Krishna
Founder, ShylCare
I spend a lot of time talking to hospital administrators across India — from 200-bed multi-specialty setups in Pune to 15-bed nursing homes in small-town Maharashtra. The picture of digital health in India in 2026 is genuinely interesting, but it's not the picture you'll read in press releases.
Here's what I'm actually seeing on the ground.
The Ayushman Bharat Digital Mission has made genuine technical progress. The Health Facility Registry works. ABHA number generation is smooth. The consent framework for sharing records between providers is well-designed on paper.
But adoption is another story.
Large hospital chains in metros have integrated ABDM because they have the IT teams to do it. Government hospitals are integrating because they have to. But the vast middle — private hospitals between 10 and 100 beds — most haven't started. Not because they're resistant, but because their software vendors haven't built the integration yet, or because the operational benefit isn't clear enough to justify the effort today.
The ABDM team knows this. They're working on making integration easier (the sandbox has improved a lot in the last year), and the push toward making ABDM a condition for more government scheme participation is the real forcing function.
My honest take: ABDM will reach meaningful adoption, but we're looking at 2028-2029 before it's truly widespread outside tier-1 cities.
The Unified Health Interface is ABDM's more ambitious sibling — the idea that you could discover and book healthcare services through an open protocol, the way UPI works for payments.
It's a genuinely good idea. Imagine a patient searching for an orthopaedic consultation near them and seeing availability across hospitals, clinics, and teleconsultation providers — all through one interface.
The reality? UHI is still very early. The protocol exists, a few integrations have been piloted, but there's no consumer-facing momentum yet. Most patients still discover hospitals through Google Maps, word of mouth, or Practo. UHI needs the same kind of government push and private-sector incentive structure that made UPI work.
I think UHI has a 50-50 chance of becoming meaningful in the next five years. The technical foundation is there, but the go-to-market challenge is enormous.
The Digital Personal Data Protection Act is the one most hospitals haven't thought about yet, and probably should.
DPDPA applies to health data. If you're a hospital processing patient data — which you obviously are — you are a "Data Fiduciary" under the act. This means consent requirements, data minimisation, breach notification obligations, and patients' right to have their data erased.
Most small hospitals currently operate with zero formal data governance. Patient records are on shared WhatsApp groups, lab reports are sent via personal phones, and there's no audit trail for who accessed what.
When DPDPA enforcement begins in earnest, this will be a problem. Cloud-based EMR systems with proper access controls and audit logs will shift from "nice to have" to "you need this for compliance."
I don't say this to be alarmist — enforcement will take time, and initial focus will likely be on large organisations. But the direction is clear: informal data handling in healthcare has an expiry date.
Here's something that surprises people: most hospital administrators under 45 are perfectly willing to use cloud software. The "I want my server in my building" crowd is aging out. The resistance has shifted from mindset to infrastructure.
In tier-1 cities, reliable broadband and 4G/5G backup make cloud EMR practical. Internet outages are rare and short. Hospitals run cloud systems the way they run cloud email — it just works.
In tier-2 and tier-3 towns, the story is different. I've spoken to hospital owners who want to use cloud software but deal with 2-3 hour internet outages weekly. Their 4G backup is on BSNL, which is... well, BSNL. Running a hospital on software that goes down when the internet goes down is a non-starter when you have patients in front of you.
This is improving — Jio's fibre expansion, Airtel's 5G rollout — but it's improving unevenly. The gap between a tier-1 city and a small town in terms of internet reliability is still about 3-5 years.
For us as software builders, this means thinking about offline-capable designs, graceful degradation, and not pretending that "just get a backup connection" is an answer for everyone.
AI in healthcare is the topic everyone wants to talk about. Here's what's actually useful today versus what's still a demo:
Actually useful right now: AI-generated discharge summaries, clinical documentation assistance, prescription auto-suggestions based on diagnosis. These save doctors real time on administrative work and the quality is good enough to be helpful.
Getting useful: AI-assisted radiology reads (flagging abnormalities for review), lab result interpretation summaries, clinical decision support for common conditions. These work but need careful guardrails — you can't have an AI making clinical decisions without a doctor reviewing them.
Still mostly demos: Fully autonomous clinical AI, AI-driven diagnosis without physician involvement, predictive models that actually change clinical decisions at scale. The technology might work in a research lab, but the regulatory framework, liability questions, and physician trust aren't there yet.
The practical opportunity right now is reducing administrative burden. Indian doctors see 40-60 patients a day. Anything that saves them five minutes per patient on paperwork is genuinely valuable.
India's digital health trajectory is real. The building blocks — Aadhaar for identity, UPI for payments, ABDM for health records — are architecturally sound. The government's intent is clear. The technology exists.
What's missing is the last mile. Getting the 150,000+ small and mid-size hospitals across India to actually adopt these systems is a distribution problem, a training problem, and an affordability problem, not a technology problem.
The companies and products that win in this space will be the ones that meet hospitals where they are — not where the press releases say they should be.
This is the future we're building toward at ShylCare. Come see where we are today.
We'll walk through your actual workflows — no generic demo, no slide deck.