Editorial Disclosure: This article is authored by CaladriusHealth.AI, a revenue-cycle and claims-intelligence platform. We are actively building toward ABDM and NHCX integration and have a commercial interest in the digital health infrastructure developments described. While we have made every effort to present an accurate and independently sourced analysis, readers should note this context. All data cited is drawn from publicly available sources listed at the end of this article.
A patient’s clinical records should travel with them through life. In India, the infrastructure to make that happen is still being built, and understanding what that requires starts with a problem that sits entirely upstream of insurance claims.
To illustrate what this gap looks like in practice, consider a hypothetical but plausible scenario: a patient undergoes a CT scan at a private hospital in Chennai. Three months later, after relocating to Pune, she visits a second hospital for a follow-up. The radiologist there has no access to her earlier imaging, no knowledge of her prior diagnosis, and no baseline to compare against. He orders a fresh scan. In such a scenario, the patient pays again for a duplicate procedure, and the clinical story effectively starts from scratch.
This hypothetical reflects a structural gap that peer-reviewed research has consistently documented: the evidence indicates that in the absence of shared clinical infrastructure, care continuity across India’s fragmented provider network is difficult to achieve in practice. [7] [9] Insurance reform alone does not address it. The Ayushman Bharat Digital Mission (ABDM), India’s national digital health initiative under the National Health Authority (NHA), was designed specifically to close this gap by building the shared infrastructure that allows patient records to travel with the patient. [18]
This article is the first in CaladriusHealth.AI’s series on India’s digital health stack. It focuses on the clinical data layer: what fragmentation looks like at scale, why it persists, and what ABDM’s architecture is designed to do about it.
A System Built Across Thousands of Independent Silos
India’s healthcare network is vast and structurally diverse. On the public side, the Ministry of Health and Family Welfare’s Health Dynamics report (2022–23) counts 1,69,615 Sub-Centres, 31,882 Primary Health Centres, 6,359 Community Health Centres, 1,340 Sub-Divisional Hospitals, and 714 District Hospitals. [1] The private sector operates across a similarly wide range; corporate chains, standalone tertiary hospitals, nursing homes, polyclinics, and solo-practitioner clinics, and accounts for a substantial share of India’s overall hospital bed capacity. [1]
Each of these facilities, public or private, operates largely as an independent information unit. Patient records, clinical notes, lab results, imaging, discharge summaries, and prescription histories are stored at the facility where they were generated, in whatever format that facility uses, under whatever filing system it maintains.
The private sector also accounts for a substantial share of outpatient care, with private providers estimated to handle approximately 80% of outpatient visits in India, a figure that varies by methodology and geography, but is broadly consistent with how care-seeking in India is structured. [3] The scale of this means the overwhelming majority of day-to-day clinical activity occurs outside any common digital infrastructure.
The diagnostic layer compounds this further. India’s laboratory ecosystem is large and highly fragmented, with NABL accreditation, the benchmark for quality assurance, covering only a fraction of the overall lab universe. [4] The records these facilities generate typically do not flow into any shared system. They stay with the patient as a physical printout, or remain with the ordering facility.
Electronic Records: Adopted by the Few, Absent for the Many
The natural counterargument is that electronic health records (EHR) would solve this. And they would, if adoption were widespread. It is not.
