Telemedicine has become essential for healthcare delivery, but building platforms that scale, maintain quality, and comply with regulations requires careful architecture.

Here’s how we design telemedicine platforms at NsisongLabs.

Core platform components

A production telemedicine platform includes:

Video conferencing: Real-time video and audio for patient-provider consultations.

Scheduling system: Appointment booking, reminders, and calendar management.

Patient portal: Interface for patients to access records, messages, and visit history.

Provider dashboard: Tools for providers to manage schedules, access patient records, and conduct visits.

EHR integration: Connection to Electronic Health Records for accessing and updating patient data.

Billing integration: Integration with billing systems for insurance and payment processing.

Video conferencing architecture

Video is the core of telemedicine:

WebRTC: Use WebRTC for peer-to-peer video when possible to reduce latency and costs.

Media servers: Use media servers (Kurento, Janus) for multi-party calls, recording, and advanced features.

Cloud video services: Consider services like Twilio Video, Zoom SDK, or AWS Chime for managed infrastructure.

Quality optimization: Adaptive bitrate, network quality detection, and fallback to audio-only when needed.

Recording and storage: Secure storage of recorded visits with proper access controls and retention policies.

Scheduling and workflow

Manage the patient journey:

Appointment scheduling: Online booking with provider availability, time zone handling, and buffer times.

Reminders and notifications: Automated reminders via SMS, email, or push notifications.

Check-in process: Pre-visit check-in for insurance verification, consent, and intake forms.

Wait room: Virtual waiting room where patients wait for providers to join.

Post-visit follow-up: Automated follow-up messages, surveys, and care plan delivery.

EHR integration

Connect with existing systems:

FHIR APIs: Use FHIR to read and write patient data, observations, and care plans.

Real-time sync: Sync visit notes, prescriptions, and orders to EHR immediately after visits.

Document management: Upload visit recordings, images, and documents to EHR.

Provider context: Pre-populate visit notes with patient history and current medications from EHR.

Security and compliance

Telemedicine requires strong security:

HIPAA compliance: Encrypt all data, implement access controls, and maintain audit logs.

Authentication: Strong authentication for both patients and providers, with multi-factor authentication.

Video encryption: End-to-end encryption for video streams to protect patient privacy.

Data residency: Ensure data is stored in compliant regions based on regulations.

Business Associate Agreements: BAAs with all vendors that handle patient data.

Scalability and performance

Handle demand spikes:

Auto-scaling: Scale video infrastructure and application servers based on demand.

CDN for static content: Use CDN for patient portals, forms, and other static content.

Database optimization: Optimize database queries, use read replicas, and implement caching.

Load balancing: Distribute load across multiple servers and regions.

Monitoring: Monitor system performance and scale proactively before hitting limits.

Mobile applications

Many patients use mobile devices:

Native apps: Native iOS and Android apps for better performance and device integration.

Progressive Web Apps: PWAs for cross-platform support with native-like experience.

Offline capability: Allow patients to complete forms and view records offline, sync when online.

Push notifications: Notify patients of appointments, messages, and test results.

Analytics and insights

Learn from platform usage:

Usage analytics: Track visit volumes, no-show rates, and platform adoption.

Quality metrics: Monitor video quality, connection stability, and patient satisfaction.

Clinical outcomes: Track patient outcomes and care quality metrics.

Operational metrics: Monitor provider utilization, scheduling efficiency, and revenue.

Telemedicine platforms are complex, but with the right architecture, they can scale to serve thousands of patients while maintaining quality, security, and compliance.