An EMR and practice management software for eye care professionals.

ROLES

Co-founder
Principal Designer
Principal Engineer
Technical support

PERIOD

January 2023 onwards
(3 years)

ASIRA Clinical is an affordable and simple, cloud-based practice management and electronic medical record (EMR) software for eye care professionals, particularly hospitals and clinics in developing markets.

TL;DR version

TL;DR version

Challenge

Majority of eye care practices and hospitals in emerging markets still rely on paper to record patient data. Misplacing or losing records is a poor patient experience which leads to losing the patient and revenue. Owners however, are apprehensive about moving to the cloud due to data theft and privacy concerns. Existing desktop solutions focus on orders and billing and lack comprehensive tests and templates required for an accurate diagnosis.

Solution

Launched a browser-based EMR tool with over 60 tests and features like pre-filled templates for common vision disorders, WhatsApp integration, AI for clinical analysis, and order and invoice management, helping practices save time, reduce overheads, retain patients, and increase revenue. Privacy concerns are addressed using a role-based system which controls which resources a user can access.

Impact

onboarded

~150

hospitals and clinics over 3 years helping them move from paper to digital, saving time and money.

REDUCED CHAIR TIME BY

~ 50%

by auto-populating previous test data, using pre-filled patient history forms and using AI for faster clinical analysis.

INCREASED FOLLOW-UPS BY

60%

using automated WhatsApp reminders a day before the booked follow-up appointment, with an option to reschedule.

Avg. revenue increase of

₹ 250-300

per consultation as patients value more comprehensive reports sent digitally, and a professional clinical experience.

time saved per day

1-3 hours

Since reports are automatically created and sent to patients digitally, there are no paper reports to complete.

reduced Wait time PER patient by
reduced Wait time
PER patient by

~11 minutes

eNHANCED CLINICAL EFFICIENCY BY OFFERING

60+ tests

reduced missed orders by

25%

Users have been able to easily find, follow up and complete unfulfilled and past due orders.

data privacy with

user roles

Roles for Front office, Practitioners and Admin come with different resource access rules.

YOY APPOINTMENTS GROWTH

300%

The growth in appointments booked corresponds to usage by newly added practices.

Meeting customers and getting feedback

" ASIRA has allowed me to increase my consultation charges as I can now show patients a full mark up of the work done. "

Monica Chaudhry
Director of MCVI, Gurugram

in-depth version

How it started.

In the summer of 2022, my co-founder Isha Dave - a practicing optometrist of 15 years who graduated from the City University of London and lecturer at the Lotus School of Optometry, Mumbai - shared many concerns that she and other practice owners face daily because of their paper based systems. They also shared their concerns and fears about moving from paper to digital.

Problems with paper records

loss of patients and revenue.
  • Losing patient records means the practice cannot contact the patient again for follow up appointments, order pick ups or for regular check up reminders.
  • Completing a written diagnosis and discharge summary increases patient wait time by 15-20 minutes.
  • Misplaced orders leads to loss of revenue for the practice.
  • Not knowing which invoices have been settled and which are pending.
incomplete clinical diagnosis.

  • Practitioners take time determining the next tests to perform during an eye exam and can incorrectly conclude an exam early if not experienced.

  • Practices struggle to increase their consultation fees since they lack the time to write out a complete report of the tests performed as proof to the patient.

Poor patient experience.

  • Not having timely access to patient data during an appointment or if the patient messages the practitioner after practice hours.

  • Practitioners often need to spend 2-3 hours after clinic hours in order to complete patient reports within the 24 hour period of ending the exam.

  • Since 2020, patients prefer digital reports and orders sent to them via WhatsApp or email instead of a hand written paper copy that they might lose.

Fear of losing Data and privacy concerns.

  • Employees can carry paper records with them or even take a photo of a practice's paper records, violating the patient's privacy.

  • Front office can access patient health records.

  • Losing patient records due to fire, flooding or other unforeseeable damage.

Many practices Had Worked with Freelancers and Development Studios to bUILD thIER own software but…

Problem #1

Software developers were not skilled leading to many bugs and endless delays.

Problem #2

UX did not follow any clinical flows and relied heavily on manual, typed inputs.

Problem #3

Felt forced to agree with developers since they did not know the technology.

Examples of bespoke software with complex, form heavy experiences.

others also used generic software that only supported managing patients and booking appointments.

Local, home grown solutions offered competitive pricing advantages, though the UX and usability of the software was poor.

International offerings were too expensive for the price conscious Indian buyer.

