Your Turn, On Time

Anyone who has visited a busy public hospital in Kathmandu knows the morning ritual. People arrive before sunrise, a line forms outside the registration window, and the question on everyone's mind is the same: will I get a number today, and will I see the doctor I came for?

At Civil Service Hospital in Kathmandu, that question now has a faster, fairer answer. The hospital's outpatient and ultrasound services issue their tokens through the Healthcare Transformation Engine, known as HTE, a hospital platform with a self-service queue system at its front door.

From a queue at the window to a token in your hand

The first thing a patient meets is a touch-screen kiosk. It speaks both Nepali and English, shows the Bikram Sambat date and the live time, and asks only what it needs.

A patient picks the service, such as an outpatient consultation or an ultrasound. For an outpatient visit they choose the department, and the doctor where that applies. They enter their mobile number on an on-screen keypad, and a printed token comes out of the kiosk a moment later. The slip carries the token number in large type, the service, and a QR code.

The mobile number is not a formality. It is how the patient can be reached when their turn approaches, and it stops one person from taking several tokens for the same service on the same day.

Fair quotas, set every morning

Every doctor and every service has a daily capacity, and the system enforces it at the moment a token is printed. When a doctor's list for the day is full, the kiosk says so straight away, instead of letting someone wait in a line that was never going to reach them.

Quotas are split by who the patient is:

• Civil servants (nijamati), the hospital's founding purpose, have their own reserved share.
• The general public (sarvasadharan) have a separate share, so they are never crowded out.
• Extended Health Service (EHS), the hospital's paid afternoon service, has its own window and its own numbers.

The counters are atomic: several kiosks can issue tokens at the same moment, and the system still cannot overbook a doctor. Numbering is clear at a glance. Civil-servant, general and EHS tokens each run in their own hospital-wide series, so two patients in the same waiting area never hold the same number.

A timetable that runs itself

Hospitals keep different hours on different days, and the engine knows the calendar.

On ordinary weekdays the morning is for civil servants and the general public. From early afternoon the kiosk switches automatically to EHS-only tokens. On Saturdays outpatient and ultrasound services are closed, and the kiosk shows a clear closed screen with the time, the date and the reason, rather than a blank one. On Sundays the hospital serves civil servants only.

On those civil-servant days the kiosk checks eligibility against the government's Personnel Information System. The patient enters their staff (sanket) number and the last digits of their registered mobile or citizenship number. The check happens on the server, and the full numbers are never shown on screen. Eligible family members, a spouse or parents, can be booked under the same record. Approved concessions are applied automatically.

Seeing the doctor you came for

Choosing a doctor used to depend on who you knew and how early you arrived. On the kiosk, a patient sees which departments and doctors are working today and how much room is left, then takes a token for that list.

For busy departments such as orthopaedics and general surgery, the hospital can offer an "any available doctor" option. The patient picks the department, and the token goes to whichever doctor in that department has capacity. Doctors on leave simply do not appear for that day. Patients are never handed a token for someone who is not in.

Live boards and fewer anxious glances at the door

Once a patient has a token, the waiting room does the rest. Display boards around the hospital show the number being served at each counter and room. When a staff member calls the next token, the board updates, and the patient can be notified on their phone by SMS.

Behind the counter, staff see the queue for their own room in order. They can see who is waiting and who has been called, and they can reprint a lost slip without issuing a second token.

Paying without another queue

Some services, such as ultrasound, carry a fee. The engine prices each token on the server for the patient's category, including the civil-servant concession, so the amount on the slip is the amount to pay. A mobile payment page is already built: scan a QR code and pay by mobile banking or connectIPS instead of joining a second line at the cashier. It will open to patients once the bank gateways are switched on. Until then, and for anyone who prefers it, payment stays at the counter.

Built to keep working

A hospital queue cannot go down at 5 a.m. The kiosks run a locked-down operating system built for the job. They show a branded "connecting" screen if the network drops, and they recover on their own. They are managed remotely over the air, so settings, screens and software updates reach every kiosk without a technician visiting it. Every kiosk prints an identical bilingual slip because the slip is rendered centrally. A printer that is switched off is detected, and the screen asks the patient to wait instead of losing their token.

What it means for patients

The promise of a system like this is simple. Fewer people should stand in a line that cannot serve them, everyone should know their number and their place, and a patient's chance of seeing a particular doctor should depend on fair, visible rules rather than on luck.

The same data already feeds an outpatient queue report for the hospital: token volumes by department and time of day, trends, and how patients move from token to consultation. Over the coming months that will show, in numbers, how much waiting the new system saves. DigiNepal Magazine will return to those figures when they are published.

Disclosure: the Healthcare Transformation Engine is developed by the team of Padam Sundar Kafle, founder of DigiNepal and AlifZetta Superintelligence and the subject of this issue's cover story.