eSanjeevani at 50 Crore Consultations: Lessons for Private Hospitals

eSanjeevani, the Health Ministry's national telemedicine platform, crossed 50 crore teleconsultations in 2026. It now handles roughly 2.5 to 3 lakh consultations a day, with peaks above 6 lakh. Whatever you think of public health IT, that is one of the largest telemedicine deployments in the world, and it runs in 15 languages across every state and union territory.

Private hospitals often look at eSanjeevani as irrelevant to them: free, government, rural. That misses the point. The platform's growth came from a specific design choice, assisted provider-to-provider consultation through a hub-and-spoke network, which solves problems private hospital groups face too.

This post looks at how eSanjeevani works, what its usage data tells us, and which lessons transfer to private providers building virtual care. For the software build side, see our guide to telemedicine software development.

The numbers, and how they grew

The milestones, from parliamentary replies and Ministry releases:

• Over 33 crore consultations as of 23 January 2025.
• Over 43 crore as of 23 November 2025, according to the Minister of State's reply in Parliament (IANS report).
• Over 50 crore by October 2026 (News On AIR).

The October 2026 release also described the network behind those numbers:

Two things stand out. First, women and older patients are heavy users, the groups private telemedicine apps often struggle to reach. Second, the scale sits on the spoke network, not on a consumer app.

How the hub-and-spoke model works

eSanjeevani runs two variants:

• eSanjeevani AB-HWC (provider-to-provider): a patient visits an Ayushman Arogya Mandir (the renamed health and wellness centres), where a community health officer or health worker connects them to a doctor or specialist at a hub. The health worker is in the room, takes vitals, examines, and helps the patient follow the advice.
• eSanjeevani OPD (patient-to-doctor): a patient consults a doctor directly from a phone or computer, through the 901 online OPDs.

The assisted, provider-to-provider variant accounts for most of the platform's usage. That matters because it sidesteps the biggest weaknesses of direct-to-patient telemedicine: no physical examination, low digital literacy, poor connectivity at home, and patients who do not trust a stranger on a screen.

Features that matter beyond the video call

The 2026 platform does more than connect video:

• AI-powered clinical decision support (AI-CDSS) that supports providers during consultations.
• Integration with ERSS-112, the national emergency response system, so a consultation that turns into an emergency has a defined escalation path.
• Specialist OPD teleconsultations rolled out at AIIMS Jodhpur, AIIMS Jammu and AIIMS Patna.
• Multilingual interface across 15 languages.

The platform is developed by C-DAC, with C-DAC Mohali providing the engineering, and it won a Gold Award at the National Awards for e-Governance 2026.

All of these are workflow features, not video features. The private-sector lesson is the same: the video stack is a commodity, and the value sits in triage, escalation, records and follow-up.

Five lessons for private hospitals

The platform's design choices translate into five practical lessons for private hospitals and hospital groups.

Lesson 1: assisted spokes beat pure direct-to-patient

Many private hospitals in Kerala and elsewhere run satellite clinics, collection centres or tie-ups with smaller nursing homes. These are natural spokes. A nurse or junior doctor at the spoke, a specialist at the main hospital, and a structured teleconsult between them gives you:

• Specialist reach without the specialist travelling.
• Examination findings and vitals captured by a trained person, which makes the remote opinion safer.
• Referrals that land at the hub with history attached, rather than as a scribbled note.

Lesson 2: language and the 46-plus patient

Forty per cent of eSanjeevani consultations come from people aged 46 and above, and over 57% of use is by women. Those are the patients who drive chronic disease follow-ups, maternal care and family health decisions.

A private telemedicine flow that works only in English, needs an app download and assumes the patient can manage a video call on their own will miss them. Practical fixes:

1. Offer booking and reminders on WhatsApp in Malayalam, Tamil, Hindi or the local language. Our guide to WhatsApp automation for hospitals covers the patterns.
2. Allow a family member to join and manage the call.
3. Keep audio-only as a supported mode, not a failure state.
4. Send the prescription and advice as a simple message in the patient's language, not only a PDF.

