Telemedicine app technology is evolving at breakneck speed. Is your product architected to stand out against the competition?
•Published: Nov 12, 2020
Telemedicine app usage is exploding as patients seek new ways to connect with healthcare providers and have fewer in-person visits with doctors. Current events have accelerated telemedicine’s growth, and there’s good reason to believe the technology is here to stay and will continue to grow more popular as access to it and functionality improve.
Like online banking, online learning, and videoconferencing technologies, telemedicine had already been adopted by many users — just not most users — before 2020. Now, telemedicine statistics show that practitioners provide 50 to 175 times more telemedicine visits than they did in prior years. The result is that patients, providers, and insurers who had been reluctant to try telemedicine in the past are now recognizing and enjoying its benefits, so they’ll likely continue to choose it in the future.
Existing solutions function on a basic level, but opportunities abound to improve reliability, performance, security, and streamline the user experience for both patients and providers. The next generation of telemedicine apps will solve more healthcare problems more elegantly, driving even greater adoption and solidifying telehealth’s role in modern society.
The idea behind a telemedicine app, that a patient meets with a provider over a video call instead of in person, is simple. But the technology to make that happen seamlessly and support the entire experience from appointment through treatment is less so. Patients use a wide variety of devices and operating systems, and many in rural areas still lack access to high-speed internet or mobile networks. Infrastructure limitations aside, it’s harder than it sounds to make a simple, secure video chat portal that’s easy for both patient and provider to access and just works every time. The frustrating truth is that technologically flawless video calling isn’t yet universally available, and some apps still struggle with the basics.
Telemedicine app developers should be prepared to overcome these technical challenges along with broader philosophical ones, like how to make up for what’s missing outside the physical exam room. Whether you’re a product manager at an existing telehealth company or an independent app developer, working with an enterprise or a startup budget, the telemedicine product roadmap considerations below will be critical to staffing, architecting, developing, testing, and launching your telemedicine app product.
Note: This guide focuses on common product management questions and architecture decisions encountered in planning and developing a telehealth app, or redesigning/updating an existing one. If you’re a software developer looking for a more granular tutorial with specific code examples and instructions instead, check out our technical guide to building a telemedicine app→
What is a Telemedicine App?
In its simplest form, a telemedicine app connects a patient with a healthcare provider virtually, using some combination of live video and text chat to replace an in-person visit.
This functionality sounds simple at first, but the component pieces required to make it function smoothly and securely at scale can be surprisingly complex to build. In order to establish a reasonable project scope, it’s important to decide up front which functions are required and which belong as part of a broader telehealth platform.
Telemedicine itself may only be one part of a larger platform that includes forums for patients with similar diagnoses, insurance assistance, libraries of medical resources, and other resources outside of the direct patient-provider relationship. For the purposes of this article, we’ll stay focused on identifying and building the core components necessary to support a standard patient-provider visit.
Telemedicine vs. Telehealth
Though the words telemedicine and telehealth are sometimes used interchangeably, the US National Coordinator for Health IT offers the following distinct definitions:
“Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.”
Sizing Up the Competition: Leading Telemedicine Apps
Telemedicine is a crowded market, with hundreds or even thousands of solutions at various stages of development across the world. Most of these apps fail to achieve widespread adoption, unable to deliver a great user experience that’s also scalable and reliable. Proactively avoid their mistakes and take a few cues from the best telemedicine apps available, and you’ll greatly increase your chances of success. These four are especially worth a closer look:
As a comprehensive telehealth platform, Amwell provides field-specific functions for a full spectrum of health specializations, from urgent care to cardiology to behavioral health. Its feature-rich platform includes physician directories, ePrescriptions, and integrated billing. Trusted by a number of global healthcare organizations, Amwell has also solidified its position in the market by partnering with insurance giants like Cigna to give patients pre-approved access to the app and its network of providers at a low flat copay rate.