Comparing OptiSky, OpticalCRM and EZ Solutions

mAIN FINDINGS

~$100/month

The average monthly cost of software including training, maintenance and annual renewal fees.

refraction only

Most software only offered basic refraction tests and focussed more on order and inventory management.

Custom Software

Practices chose to build custom software since there were no off-the-shelf solutions for eye care.

That's when it hit US!

With my design and engineering skills and with Isha's clinical background, There was an opportunity to build a Secure, user friendly and clinically aligned EMR for eye care professionals.

Huzzah! ✊🏽

Defining Goals for the system

Increase patient retention and follow-ups.

  • Follow up appointments should be automatically created and reminders sent.

  • Practitioners should be able to share reports, orders and invoices with patients through WhatsApp.

  • Practices should be able to send reminders to patients for check ups.

  • Users should be able to access patient data anytime, anywhere to reply to patient queries.

Provide a Comprehensive set of Clinical tests aligned with real world eye examinations.

  • EMR should support a comprehensive set of tests and default templates. Practices can create templates to match their existing workflows.

  • Using the results of the tests, they should be able to place orders for spectacles, contact lenses and other eye care. They should be able to connect their existing inventory workflow so as to maintain their order workflow.

  • data should be sent directly from devices to the system into the appropriate test.

Ensure patient data is secure and only accessible to authorised staff.

  • Only practitioners should be able to view patient records.

  • Admin should be able to control what access a user has to resources.

  • System should work both online and offline. When an offline system is brought online, it should sync existing data with the server without any loss of data integrity.

Reduce missed/lost orders and invoices.

  • Practitioners should be able to share reports, orders and invoices with patients through WhatsApp.

  • Practices should be able to view all orders and invoices that are pending and cleared. They should be able to send reminders for pending invoices and to pick up ready orders.

  • Practices should be able to manage and track inventory.

Product positioning

  • are we desktop based, cloud based or both?

  • are we focussed on order management first or EMR first?

Considerations

  • Many order management and inventory softwares already existed. Practices were also comfortable using excel sheets to track orders.

  • Few to no options available for comprehensive test records.

moving forward

Build a web-based, EMR-first product focussed on clinical excellence, giving ASIRA a clear market differentiator. Over time we will add order and invoice management features to build a single platform for eye care practices and hospitals.

Building and demoing a prototype

We had three weeks to prototype and demo ASIRA at Masterclass Pune in August 2022 and get feedback from practicing optometrists. We built a static HTML-only prototype to highlight how ASIRA simplifies the primary workflows of an eye care practice.

Workflows for the prototype

  • Add a patient.

  • Add an appointment booking.

  • Perform a routine eye exam.

  • Create a discharge summary.

  • A landing screen from where practices can manage their day.

Research and planning

Identifying primary entities

We first mapped the patient and practitioner journey to identify all the primary entities of the system.

Documenting the required Tests and form fields

The clinical team created spreadsheets detailing the different inputs required for each test while highlighting single choice, multiple choice and input fields along with default values.

constraints

An optometrist may perform any tests from a set of 43 tests, depending on the type of ocular disorder being treated.

An eye exam MUST always START with a patient's history and END with an action and advice, i.e, the next steps.

Refractive tests MUST be available as they are the most widely performed tests, though they are not mandatory.

An eye exam can only be edited for 24 hours after the exam has ended. This is a legal requirement.

Planning the Appointment booking experience

Since most practices use Google Calendar or an equivalent software to manage their day, we decided to add a calendar for booking appointments.

Benefits

⭐

Provides a familiar experience and reduces the learning curve.

⭐

Simplifies UI when syncing users' Google Calendar with the system.

Exploring Concepts

managing Patients

  • Display appointment history for a patient and allow users to download discharge summary and other reports.

  • Users should be able to start an appointment from the patients page for a patient.

  • Add notes on patients for quick reference during an eye exam.

  • Users should be able to find patients by name, phone, age and identify which patients are due for follow up by timeline.

Wireframes and design decisions

managing Appointments

  • Front office staff should be able to see schedules of all staff so as to be able to book appointments that don't conflict.

  • Every time an exam is ended and a follow up date exists, add an entry to the calendar.

  • Before starting an eye exam, practitioners need to record that they have taken the patients consent. This needs to be done each time.

  • Practices should be able to adjust their work hours to book appointments only during business hours.

  • Display 'Start Test' button only to practitioners.

Wireframes

v1: Table view

We tried a tabular approach similar to the patients page in order to save development time.

v2: Calendar View

The UI for calendar view was based on modern calendar tools from Google, Apple and Notion.

Wireframes depicting booked, new booking and patient search states of the booking modal.