Lesson 3: design the escalation path first

eSanjeevani's link to ERSS-112 is a reminder that telemedicine needs a defined answer to "what happens when this is serious?" For a private hospital:

• Define red-flag symptoms that end the teleconsult and trigger an in-person visit or ambulance.
• Make sure the remote doctor can see the nearest emergency department, and that your ED can see the teleconsult note.
• Record the escalation decision in the patient record.

The Telemedicine Practice Guidelines issued in 2020 already expect the doctor to judge whether telemedicine is appropriate for the case. Your software should make that judgement easy to act on.

Lesson 4: records and continuity, not one-off calls

The biggest weakness of many private teleconsult products is that the consultation is an island. The note sits in a video vendor's system, the prescription is a PDF in WhatsApp, and nothing reaches the hospital's EMR.

For a hospital, every virtual consultation should:

• Create an encounter in the same record as in-person visits.
• Use the same prescription, lab order and follow-up modules.
• Link to the patient's ABHA where they consent, so the record can travel through ABDM.
• Feed the same dashboards you use for OPD volumes and revenue.

That is an EMR and HMS design decision, not a telemedicine-vendor decision, which is why we usually build virtual care as a channel of the core hospital system rather than a separate app.

Lesson 5: AI decision support belongs in the workflow

eSanjeevani's AI-CDSS sits inside the consultation, supporting the provider rather than replacing them. That is the right pattern for private hospitals too. Useful places for AI in a teleconsult flow:

• Structured pre-consult intake that summarises symptoms and history for the doctor.
• Prompting for missing vitals or red-flag questions at the spoke.
• Drafting the consultation note and patient instructions for the doctor to review.

Each of these keeps the clinician in control. Our AI agents in healthcare work follows the same rule: the AI prepares, the clinician decides.

What it costs and what it takes

Private hospitals often budget for a telemedicine platform and forget the operating model. The software is usually the smaller line. Indicative cost drivers for a hub-and-spoke service:

The doctor-time line is the one that decides success. eSanjeevani runs over 19,000 hubs, which means doctors at those hubs have teleconsultation as a scheduled part of their day. When private hospitals make teleconsults an interruption between in-person patients, waits grow, spokes lose confidence and volumes fall.

Two operational habits from public programmes are worth copying. First, roster the hub doctor for teleconsult blocks the same way you roster OPD sessions, and publish those blocks to the spokes. Second, give spokes a simple dashboard of their own: consultations done, waiting times, referrals converted. Spoke staff who can see their numbers improve them.

What eSanjeevani does not solve

It is worth being clear about the limits, so you do not copy them. A national platform has to serve every state with one design. It cannot integrate deeply with each private hospital's pharmacy, lab and billing. Follow-up continuity depends on the patient returning to the same spoke. And a free public service does not need to think about revenue cycle, packages or insurance. A private hospital does, which is one more reason to build virtual care inside the same system that handles billing and insurance claims.

How to start: a 90-day pilot for a hospital group

1. Pick one speciality and two spokes. Diabetology or cardiology follow-ups work well because they are frequent and protocol-driven.
2. Staff the spokes. A trained nurse with a vitals kit and a reliable connection at each.
3. Integrate with the core record. Teleconsults create encounters in your HMS from day one.
4. Define escalation and red flags with your clinical team.
5. Measure consultations per day, conversion to in-person visits, no-show rates for follow-ups and patient satisfaction in the local language.

Expect the first month to be about workflow, not technology. That is normal.

Conclusion

eSanjeevani's 50 crore consultations are not a story about video software. They are a story about assisted care, language, escalation and a network of staffed spokes. Private hospitals building virtual care can borrow every one of those ideas, and add what a public platform cannot: tight integration with their own records, pharmacy, labs and follow-up.

If you are planning a hub-and-spoke or virtual OPD service, start with the workflow and the record, then pick the video layer. Talk to us if you want help designing it around your existing hospital system.