Wired Into the Walls:
Designing for NABH 6th Edition's Digital Health Requirements

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The Brief Has Changed

For most of the hospitals I have worked on, the digital infrastructure conversation happened too late. The civil shell was largely decided. Riser shafts were committed. The nursing counter was set at 600mm because that is what the contractor proposed. And then the IT vendor arrived with a requirements list that the building could not easily accommodate.

NABH 6th Edition, effective January 2025, addresses this problem structurally. The Information Management System chapter — which covers the full stack of HIS, EMR, RIS/PACS, LIS, QMS, CDSS, and Tele-ICU — is now classified as a patient safety parameter, not an administrative function. For Platinum-tier accreditation, the hospital must demonstrate that its digital infrastructure was designed into the building. Not added after.

The Ayushman Bharat Digital Mission adds a further layer. ABDM requires hospitals to generate ABHA-linked patient IDs at registration, exchange data in HL7 FHIR R4 format, and maintain consent-managed records. Each of these has a spatial consequence that the architect must resolve — a specific counter geometry, a server room that maintains its temperature, a patient-facing display the counter design must accommodate.

Four Decisions That Cannot Be Retrofitted

There is a long list of digital design requirements — but in my experience, most problems trace back to four decisions made too early and too casually.

Where the server room is located

The server room is typically allocated last — whatever space remains after the clinical departments are planned. That space is almost always in the wrong location. For a hospital targeting Tier-III performance (99.982% availability — roughly 1.6 hours of permissible downtime per year), the server room must be on the ground floor, centrally located, with no wet areas above it and no high-voltage electrical plant within close proximity. It needs a floor-to-ceiling height of at least 3 metres, a raised anti-static floor of 300 to 450mm, and precision air conditioning — not a split AC — running on its own dedicated circuit. These are not generous specifications. They are the minimum to keep the hardware alive through a Rajasthan summer. In hospitals I have designed across Jaipur, Bikaner, and Sikar, the server room treated as a leftover space is the one that called us back — for emergency civil works, for insurance claims, or for failed pre-assessment audits.

Whether the network has two physical paths

A single ICT riser is a single point of failure. If it is damaged — by a fire, a flood, or a contractor's drill in a live building — floors or entire departments can lose connectivity. NABH Platinum requires that this not happen. The solution is two physically separated riser shafts, on opposite sides of the building, each capable of carrying full load independently. The fibre installed in each riser should have at least 50% spare capacity from day one — dark cores that can be activated without civil works when the hospital expands.

How nursing counters are sized

A counter at 600mm depth cannot simultaneously carry an EMR workstation, a barcode scanner, a medication tray, and a mobile tablet dock. A visually neat nursing station that is digitally undersized becomes unusable within a few months of commissioning — staff improvise, surfaces get cluttered, and the infection control logic of the original design is quietly undone. Minimum counter depth for a clinical nursing station with EMR integration is 750mm. Mobile EMR cart docking bays — with a data port and a backed power socket — need to be designed into the counter or the wall, not figured out post-construction.

How IT power is classified

Not all digital points have the same consequence when they fail. ICU monitoring gateways, OT anesthesia data ports, and emergency EMR terminals must be on UPS with zero transfer time. Ward workstations and pharmacy dispensing terminals can tolerate a brief interruption. Administrative billing counters can tolerate more. Designing all IT power as a single undifferentiated load — or sharing IT circuits with general power — means a surge to an HVAC motor can bring down a clinical system. The classification needs to be in the electrical drawings, with sockets physically labelled by tier, before construction.

What NABH Auditors Look At

Based on the compliance work I have done on accredited hospital projects, the audit checkpoints that most commonly trip hospitals are not the obvious ones. The items below are frequently underprepared:

What This Means for the Project Brief

The hospital promoter and the architect both benefit from treating digital infrastructure as a primary design system — parallel to medical gas, electrical, and HVAC — rather than as a procurement item sorted out after handover.

In practical terms, this means asking for three things before design freeze: a room-wise digital endpoint schedule from the ICT consultant, a power classification schedule from the MEP engineer, and confirmed dual-riser routing on the structural coordination drawings. If any of these do not exist at schematic design, they will exist post-construction — as costs, as disputes, or as compliance gaps.

The architect who resolves these questions at schematic stage is not adding scope — she is preventing the project from inheriting liabilities that will compound through the building's operational life.