Fully paperless EHR implementation across India’s hospital network remains very low, with significant penetration limited to a small segment of facilities. [5] Globally, the contrast is stark: the United States moved from 9.4% EHR adoption in 2008 to 96% by 2017 through the HITECH Act’s financial incentives and meaningful use mandates; China went from 18.6% in 2007 to 85.3% in 2018 through centralised policy requirements. [5] In India, sophisticated deployments at the HIMSS EMRAM Stage 6 level remain concentrated at large corporate hospital chains, with limited penetration beyond them. [5]
India’s interoperability standards are defined through the FHIR Implementation Guide for ABDM, maintained by NRCeS, a C-DAC body, with version 6.5.0 published in 2024. [6] It mandates ICD-10, SNOMED CT, LOINC, and HL7 FHIR R4 as the coding and transport standards for all clinical data exchanged across the ABDM ecosystem. [6] Compliance requires facilities to have EHR software capable of generating structured, coded records, a capability that remains limited outside large hospital chains. [5]
Where EHR adoption is this constrained, paper-based records remain the prevalent mode for a significant share of healthcare interactions. Patients in India routinely move across public, private, formal, and informal providers, and their clinical history often does not follow them. [7] As one peer-reviewed assessment puts it: “One of the biggest barriers in primary health care has been the lack of longitudinal patient data. People often visit multiple providers, government and private, formal, and informal, without any continuity of records.” [7]
ABDM’s mandate was framed specifically around this gap, addressing deep structural fragmentation across payers, providers, service levels, and the digital infrastructure connecting them, not simply creating a registry of health accounts. [9]
Two Fragmentation Problems, And Why Conflating Them Creates Confusion
India’s health technology policy conversation now recognises two distinct fragmentation problems, each requiring a different solution.
Claims fragmentation describes the gap that prevents hospitals, insurers, third-party administrators (TPAs), and government schemes from exchanging claims-related information through a common, standardised channel. Each payer has historically operated its own proprietary portal with its own data format, submission process, and adjudication logic. NHCX went live in June 2024 [16], and IRDAI has formally urged all insurers and providers to onboard. [17]
Clinical data fragmentation describes the gap that prevents a patient’s medical records from traveling between providers, not a billing problem, but an infrastructure challenge that requires a shared patient identifier, a unified provider directory, a consent mechanism, and EHR interoperability standards to solve. ABDM’s Health Information Exchange and Consent Manager (HIE-CM) addresses this layer.
These are architecturally distinct gateways. NHCX and HIE-CM are two of the three core digital gateways within ABDM, the third being UHI (Unified Health Interface), which handles service discovery and transactions. [8] NHCX standardises message exchange for cashless claims processing. HIE-CM enables consent-based sharing of clinical health records between providers, without any claims context required. [8]
Understanding which problem a given initiative is solving matters for hospital CIOs and health IT teams deciding where to direct integration resources and technology investment.
What ABDM Was Architecturally Built to Do
ABDM’s response to the clinical data problem rests on four interconnected components.
ABHA (Ayushman Bharat Health Account) is a 14-digit unique health identifier that any resident can register for. [18] It functions as the patient’s anchor identity across the ABDM ecosystem, designed to enable clinical records from multiple providers to be linked to a single, patient-controlled account, subject to consent and facility integration. By March 2026, over 86.64 crore (approximately 866 million) ABHA numbers had been created, [19] up from 79.71 crore in August 2025 [10], a growth of over seven crore registrations in under eight months.
The Health Facility Registry (HFR) is a verified directory of healthcare facilities, public and private, enrolled on ABDM. As of July 2025, 4.17 lakh facilities were registered, forming the foundation for routing health information between providers. [10]
The Health Professional Registry (HPR) performs the same function for individual practitioners, with 6.76 lakh professionals registered as of the same period. [10] Together, HFR and HPR create the provider-side directory infrastructure that any national data exchange requires.
The HIE-CM (Health Information Exchange and Consent Manager) is the gateway through which clinical records actually move. Under this model, a patient controls who can access their records and for how long, consent is explicit, time-bound, and revocable. Records are not stored centrally; ABDM operates on a federated architecture [11] where data stays at the originating facility and is shared, on consent, through the exchange layer. No single repository holds all of a patient’s data. [11]
Linked health records reached 90.70 crore by March 2026, up from 65.09 crore in mid-2025, nearly 40% growth in under eight months. [19] On facility software, two figures exist that reflect different measures: as of July 2025, approximately 3.2 lakh facilities were equipped with ABDM-enabled software [10] while a March 2026 Rajya Sabha reply cited 2,56,542 facilities as actively using it [19], the gap reflecting the difference between deployment capacity and verified active use.
