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SUTRA

sutra: Sanskrit for “thread”

Follow-through for cancer care,on top of what a hospital already has.

Doctors already decide the plan, and hospitals already hold the records. SUTRA connects the steps in between, from booking and reminders to reports, follow-up and visibility, without replacing the systems a hospital’s teams use today.

One thread runs through a patient’s care, from the plan a doctor signs to the day the treatment happens. Every figure on this site is sourced.

Cancer care is continuous.The record of it isn’t.

ABHA, the national health ID, gives India the foundation for a lifelong health record. Inside most hospitals, though, a cancer patient still moves from the outpatient department, the OPD, to the lab, the pharmacy and back, through paper, phone calls and systems that do not talk to each other.

Same patient.
Different systems.
Too many gaps.

Patient

It starts with a person.

OPD paper
OPD

A visit is logged, maybe.

Lab tests paper
Lab tests

Reports live in another system.

??
Diagnosis paper
Diagnosis

Critical information, often on paper.

A phone call

“Sir, report WhatsApp kar dijiye?”

Pharmacy paper
Pharmacy

Yet another system.

Scheduling paper
Scheduling

Often done by hand.

Surgery paper
Surgery
?
Follow-up

Will they come back?

Systems don’t talk. People fall through.

2.72 lakh

of 5.33 lakh registered facilities run software connected to ABDM, the national health record network1

9 of 10

district hospitals ordered to computerise OPD registration still did it by hand2
  1. MoHFW via IBEF, 13 Jul 2026
  2. CAG Uttar Pradesh, 2024

Planned steps slip between desks.Nobody sees it until it is late.

This is one ordinary week in the oncology unit of a district hospital. Every step was planned correctly, and several of them still did not happen.

  1. Monday · the OPD

    The doctor writes “CBC before cycle 4” on each patient’s slip. A CBC is a routine blood count, but the slip does not say where to have it done or by when.

  2. Wednesday · the lab

    Three caregivers bring patients to the lab in the afternoon. The lab stopped taking samples at 11, so they are sent home and told to come back.

  3. Friday · day care

    Two chemotherapy chairs stay empty at 09:00 because the blood reports have not arrived. One of them was Meena’s, so her cycle 4 is pushed back by a week.

Every instruction in that week was right. None of them was turned into a booked slot with a report due in time.

An empty chemotherapy chair
CBC before
cycle 4

1 in 7

scheduled chemotherapy visits at AIIMS Delhi were missed; 3.4% of all visits were missed because the tests before chemotherapy were not done in time (a children’s cancer series)1

33.5%

of cervical-cancer patients who finished treatment were lost to follow-up, Guwahati, 2017 to 20222

14–30%

of breast-cancer patients lost to follow-up in 5 years3
  1. Cancer Reports 2020
  2. Eur J Obstet Gynecol 2024
  3. BIACH&RI 2025

Every desk has its own system.None of them holds the plan.

A paper OPD registerA closed hospital system on a screen

The plan lives on a
slip of paper.

Most systems are closed, or there is none.
The large state hospital systems do not let outside software connect to them. Many district hospitals have no system at all and still run on paper registers and a spreadsheet.
ABHA exists, but most care never touches it.
Two in three Indians now have an ABHA. But only half of registered facilities run software linked to ABDM, the national network that carries those records.
Mandates are arriving faster than software.
Medical colleges and hospitals in PM-JAY, the national health insurance scheme, are being told to connect to ABDM. That will only happen when the tools staff use every day create and link ABHAs as part of their normal work.

93 crore+

ABHA accounts, with 104 crore+ health records linked4

~450

medical college hospitals flagged for not integrating with ABDM5
  1. PIB, 6 Jul 2026
  2. NMC notices, Jul 2026

SUTRA sits on top of the hospital’s systemsand follows the plan through.

SUTRA reads the register or the EHR, the electronic health record, and books through the hospital’s scheduler. An engineer from our team sets it up on site in thirty days.

Who keeps what

  • The EHR or register keeps the patient’s identity and the clinical record.
  • The hospital’s scheduler keeps the free slots and the confirmed bookings.
  • ABDM keeps consent and the national record when the patient has an ABHA.
  • SUTRA keeps the signed plan, the messages and a log of every step.

If a system is missing, open source fills the gap

  • No EHR? The hospital can use Bahmni, an open-source hospital system built in India.
  • No scheduler? Bahmni’s appointments module can take bookings.
  • No lab or pharmacy system? OpenELIS and Odoo, open-source lab and pharmacy systems, come with Bahmni.
  • Only paper? Pages are photographed, read by OCR (optical character recognition) and checked by a clerk.

Nothing leaves the hospital without a doctor’s signature and the patient’s consent.

The doctor sees the whole history,and signs one plan for six months.

