backdrop of increasingly dynamic public service delivery systems, digital health solutions represent an important inclusive growth driver. India’s healthcare system, otherwise plagued by inefficiencies, has begun adopting digital technologies to enable access, transparency, and accountability. Of these, the Online Registration System (ORS) is a revolutionary program offering centralized and Aadhaar-linked online appointments at government hospitals. Launched in 2015 as part of the Digital India program, ORS bridges the gap between citizens and healthcare services, primarily in congested public hospitals.
Background
The ORS platform forms a significant part of the eHospital program, which runs on the National Health Portal (NHP) and is supported by the National Informatics Centre (NIC). It was created to tackle significant inefficiencies in outpatient department (OPD) registration, follow-up of patient records, and appointment issuance in government hospitals. Before the launch of the Online Registration System (ORS), patients had to visit hospitals in person—often at inconvenient times and in long queues—for registrations, reports, or prescriptions. A study found walk-in patients waited a median of 60 minutes, while ORS users waited just 15 minutes; only 29% of walk-ins were satisfied compared to 90% of ORS users (Kumar et al., ResearchGate, 2022).
ORS is Aadhaar-based online authentication and is linked to over 400 hospitals in India, including top institutions such as AIIMS Delhi, Safdarjung Hospital, and PGIMER Chandigarh. It aims to enable the government to achieve “One Nation, One Health Record.”
Objectives
- To facilitate patient registration and cut wait times within the hospital.
- To enable a centralized process for executing appointments within government hospitals that will support the healthcare system, become less bureaucratic, and more transparent.
- To promote interoperable patient records linked to Aadhaar.
- To support policy planning in the provision of summarized healthcare information.
Key Features
- Electronic Appointment Scheduling: ORS supports patient appointment scheduling by patients for authorized hospitals through the web or mobile interface.
- Aadhaar Integration: Aadhaar Authentication offers identity verification and avoids duplication.
- Reports and Prescriptions Access: Laboratory reports, diagnostic test results, and previous prescriptions are available to patients online.
- Real-Time Synchronization of Data: ORS synchronizes real-time patient data to enable efficient diagnosis and referral.
- Multi-Language Support: The site provides interfaces in several Indian languages for local accessibility.
- Mobile Optimization: ORS is accessible through mobile browsers, which makes it accessible even in low-resource settings.
Effects of the ORS Patient System
- 1. Expanded Health Care Access
ORS has changed the way patients interact with government hospitals. Individuals are no longer required to visit a hospital to simply get registered physically. Advance booking of appointments saves patients from the expense of traveling and loss of income due to waiting for hours on end. It has benefited especially the elderly, differently abled people, and women who suffer from physical and social mobility disabilities. The access to good hospitals such as AIIMS is also democratized, and the fair distribution of healthcare facilities among socio-economic communities is possible. - 2. Administrative Efficiency
Hospitals that implement ORS experience a 15-20% reduction in OPD overcrowding, especially at the registration counters. Electronic appointment records and patient waiting lists are advantages to hospital administrators in terms of facilitating efficient resource allocation and deployment. It also reduced the administrative burden of handling physical registers and facilitated paperlessness, which is cost-saving and eco-friendly. - 3. Improved Patient Results
Continuity of care is greatly enhanced as doctors can see patients’ electronic medical records (EMRs) between appointments. This reduces the chance of drug interactions and redundant tests. The system also allows for timely intervention in chronic conditions like diabetes, hypertension, or cancer, where historical medical information is crucial in determining treatment. Early results by NIC show that ORS saves 15–30% in time to initiate treatment for returning patients. - 4. Evidence-Based Governance
ORS generates big health data that enables government agencies to understand disease prevalence, hospital load, patient population, and seasonal trends in health. It enables data-driven decision-making in guiding public health policy, epidemic preparedness, and efficient budgeting. It provides real-time appointment statistics, making the system traceable and accountable to public audit. - 5. Savings to Patients and the Government
Travel, accommodation, and loss of income are major costs of accessing distant hospitals. Online registration and electronic patient information minimize these costs using ORS. Besides that, it decreases operational costs in hospitals regarding stationery, staff, and storage. As per the National Health Authority report, the cost was estimated at over ₹35 crores per year for all the integrated hospitals, simply due to a change from paper registration to ORS.
