Going live on ABDM and being ABDM-ready aren't the same thing. A small clinic can let patients scan its QR code and pull their ABHA details in at the front desk, and still be unable to send the prescription from that visit to the patient's health locker. The patient notices weeks later when the record never shows up in their app, and nobody at reception can explain why. Many clinics find that electronic medical records in India can be digital, and even connected to ABDM in one direction, without being able to send anything back.
Getting records ABDM-ready involves several separate steps, and different people handle each one. Most clinics finish one or two and assume they're done.
Four steps, usually handled by different people
1. The facility gets an identity. Someone at the clinic registers it on ABDM's Health Facility Registry (HFR) at facility.abdm.gov.in. ABDM's own procedure for verifiers explains that the person applying needs their own ABDM professional identity first, fills in the facility's details and services, signs digitally, and receives a 12-digit facility ID. Verifiers appointed by the state or UT then check the details. The same document is careful to say HFR "is not mandated to regulate or set standards" for facilities. That job belongs to laws like the Clinical Establishments Act. An HFR ID proves your clinic is listed. It says nothing about your records.
2. The software gets connected. Your clinic software needs to be integrated with ABDM. Vendor documentation describes this as staged: first ABHA creation and verification, then the ability to share records as a health information provider, then the ability to fetch records from elsewhere, with a security audit before going live. Find out which stages your vendor has completed in production, not just in the sandbox (ABDM's test environment).
3. Patients get linked. Each visit has to be linked to the patient's ABHA so that records land in the right place. Scan & Share, where patients scan a QR code to register at the OPD counter, handles identity. The consultation still has to be linked to the ABHA afterwards.
4. Records go out in a format others can read. For ABDM exchange, the National Resource Centre for EHR Standards publishes a FHIR R4 implementation guide with record types for OP consultations, prescriptions, diagnostic reports, discharge summaries, immunisations and wellness records.
In the scenario above, the clinic completed steps 1 and 3 but its software never reached step 2 as a record provider. Scanning the QR code worked. Sending the prescription back didn't.
ExaHealth is an ABDM-certified PHR and Health Locker. A clinic using it can link a patient's ABHA and, once the patient consents, receive records from other providers and send its own. It logs who opened each record and when, and tracks the clinic's activity for the Digital Health Incentive Scheme. We'd still expect you to check step 2 with us as with anyone else: find out which ABDM capabilities are live in production for your setup.
Structured versus unstructured
A common claim is that free-text records simply can't go through ABDM. That isn't accurate. The FHIR guide includes a HealthDocumentRecord profile specifically for unstructured historical health records, so a PDF discharge summary or scanned report can be shared.
What you lose with unstructured records is usefulness. A receiving doctor can open a PDF but their software can't read it: it can't chart a creatinine trend or check a new prescription against a recorded allergy. India's EHR Standards (notified in 2013 and revised in December 2016) recommend SNOMED CT for clinical terms, LOINC for lab observations and ICD-10 for classification. The more of your records follow those codes, the more useful they are to the next doctor and to your own clinic a few years from now. The same standards say records should be preserved for the patient's lifetime.
If you are unsure what your system produces, our EMR vs EHR explainer has a quick test.
Consent comes before sharing
ABDM doesn't store records centrally. Data stays with the facility or app that created it, and a consent manager handles requests between whoever holds records (the provider) and whoever wants them (the user). A patient approves each request. For the clinic, that means the front desk needs to explain, in about one sentence, what the patient is agreeing to. Many patients will turn it down if nobody explains why it helps them.
Don't rush the paper backlog
When a clinic digitises years of paper files under deadline, staff type history into free-text boxes to get through the pile. That gets the clinic digital, but the result is the least useful kind of digital record. A better split is to scan old files as documents (still shareable as documents through ABDM) and put the typing effort into coding active problems, allergies and current medicines for patients who still visit. That's a few fields per patient, not a full re-typing of their history.
ABDM readiness checklist
- Facility registered on HFR, details verified, and the 12-digit ID recorded in your software settings.
- Every doctor has a professional registry ID linked to their user account.
- Vendor confirms in writing which ABDM integration stages are live in production.
- Test: link a staff member's ABHA to a visit, issue a prescription, and confirm it appears in their ABHA app.
- Allergies, active diagnoses and current medicines captured as coded fields for returning patients.
- Old paper records scanned and attached as documents, not re-typed as free text.
- Access log showing who viewed or shared each record.
- A one-line consent explanation written down for the front desk.
- Data storage and breach process documented, ahead of the DPDP Rules' main obligations from around May 2027.
The test prescription is the most useful item on this list. If it shows up in the ABHA app, your setup works. If it doesn't, one of the integration steps is missing.
For a walk-through of ABHA linking and consent-based sharing, contact ExaHealth.
Two guides that pick up where this one stops: EMR vs EHR: What Indian Doctors Actually Need, and EHR Systems Explained: How They Work for Indian Clinics.
Sources checked
- ABDM: HFR standard operating procedure for verifiers (PDF)
- ABDM: Health Facility Registry sign-up
- NRCeS: EHR Standards for India
- NRCeS: ABDM FHIR implementation guide
- DPI Global: Ayushman Bharat Digital Mission overview
- Press Information Bureau: ABHA-based Scan and Share crosses 2 crore OPD registrations
- Press Information Bureau: DPDP Rules, 2025 notified (November 2025)