Performing a Routine eye exam

  • Provide a guided experience that reduces cognitive load for practitioners.

  • Provide a comprehensive set of tests for a majority of ocular conditions.

  • Use dropdown menus, checkboxes and selections to reduce user errors from manual input.

  • Automatically cut off editing after 24 hour period.

  • Increase efficiency by supporting keyboard tabs.

  • Allow users to add notes to tests if they need extra information.

  • Completing the action and advice is mandatory to end the exam.

Layout For
an active eye exam

We divided the interface into 3 sections to isolate functionality and increase focus on the tests within the body.

Header: Fixed UI that displays patient and appointment details at all times. Click Finish Test to end the exam at any point.

Navigation: Guides the user through the tests that need to be performed.

Body: Largest section displays form fields for the active test. This section changes based on the selected test.

Wireframes for Patient history

Wireframes for Refractive tests

We modelled the design of refractive tests around real prescriptions and designed custom keypads to reduce errors from manual input.

Example of a real spectacle prescription.

Wireframe for Discharge summary

We referenced real world reports and discharge summaries to design the digital PDF. When an eye exam is complete, the discharge summary is automatically created and can be downloaded or shared with patients via WhatsApp immediately, after review by the practitioner.

Messy hand written discharge summaries

Visual Design

Style guide

We extended the style guide and created a set of input and test components that we used to put the prototype together.

Component Library

Input and form components

Final Designs for the Prototype

Step 1: After signing in, users land on the Today page, which gives them a summary of patients for the day.
Step 2: Before starting an eye exam, the Lobby screen displays appointment details.
Step 3: eye exam / Reason for Visit
Step 4: eye exam / Refraction
Step 5: Discharge Summary PDF That practitioners can download and share.

Affordances

Single location to manage appointments

The Today page displays all appointments for the day and at hat stage they are in. This gives the front office a single UI to manage bookings.

Guided testing experience

Navigation reduces cognitive load by providing step-by-step list of which tests to perform along with markers for completed, ongoing and pending tests.

Less manual input for fewer errors

To enhance the guided experience, we replaced manual input fields with pre-filled dropdowns and buttons, reducing human error due to manual input

TextBox for Remarks in all tests

We added a text field where the test taker can add extra notes for each test without any limit.

Automatically generated reports

Automatically generated discharge summaries and prescriptions saves time, allowing the practice to see more patients and reduce chair time.

Demo day!

With the prototype ready, we designed a landing page that we could use to capture emails.

The launch page that we created for Masterclass 2022 in order to gauge user interest and capture leads.
Isha and the clinical team demoing the basic workflows of ASIRA to engaged practitioners and students.

we captured 113 Leads!

During the three day event, we captured 113 emails and phone numbers of leading optometrists and ophthalmologists that expressed interest in ASIRA. After the demo, we received inquiries from small-medium sized practices and hospitals about how they could start using ASIRA.

It was at this point that we decided to go all in and build an MVP from the prototype and launch it during the OCI conferences taking place across India from Jan - Feb 2023.

Feedback from masterclass

Exam templates to match existing workflows at their practice.

Require SLA and guarantees around security and data privacy.

Only want to share some parts of the eye exam, not all tests.

prioritising features

After speaking with hundreds of practitioners, we reviewed their feedback and used the MoSCoW method to determine how to prioritise which features to build and when.

The MoSCoW board we used to prioritise feature development based on the features we mapped to corresponding user concerns.

From Prototype to MVP.

Trade offs

🚩

Launching without order management would reduce the serviceable market. However, our focus was to build an EMR first product.

🚩

We moved the feature of sending follow-up reminders through WhatsApp to after the launch of the MVP.

🚩

We accepted the friction of the AWS Cognito UX in order to ensure security and long-term compliance.

🚩

The Mantine UI framework would help us build the MVP faster than creating components aligned with the design system.

🚩

Removed custom keypads and relied on users' familiarity with the keyboard and the number pad for refractive tests instead.

Designing the remaining tests

To support default speciality templates in the MVP, we designed mock-ups for all the tests and engineered them using Mantine UI components with Tailwind CSS, instead of using our own design system.

Why mantine?

We reviewed shadcn, Tailwind UI and the ANT framework, but found that Mantine UI offered a larger set of form fields and input components that aligned with our style. shadcn required more effort for styling than we had time for.

Data privacy and security

Building a Secure backend

Designing A Scalable & sECURE architecture

For a healthcare system handling many database relations, we chose PostgreSQL allowing us to scale vertically as needed. For secure authentication, we chose AWS Cognito.

Design consideration

We rejected MongoDB since clinical workflows require relational consistency across patient details like appointment history, orders and billing - denormalization and lack of transactional support affect data consistency.