The operational impact is beginning to show at the facility level. The Scan-and-Share feature, allowing outpatient departments to digitally retrieve patient details via ABHA, had been deployed across 17,481 facilities by November 2024, generating 6.64 crore digital tokens and reducing OPD wait times from 30–40 minutes to approximately 5–10 minutes at integrated facilities. [12]
Where the Work Continues
Scale of account creation is a meaningful indicator of adoption momentum, but it is not the same as functional interoperability. Several areas warrant attention.
HFR registration has progressed significantly, but verification of registered facilities and inter-state variation in both HFR and HPR uptake continue to affect the network’s completeness and practical reach as a clinical data exchange layer. [9] Progress is uneven across states, and monitoring state-level uptake remains an important part of assessing overall readiness.
On the EHR software side, 4.17 lakh facilities are registered on HFR, but only 2,56,542 are actively using ABDM-enabled software as of March 2026, indicating that software integration is still ongoing. [19] For HIE-CM to function as a genuine longitudinal record system, facilities must be able to push records into the exchange in structured, FHIR-compliant formats. That capability is still being built out, particularly across smaller private facilities and rural public facilities.
On the patient side, a substantial portion of India’s population lacks consistent internet connectivity, potentially running into hundreds of millions of people, based on NFHS survey data and telecom subscriber figures. [15] A consent-based digital exchange requires an internet-connected patient to function fully, which means ABDM’s clinical data layer is currently more accessible in urban and semi-urban settings than in rural areas.
None of these are unexpected challenges for a national-scale digital infrastructure programme at this stage. They are the areas where the next phase of implementation is focused.
Why This Matters for Hospital and Health IT Leaders
For hospital CIOs and health IT teams, the clinical data fragmentation problem is not an abstract policy issue. It has a direct operational dimension: how records are generated, stored, structured, and, progressively, expected to be shared.
ABDM’s federated model means hospitals remain the custodians of the records they create. [11] Integration does not require surrendering data to a central repository. It requires enrolling on HFR, adopting FHIR-compliant structured record formats, and enabling the HIE-CM consent mechanism, so that when a patient consents to share their records with another provider, the exchange can happen programmatically rather than through a courier or a photograph of a discharge summary sent via messaging app.
The scale of the opportunity is significant. India’s digital health market was valued at approximately US$8.8 billion in 2024 and is projected to reach nearly US$47.8 billion by 2033, at a compound annual growth rate of approximately 17.67%. [13] A January 2026 World Economic Forum analysis frames ABDM as the foundational infrastructure enabling this growth, noting that as of late 2025, more than 834 million citizens hold ABHA digital IDs, with approximately 4.38 lakh health facilities and 7.38 lakh professionals registered. [14]
In practical terms, this means mapping current Hospital Information System, Laboratory Information System, and PACS infrastructure against ABDM’s building blocks, prioritising FHIR-ready modules, and planning HIE-CM and NHCX integrations as parallel but distinct workstreams, each serving a different operational goal.
The Problem That Comes Before the Solution
Any discussion of digital health in India benefits from clarity about what problem is being solved. ABDM was not built to fix insurance claims. NHCX was built for that. ABDM was built to address a deeper and older challenge: the absence of any mechanism for clinical information to follow a patient across the providers, geographies, and life stages that define real healthcare journeys. [8] [18]
The infrastructure, ABHA, HFR, HPR, HIE-CM, is the shared substrate that makes continuous, longitudinal, consent-governed health records possible at national scale. The adoption trajectory indicates that this substrate is being progressively built, with clear momentum at the account and facility level [10] and meaningful work continuing at the interoperability and integration layer. [9]
The next articles in this series move from infrastructure to implementation, examining ABHA from the patient’s perspective, the registry layer that makes every ABDM transaction legitimate, how clinical data actually flows under the HIE, and the consent architecture that puts patients in control. Each article is aimed at a different team navigating India’s digital health transition.
CaladriusHealth.AI covers India’s health technology landscape with a focus on ABDM, NHCX, medical billing, and AI in healthcare. This article is part of a series on India’s digital health infrastructure.