In the consultation room, the unit’s oncologist, Dr Kulkarni, sees the history from every hospital on one screen, with a source on every line.

  1. One screen, three hospitals

    The biopsy report arrives from another city through ABHA, the discharge summary from a photo the family sent, and the earlier cycles from this unit’s own register.

  2. Dictate, check, sign

    She dictates or types the prescription, then checks every date and dose herself and signs it. The signed text is the medical record, not the audio.

  3. A six-month pathway

    She lays out surgery, six cycles with a blood test before each, radiotherapy and follow-up, and decides when each test is due. No model can change these timings.

Doctor app: the whole history on one screen
Doctor · whole history
Doctor app: the signed pathway
Doctor · signed plan

She signs,
not the audio.

Six months, one signed pathwayThe doctor sets every timing

  1. Surgery
  2. Blood test
  3. Cycle 1
  4. Blood test
  5. Cycle 2
  6. Blood test
  7. Cycle 3
  8. Blood test
  9. Cycle 4
  10. Blood test
  11. Cycle 5
  12. Blood test
  13. Cycle 6
  14. Radiotherapy
  15. Follow-up
SignedDr Kulkarni · Oncology

One signed pathway replaces a fresh slip at every visit. The lab, the day-care nurses, the pharmacy and the family all see the same plan.

6.9 min

average time with the doctor in a Pune government hospital OPD, 80 patients observed in 20211

14–30%

of breast-cancer patients lost to follow-up in 5 years2
  1. IJCMPH 2023
  2. BIACH&RI 2025

SUTRA books every step,and a person answers every question.

The caregiver uses the WhatsApp number the family already has, so there is no app to install. SUTRA turns each signed step into a booked slot and brings the report back to the doctor.

  1. Asked, then booked

    SUTRA offers the caregiver free slots from the hospital’s scheduler and confirms a time only after the scheduler has booked it. The OPD desk sees who is coming, with their papers attached.

  2. Sent, then filed

    The caregiver sends a photo of the report. A records clerk checks that it belongs to the right patient, and it is filed for the doctor to read before the next cycle.

  3. Questions reach a person

    A question about the plan is answered with the plan’s exact words. Questions about symptoms or medicines go to a nurse, and a message containing a word the doctors marked as urgent alerts the nurse at once.

District Hospital OncologyBusiness account
  1. Namaste. Dr Kulkarni’s signed plan says Meena’s blood test, a CBC, is due before cycle 4. Which time suits you?Tue 22 Sep, 10:30Wed 23 Sep, 08:30Thu 24 Sep, 08:30
  2. Thursday, 08:30
  3. Asking the hospital’s scheduler for that slot. You will hear from us only once it is booked.
  4. Booked. Blood test (CBC), Thursday 24 Sep, 08:30. Lab counter 3, ground floor, OPD building. Reference LAB-91843.
  5. Report photo
  6. Received. A records clerk will check that it is Meena’s and file it for Dr Kulkarni before cycle 4.
  7. When is her next test due?
  8. From the signed plan, word for word: “CBC within 3 days before each cycle, booked through the hospital scheduler.”
  9. She has had loose motions since yesterday. Is that normal?
  10. I have passed this to the nurse on duty. A nurse will call you back on this number.
Message

Sample data · the real conversation runs in the family’s language

Booked means booked.

How a family question is routed

“When is her next blood test?”
“She has a fever tonight.”A model tags each message. The clinicians’ own rules decide where it goes.
  1. The plan’s exact words

    If the question is about a planned step, SUTRA sends the matching line of the signed plan, word for word.

  2. A nurse, or the doctor

    Questions about symptoms or medicines go to the nurse’s queue, and the nurse calls back. Anything only the doctor can answer waits on her list.

  3. Straight to a person

    If a message contains a word the doctors have listed as urgent, SUTRA sends the casualty number and 112 and rings the nurse at once.

Nothing in SUTRA judges how ill anyone is. The design follows Noora Health, a nonprofit WhatsApp helpline for families in Indian public hospitals, where a model only reads each message and clinician-written rules decide who sees it.

231

clinician-written rules route messages at Noora Health, a nonprofit WhatsApp helpline for families in Indian public hospitals; the model only reads each message1

152,421

messages have been routed this way; 18.7% were flagged as urgent, and nurses made every decision2

40% → 18%

treatment deferral fell with step-by-step navigation plus financial support. We claim only the navigation part.3
  1. arxiv.org/abs/2609.09356, Sep 2026
  2. arxiv.org/abs/2609.09356, Sep 2026
  3. Indian J Palliat Care 2026
Admin console with sample data
Admin console · sample data

The hospital sees its own follow-through

Every step in every plan is recorded as a dated event with its source. The hospital admin can also ask questions in plain words, and every answer is counted from that log.