Challenges in Implementation and Accessibility
- 1. Digital Divide
While it has its merits, the majority of the Indian population, particularly the rural and tribal belts, lack smartphones, internet access, or digital literacy. Elderly patients, particularly in undeveloped states such as Bihar or Chhattisgarh, cannot cope with online systems. The urban-rural divide is sure to lead to digital exclusion in healthcare. - 2. Aadhaar Reliance and Data Privacy
While Aadhaar linking provides identity accuracy, it is problematic in terms of informed consent, exploitation of biometric information, and surveillance. Aadhaar-less individuals (e.g., homeless individuals, refugees, or migrants) are excluded from the system. Moreover, the absence of robust enforcement provisions for India’s data protection law (still pending under the Digital Personal Data Protection Act, 2023) is a factor in exposing patient data. - 3. Technical and Interoperability Issues
Indian hospitals utilize various implementations of Hospital Management Information Systems (HMIS), and their integration with ORS is a technical hurdle. There is no uniform data structure, and frequent server crashes hinder progress towards real-time capability. Small district-level hospitals lack the IT staff to provide system hygiene or respond to interruptions. - 4. Resistance from Hospital Staff
The shift from manual to computer systems needs extensive training and adjustment of attitude. The government hospital staff resists it because they are not familiar with it, or they fear losing their jobs, or simply because there are no incentives. Human resistance to technology hinders the complete integration and impacts the dependability of ORS services. - 5. Cybersecurity Threats
As it contains confidential health data, ORS is vulnerable to hacking, ransomware, and data breaches. The system is insecure with no multi-factor authentication, role-based access, and end-to-end encryption. In a recent CERT-IN audit, certain hospital systems were found to be operating with outdated software and weak firewalls, which require more robust cybersecurity solutions.
Case Studies
Case Study 1: AIIMS Delhi – Optimizing Urban OPD Load|
At AIIMS Delhi, one of the country’s most advanced tertiary-care hospitals, ORS decreased patient registration lines by a significant percentage. Before ORS in 2016, queues for OPD began to form as early as 4 AM every day. With the option of online booking, patients now arrive exactly at the time of their slots, decreasing physical crowding by more than 30% in major departments such as neurology and cardiology. Satisfaction levels among patients have gone up, and doctors face fewer no-shows, resulting in increased efficiency.
Case Study 2: PGIMER Chandigarh
Enhancing Rural Connectivity PGIMER Chandigarh, which serves a vast rural belt of Himachal Pradesh and Punjab, integrated ORS with a local mobile helpline. Older and digitally unschooled patients are registered for consultations by village health workers. During a half-year pilot in 2023, over 18,000 rural patients availed ORS services, and follow-ups showed a 40% increase in medical compliance because of better appointment and prescription tracking. The model is currently being recommended for scaling up in other states.
Way Forward
- Scaling Digital Infrastructure in Tier-2 and Tier-3 Cities: The government will have to enhance broadband penetration and provide digital infrastructure support to small hospitals.
- Inclusive Design and Support Programs: Create offline-supported models via community health workers for the digitally illiterate.
- Implement Comprehensive Data Protection Policies: Robust implementation of healthcare data privacy policies and stricter adherence to ABDM standards are the need of the hour.
- Ongoing Staff Training and Incentivization: Hospitals should be incentivized to upskill employees on digital technologies and incentivize early movers.
- Integration with UHI: Smooth integration of ORS with Ayushman Bharat Digital Health ID and Unified Health Interface (UHI) will promote an integrated, interoperable national healthcare ecosystem.
Conclusion
The ORS Patient System is a model of India’s journey towards digital and inclusive healthcare. Not only has it enhanced patient satisfaction and productivity in hospitals, but it has also laid the foundation for a digital national health platform. Systemic vulnerabilities can be numerous, such as those in data protection, infrastructure, and interoperability, but the ORS program illustrates how governance technology (GovTech) can transform public health delivery.
REFERENCES:
- ORS Patient Portal. (Accessed July 2025). Ministry of Health and Family Welfare, Government of India. Retrieved from: https://ors.gov.in
- Ayushman Bharat Digital Mission (ABDM). (2023). National Health Authority. Retrieved from: https://healthid.ndhm.gov.in
- National Informatics Centre (NIC). (2020). Digital India Initiatives in Healthcare: The ORS Platform. Ministry of Electronics and Information Technology. Retrieved from: https://www.nic.in
- NITI Aayog. (2021). Health System for a New India: Building Blocks – Potential of Digital Health. Retrieved from: https://niti.gov.in
- Kumar, A. & Singh, R. (2022). E-Governance in Indian Healthcare: A Case Study of ORS Portal. International Journal of E-Government Studies, 14(2), 45–58.
- The Hindu. (2023). Digital Health Revolution: ORS Transforms Hospital Queues in AIIMS and Safdarjung. Retrieved from: https://www.thehindu.com
- Indian Express. (2022). From Paper to Portal: How ORS is Changing Patient Experience in Government Hospitals. Retrieved from: https://indianexpress.com
About the Contributor
Fatima Firdaus is a Research Intern at IMPRI, currently pursuing MA in Human Rights at Aligarh Muslim University.
Acknowledgement
I sincerely thank Aasthaba Jadeja for assigning this work and providing consistent support throughout. I am also grateful to Anushka Verma, Anto Mariya and Anshu Saroha for their valuable reviews and critical insights.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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