Identifying the components of the system
HLD of the current system architecture
Mapping entities to the database Design
Final database structure representing entities and flow of control based on real world workflows
Data privacy and security

Defining Role based Access Control (RBAC) for
data privacy.

Defining Role based Access Control (RBAC) for data privacy.

Practices needed to trust our role-based access before moving their existing patient data.

We created 3 default roles - Front office, Practitioner and Admin with only the Admin account having the ability to add/invite more users and set their role.

All role privileges are first defined in a Google Sheet that is updated regularly as new features and products are released.
Enabling granular control over resources

We created actions for resources at a granular level and allowed teams to create composite roles by extending the defaults, allowing for greater flexibility over managing resource access.

Trade off

🚩

Implementing granular controls increased the complexity of the resource-action mapping but ensured data privacy through robust access controls.

IT'S AliVe!

IT'S AliVe!

We Launched the MVP in Jan 2023.

Between January and March 2023, we betaed our MVP across five territories in India, as part of a series of seminars and workshops organised by the Optometry Council of India (OCI).

Reception

Practitioners and students were excited to finally access a tool offering a comprehensive set of clinically aligned eye care tests.

Feedback

Need WhatsApp reminders for follow ups.

Required order management, inventory and barcode scanning.

Questions around safety of the cloud and privacy of data.

Multi-practice support.

Since then we have onboarded over a hundred practices, Patched hundreds of bugs, improved existing features and Shipped orders, invoices and a performance monitoring tool.

Updates THAT got the system closer to the goals.

Increase Patient retention

Increasing Follow-ups with WhatsApp reminders.

We added a cron job to send WhatsApp reminders for upcoming appointments and Flows for patients to reply to confirm, reschedule or cancel the appointment. This has helped increase follow-up visits by 60% since patients can now reschedule appointments to a more convenient date.

Comprehensive and Accurate EMR

Advanced Speciality Templates + Custom templates

Based on customer feedback, we added new templates for advanced vision disorders like myopia, glaucoma, low vision, etc.

We extended this functionality to allow customers to create their own templates to match the workflows of their practice.

Comprehensive and Accurate EMR

AI CLINICAL ANALYSIS

Junior optometrists need senior staff to verify the accuracy of their patient recommendations. This stalls the exam or results in an inaccurate diagnosis if senior staff is unavailable, and increases wait times for patients.

We saw this as an opportunity to use AI to read anonymised patient test data and make suitable recommendations for the action and advice, along with a reasoning for how it came to the suggestions.

We experimented with Open AI models like o4-mini, gpt-4o and gpt-4.1 and found the point-based, scientific approach to clinical reasoning of the o4-mini to be the best option.

Input prompt

Forms fields and their range of values are sent to the OpenAI API along with JSON formatted patient history for clinical analysis.

Output

Form fields are auto populated by extracting responses from matching key-value pairs in the JSON output.

{
  "reasoning": "1. Review of 2026-02-13 exam findings: patient reports 1 week of reduced near vision, intermittent flashes for 1 month, occasional scotoma for 1 week in the left eye, and exam shows chronic anterior blepharitis OU and anterior uveitis in the right eye. Posterior segment exam was unremarkable but symptoms of flashes and scotoma raise concern for posterior segment pathology.\\n2. Diagnosis: right eye anterior uveitis and bilateral chronic blepharitis, with possible vitreoretinal disturbance given flashes/scotoma.\\n3. Next‐step imaging/referral: refer for Vitreo-Retinal Evaluation to rule out retinal tears or detachments.\\n4. Urgency: within 1 week to avoid progression of potential retinal pathology and monitor uveitis.\\n5. Medication: treat anterior uveitis in the right eye with topical steroid to control inflammation.\\n6. Spectacles: no change to current distance prescription; continue Single Vision Distance.\\n7. Follow up: in 1 week to assess response of uveitis and retinal symptoms.\\n8. Advice: lid hygiene and warm compresses for blepharitis, avoid eye rubbing, and to seek immediate care if flashes/scotoma worsen.",
  "furtherTests": "Vitreo-Retinal Evaluation",
  "urgency": "Within 1 week",
  "medication": {
    "name": "Prednisolone acetate 1% ophthalmic suspension",
    "eye": "RE",
    "type": "drop",
    "dose": "1 drop, 4 x daily",
    "duration": "2 weeks",
    "medicationRemarks": "Start taper after 2 weeks based on inflammation"
  },
  "spectacleRecommendation": "Single Vision Distance",
  "followUp": "1 week",
  "remarks": "Monitor anterior uveitis and any progression of flashes or scotoma; ensure compliance with therapy",
  "suggestedAdvice": "Warm compress and lid hygiene daily; avoid eye rubbing; report any increase in floaters, flashes, or vision loss immediately",
  "confidence": 75
}
Adding Guardrails

You are an AI assistant specialized in eye care practice management and clinical workflows.