Sources
[1] Ministry of Health and Family Welfare — Health Dynamics of India (Infrastructure and Human Resources) 2022–23 | PIB | Sep 2024
https://www.pib.gov.in/PressReleasePage.aspx?PRID=2053070
[2] India Brand Equity Foundation (IBEF) — Healthcare Industry Analysis | Updated 2025/26
https://www.ibef.org/industry/healthcare-india
[3] Ghia C et al. — Implementation of Equity and Access in Indian Healthcare: Current Scenario and Way Forward | Journal of Market Access & Health Policy (PMC) | 2023
https://pmc.ncbi.nlm.nih.gov/articles/PMC10044314/
[4] National Accreditation Board for Testing and Calibration Laboratories — NABL Launches New Medical Application Portal for ISO 15189:2022 Laboratories | PIB | Aug 2025
https://www.pib.gov.in/PressReleasePage.aspx?PRID=2158005
[5] Centre for Policy Research — Rapid Adoption of Electronic Health Records: Paths and Pitfalls | Jun 2022
https://cprindia.org/wp-content/uploads/2022/06/Policy-Brief_Electronic-Health-Record_9-June-22_Final_Web-Version.pdf
[6] National Resource Centre for EHR Standards (NRCeS), C-DAC — FHIR Implementation Guide for ABDM v6.5.0 | 2024
https://nrces.in/ndhm/fhir/r4/index.html
[7] PMC — Digital Foundations for Health Equity: Rethinking Primary Care Through the Ayushman Bharat Digital Mission | 2025
https://pmc.ncbi.nlm.nih.gov/articles/PMC12349786/
[8] Sharma RS, Rohatgi A, Jain S, Singh D — The Ayushman Bharat Digital Mission (ABDM): Making of India’s Digital Health Story | CSI Transactions on ICT / PMC | 2023
https://pmc.ncbi.nlm.nih.gov/articles/PMC10064942/
[9] Mishra US, Yadav S, Joe W — The Ayushman Bharat Digital Mission of India: An Assessment | Health Systems & Reform | 2024
https://pubmed.ncbi.nlm.nih.gov/39437234/
[10] Business Standard — Over 790 mn ABHA Accounts Created, 650 mn Health Records Linked: Centre | 1 Aug 2025
https://www.business-standard.com/india-news/over-790-mn-abha-accounts-created-650-mn-health-records-linked-centre-125080101224_1.html
[11] National Health Authority — Health Data Management Policy | ABDM Publications | Apr 2022
https://abdm.gov.in/publications/policies_regulations/health_data_management_policy
[12] Press Information Bureau — Update on Ayushman Bharat Digital Mission — Scan-and-Share metrics, OPD wait reduction | Nov 2024
https://pib.gov.in/PressReleaseIframePage.aspx?PRID=2081482
[13] Custom Market Insights — India Digital Health Market Size, Trends and Forecast 2024–2033 | 2024
https://www.custommarketinsights.com/report/india-digital-health-market/
[14] World Economic Forum — India Shows Health and Digital Health Is the Best Investment | Jan 2026
https://www.weforum.org/stories/2026/01/digital-health-investment-india/
[15] Digital Health News — The Digital Divide in Health: Who’s Left Behind in India’s Digital Health Push | Jan 2026
https://www.digitalhealthnews.com/the-digital-divide-in-health-who-s-left-behind-in-india-s-digital-health-push
[16] NATHealth — National Health Claims Exchange Industry Report | Jun 2025
https://nathealthindia.org/wp-content/uploads/2025/06/National-Health-Claims-Exchange_Latest.pdf
[17] Press Information Bureau — NHA Organises Workshops on ABDM Integration and NHCX Adoption with IRDAI | Nov 2023
https://pib.gov.in/PressReleasePage.aspx?PRID=1976957
[18] ABDM Official Portal — National Health Authority
https://abdm.gov.in/
[19] Rajya Sabha — Unstarred Question Reply on ABDM Implementation — ABHA registrations, linked records, and active facility software usage | Mar 2026
https://sansad.in/