Department
Front Office & Registration
Everything the hospital knows about a patient starts at this counter, and almost everything that goes wrong later starts here too. A second record for a returning patient, a name spelled differently on the lab slip, a payer captured after the admission rather than before it: each of those is minutes at the desk and days in the claims file.
The front office does one thing that no other department can do for it: it decides who the patient is.
Impact and action
The queue.
- A walk-in queues at the counter while a clerk retypes a name, a phone number and an address that the hospital already holds from a visit two years ago.Registration searches the existing record first and opens a visit against it. A returning patient is recognised rather than re-entered, and the counter keeps the fields it actually needs.Gate
- Appointments live in a book, on a phone, or in a WhatsApp thread on a receptionist’s personal number, so nobody can say what tomorrow looks like until tomorrow.Outpatient appointments are booked and managed in one place, and confirmations and reminders go out on hospital-approved templates over an audited channel with a delivery log.GateRaven
The duplicate.
- The same patient exists three times: once from the emergency arrival, once from the outpatient visit, once from the scheme registration. No single record shows the whole history.One registration creates the one identity every tool reads. Atlas is the only tool allowed to hold the health information, so no other desk is able to start a second copy of the patient.GateAtlas
- ABHA creation is a separate errand on a separate portal, done later or never, and the incentive attached to it goes uncollected.ABHA creation and linkage attach to the record at the counter. Linkage stays voluntary for the patient and a refusal never obstructs treatment. [Source 25](/research#ref-digital-incentive)GateAtlas
The money that starts here.
- The payer is discovered at discharge. A patient admitted as cash turns out to hold cover, and the whole bill is repriced against a different tariff under time pressure.The payer, the scheme and the tariff are attributes of the visit from the moment it opens, and Vault prices against them from the first order onward.GateVault
- An enquiry arrives, is answered verbally, and disappears. Nobody can say how many people asked about a service and how many came.Enquiries are recorded against the counter that took them and are visible as a live view beside the appointment book.GateFalcon
What one registration feeds
One record, five desks, no second copy.
The published record
What happens when identity is left to each desk.
India's own national auditor has published what an unresolved patient identity produces at national scale. Source 10 The audit is about a payment scheme rather than about clinical care, which is exactly why it is the cleanest available evidence: the errors it counts are identity errors, and every one of them was created at a registration desk somewhere.
The counter is also a compliance boundary.
India's Digital Health Incentive Scheme pays a registered facility for each digitised record it links, above a monthly threshold. Source 25 That payment depends on the record being created once, correctly, at the point of registration, which makes the counter the place where the incentive is earned or lost.
Interdepartmental
Who reads what this desk writes.
A registration error is never contained in the front office. It surfaces somewhere else, usually days later, in a department that cannot fix it.
- The laboratory and imaging.A sample or a study matched to the wrong record is a result that reaches the wrong clinician. The order carries the identity, so the analyser result and the completed study come back to the record they were ordered from.
- The billing counter.A duplicate record splits one episode across two bills and one of them is never collected. The visit, its orders and its charges are the same object.
- The insurance and scheme desk.A claim is returned when the name on the document pack disagrees with the name on the policy. The pack is assembled from the record the counter created.
- Medical records.Two records for one patient means a discharge summary that is missing half the history. Deficiency tracking works only against one record per patient.
The tools this counter actually runs on.
The tags below appear on screens the front office uses every day. Each row is what the tool does at this desk, with the example the receptionist would recognise.
| Tool | What it does here | Example |
|---|---|---|
| Gate | Registers the patient, opens the visit, and books and manages outpatient appointments. | A returning patient is found by phone number, and a follow-up visit opens against the existing record. |
| Atlas | Holds the record the identity points at, and the consent and access history against it. | ABHA linkage and the patient’s consent to share are attached to the record at the counter. |
| Raven | Sends confirmations and reminders on an approved template over an audited channel. | A booking confirmation goes out on WhatsApp, and the delivery status is on the record. |
| Vault | Opens the financial side of the visit: payer, tariff, deposit. | An admission advance is receipted at the counter and appears on the final bill. |
| Glyph | Runs the forms the counter fills, with the validations the hospital wrote. | A consent form is signed off formally and locks the moment it is completed. |
| Falcon | Turns counter activity into a readable view. | Registrations by hour, so the second counter opens before the queue forms rather than after. |
At the counter
One arrival, in order.
Find, then create.
The clerk searches before adding. A match opens a visit on the existing record; only a genuine first attendance creates one.
Open the visit.
Outpatient, emergency, day care, ward admission or self referral. The kind of visit decides which desks are told and what the tariff is.
Attach the payer.
Cash, corporate credit, a third-party administrator, or a government scheme. The tariff follows from this, and so does the document pack the claim will need.
Offer the linkage.
ABHA creation and linkage are offered and recorded. A refusal is recorded too, and treatment proceeds unchanged.
Hand off.
The visit is now readable by the clinic, the laboratory, the pharmacy and the billing office. Nothing is re-keyed downstream.
Governance and security
The desk with the widest reach and the least training.
A registration clerk can search the whole hospital by name. That is the point of the counter, and it is also the largest standing access question an Indian hospital has, because this is the role with the highest turnover and the shortest induction.
Access is decided per action, per person.
Cirith decides for every single action whether a specific person may take it, and it treats the patient’s consent together with the hospital’s admission as the gate that unlocks a record. An administrator can look up everything one clerk can reach, look up who currently holds access to one patient’s record, and simulate a permission change before making it.
Leaving is one action, and it is logged.
A clerk who leaves on Friday loses access on Friday. Nexus holds the roster, the teams and the identities as a digital twin of the hospital, so a role ending in the roster ends the access with it, in the same transaction and in the audit trail.
Consent is captured once.
India’s data protection rules put purpose-limited consent, notice and breach duties on the hospital, on a dated clock. What makes them expensive is an architecture of separate registration, billing and pharmacy systems with no shared consent state. Consent is held on the record here, and every tool reads it from there.