You ONLY answer questions related to:

- optometry, ophthalmology, optical retail

- billing, inventory, appointment scheduling, EMR use in eye care

- clinical conditions like myopia, glaucoma, dry eye, etc.


If the question is unrelated to eye care, respond with: "I'm sorry, I only provide assistance related to eye care."


Never answer unrelated questions. Return structured JSON when asked.

Evaluating accuracy

We recorded user feedback regarding the accuracy of the suggestions and found that 84% of users did not leave any feedback and of the 26% that did, ~54% gave it a 👍🏽.

Reduce missed orders and invoices + clinical insights

performance and clinical insights

Performance was designed to help practices monitor analytics around appointments booked, orders placed and invoices settled, giving them a summarised view of their performance for the selected period.

Venn diagrams helped practices identify the number of patients with overlapping refractive conditions while stacked graphs highlighted the ratios of refractive conditions. This helps practices determine the types of eye care products they should stock in their inventory.

We are currently building an inventory solution to connect order management with a practice's existing inventory system. This will help practices and optical stores accurately manage orders.

Features THAT did not work.

Patient search using Fuse.js

The system became unresponsive when searching through more than 20k patients because of having to recalculate the row height for each row when loading the appointment history.

We replaced Fuse.js with Postgres's pg_trgm extension, added indexes on patient table columns and loaded appointments on demand to deliver results in under 300ms to support the real-time nature of history lookups during visits.

Task management

To reduce missed appointments, orders, invoices and miscommunication with patients, we updated the modal for booking appointments to allow teams to create and assign tasks for other members of the team. Since these tasks show up on the calendar, all team members are aware of their daily/weekly tasks.

why this did not work.

Many users did not notice the new 'Create task' tab. Moreover, without active enforcement within the practice, team members were reluctant to move to a new system, despite the flaws of the existing system.

Modular Design of rEPORTS AND diSCHARGE suMMARY

Though the modular design looked more professional, customers wanted to spend less money on paper for printing the PDF, even at the cost of legibility.

why this did not work.

We incorrectly assumed that if practices sent reports digitally, patients would not want physical copies. However, many patients also wanted a physical copy of their reports as it represented a tangible takeaway of paying for a service.

Updated discharge summary PDF design

Outcomes.

Since acquiring our first customer in April 2023, ASIRA has onboarded ~150 practices and hospitals across India.

So far we have booked over 50,000 appointments, recorded 330,000+ eye tests and manage ocular EMR data of more than 30,000 patients.

The Indian eye care market is very seasonal, with July - mid-November being slow months primarily attributed to the monsoon season, national holidays, religious festivals and children being back in school.

Over a three year period we have experienced more than 300% year-on-year growth
for appointments booked.
Over a three year period we have experienced almost 288% year-on-year growth for appointments booked.
We increased the average number of appointments booked per day
from ~25-30 in 2024 to ~95-100 in 2025
Steady increase in DAU, WAU, MAU between 2023 - 2025

Next steps.

Developer API

The Developer API will allow large practices, hospitals and device manufacturers to use ASIRAs EMR capabilities within their environment.

Inventory

We use AWS Textract and OpenAI's API to read data from uploaded images and PDFs, extract order and supplier details and add them to the database, saving hundreds of hours of data input and verification.

Learnings.

Healthcare requires multiple fluid workflows.

We initially considered outsourcing the engineering since I hadn't coded in over six years. However, as a founder I think it's important to know your product inside out, including how the codebase works.

Human in the lOOP WORKFLOWS are hard to automate.

Workflows that involve patient communication requires humans to confirm that the information being communicated to the patient is accurate. A high degree of unpredictability in patient conditions and possible outcomes makes automation difficult.

Acknowledgements.

ASIRA would not be possible without the combined effort of the engineering, sales and marketing teams. As a small team of three, everyone put in their best work to build India's first eye care specific EMR. A huge thanks to Shirish Kamath for building the initial engineering infrastructure that helps Asira grow and scale with minimal effort.

A big thanks also goes out to Chirag Vyas who interned with ASIRA during the summer of 2023 and who's code is still an integral part of the product.

VISIT ASIRA CLINICAL

Frankensteined in Mumbai.
Fueled by YouTube, 90s cartoons & Heavy Metal.