  • Which patients were told to come back for surgery and have not returned after thirty days?
  • Which bookings never confirmed, and where did they fail?
  • Which OPD patients still have no ABHA linked to their record?

Counts, never scores.

A hospital joins in one sitting,from the register it already keeps.

Setup takes one sitting at the superintendent’s desk, and going live takes thirty days. Our forward-deployed engineer, a member of our team who works inside the hospital, is there from the first step to the last.

  1. 1Sign off

    The superintendent names an admin, who can see every number, and an approver who signs off staff. An engineer from our team sits with them on site.

  2. 2Register as a file

    The unit uploads the Excel register it already keeps. Rows without a hospital number go back to the records desk instead of being loaded.

  3. 3Register on paper

    If the register is on paper, the pages are photographed and read by OCR, optical character recognition. A clerk checks every cell the software is unsure of.

  4. 4Ten-day trial

    For ten days SUTRA only works out what it would have booked, and the engineer compares that with what staff did. No family hears about a booking yet.

  5. ✓Live

    Families are told about bookings after the trial. Going live takes thirty days in all, and our engineer is there from the first step to the last.

Onboarding screen: Sign offOnboarding screen: Register as a fileOnboarding screen: Register on paperOnboarding screen: Ten-day trialOnboarding screen: Live

Paper registers count too.

Onboarding screens · sample data.

82%

OCR accuracy on drug and dose in 7.4 lakh handwritten prescriptions. That is why a clerk checks every uncertain cell.1
  1. MIRAGE 2024

AI reads, tags and transcribes.People decide everything clinical.

Models transcribe speech, read documents and sort messages. People confirm anything clinical, and fixed rules set every deadline and booking. SUTRA never diagnoses, never scores a patient’s risk and never interprets a medical value.

UseWhat the model doesThe guardrail
Dictation

Turns the doctor’s Hindi or English speech into a draft prescription.

The doctor checks every line and signs it. She can always type instead.

Documents

Reads reports and register pages into structured fields.

Each field shows its source and confidence. It never judges whether a value is normal.

Messages

Tags what a family message is about.

The tag only decides who reads it first. The model never replies to a family.

Questions

Finds the matching line in the signed plan, or counts events for the admin.

It only retrieves and counts. It never scores a patient or gives advice.

Small models run on the hospital’s premises, and every model version, confidence and correction is logged. Public benchmarks are not clinical validation, so every hospital measures its own error rates.

People decide what is clinical.

40%+

of Indian clinicians used AI for work in 2025, up from 12% in 20241
  1. Elsevier survey 2025

Free and open source,so anyone can connect a hospital.

SUTRA is open source under the AGPL licence, so a hospital can run it on its own server without paying for it, and any changes to it stay open too.

  1. Skills

    Each connection is written up as a step-by-step recipe that a hospital’s IT staff, a local vendor or a coding agent can follow.

  2. MCP tools

    The adapters are also exposed through MCP, the Model Context Protocol, the open standard that AI assistants use to call tools, so other software can inspect and map a hospital’s export.

  3. What the tools can never do

    These tools can read, map and test. They cannot write a clinical record, sign a pathway or send a family a message.

Connect a hospital · tools

  • inspect_exportread the hospital’s export
  • propose_mappingdraft the column map
  • dry_run_importtest it, write nothing
  • shadow_bookwork out a booking, send nothing

read · map · test sign · send · write

Anyone can connect a hospital.

Follow the work on GitHub: github.com/sutrahealth

500+ sites

in 50+ countries run Bahmni, the India-born open-source EHR (vendor-reported)1
  1. bahmni.org 2026

Every hospital starts with one unit,measured by one number.

For ninety days we track one number: the share of planned next steps that were taken inside the window the doctor set.

  1. Weeks 1–2 · Baseline

    We count missed steps from the existing register.

  2. Weeks 3–4 · Connect

    We map the data and test bookings without telling families yet.

  3. Weeks 5–8 · Run

    Booking, pathways and report filing run live.

  4. Weeks 9–12 · Compare

    We measure again the same way and review every exception.

Each partnership begins with one oncology OPD, one pathway signed by the unit’s doctors, and a named clinical lead at the hospital. The first ninety days cover the core path: register import, WhatsApp booking, the signed plan and filed reports.

23%

of OPD patients got an ABHA in a fully digital state pilot. Each unit’s own baseline is measured in its first two weeks.1
  1. TN HMIS 3.0, 2025

Bring SUTRA to your unit

To start, we need read access to the OPD and day-care registers, the hospital’s export and appointment interface, and an ABDM sandbox account, a test account on the national network. SUTRA and its connectors are open source and free for any hospital to run, and we report each unit’s numbers whether or not they improve.

hello@sutrahealth.org

If you run an oncology unit, or you want to help connect one, write to us.