Where other telehealth solutions emphasize cost and convenience on the patient side to drive adoption, Medici positions itself with a focus on serving healthcare providers first. It’s a great option for established practices to maintain their traditional relationships with patients while beginning to offer virtual visits. In this sense, Medici is less focused on structurally changing how healthcare works than on helping the existing system adapt with technology to meet today’s needs. And that technology is pretty advanced: Key differentiating features include automatic chat translation for 20 languages, simplified appointment scheduling, and an easy way for physicians’ offices to import their existing contacts.
Lemonaid is all about making care for common ailments more accessible outside of traditional healthcare structures. An online questionnaire helps doctors make the best use of their time by automating triage and pre-diagnostics. Prescription delivery is integrated directly into the app, bypassing the conventional need to visit a pharmacy and ensuring that medications are delivered on time directly to patients’ doors.
Ranked no. 1 in Satisfaction and Customer Service by J.D. Power & Associates, Teladoc’s UI is worth some careful analysis as you design your own solution. Account setup for patients is quick and intuitive, with an automated assistant to help patients choose the right type of medical care and the right provider. Like most enterprise-level telemedicine platforms, Teladoc services are covered by most major insurance companies — another factor you’ll want to consider.
Telemedicine App Development Best Practices
Although a significant number of development decisions will need to be made through experimentation and iteration based on your telemedicine app’s unique value proposition, certain established best practices can help take some of the guesswork out of the process and ensure that your solution meets or exceeds industry standards.
Establishing a clear product development process in advance will help keep your telemedicine app development on schedule and on budget. Remember that although the stages and steps below progress from initial scoping to launch, their progression isn’t always linear. Some stages will require multiple iterations to get right, while others can happen simultaneously without waiting for the previous step to be complete. As engineer-turned-CEO Thierry Schellenbach explains in his DEV.to AMA,
“Product management is not rocket science. Talk to customers often, make sure there is a short feedback loop between customers/leads and product, and sort [priorities].”
Initial Planning, Scoping, & Architectural Decisions
Some of the most important decisions in the development process come long before a single line of code is written. What platforms will your app support? What features are required, and which of them need to be built from scratch? With patients’ confidential information on the line, how will you reassure your customers that security and compliance considerations have been incorporated from the ground up? Even on a tight deadline to deliver an MVP, a little extra time invested in getting these decisions right up front can save exponentially longer delays later on.
Platform Compatibility & Codebase Considerations
With your app’s target market and development budget in mind, you’ll need to decide which platforms to support and which languages to code in. These high-level codebase considerations will determine the number of developers needed and their skill sets.
The major platforms in play are iOS, Android, and web — and most telemedicine solutions will want to support all three. It may be worth considering native desktop apps for Mac and Windows as well, but in most situations a browser-based web app will be preferable, eliminating the need for these desktop versions.
If your team isn’t ready to invest in all iOS, Android, and web app development all at once, a responsive browser-based web app may provide the most universal value out of the three since it will be equally compatible with laptops, tablets, and chromebooks. This approach does sacrifice mobile flexibility, though, with many users expecting to conduct most video calls on their smartphones.
If you do commit to developing a mobile app for iOS and Android, be prepared to hire developers with strong backgrounds in Swift and Java, respectively. It may be possible for the app’s two platform versions to share a common codebase in React Native, but further customization to keep up with updates and UI differences will still be required. Apple’s Human Interface Guidelines will dictate a number of UI design considerations for iOS, whereas Android requirements are not as strictly standardized.
UI Design, Sketching, & Prototyping
In today’s fast-paced development workflows, it can be tempting to rush the prototyping phase and make decisions based on assumptions instead of real user feedback. But unlike other app categories, telemedicine presents unique challenges in that it must be accessible to users who may be either elderly or very young. Patients of any age may even be in a state that makes communication difficult physically, mentally, or both. Basics like button design, screen layout, and menu hierarchy may need to be tweaked in ways that at first feel counterintuitive, so it’s critical to take the time for proper UX testing cycles with focus groups and clickable mockups.
Choosing the Right Telemedicine API & SDK Foundations
Most telemedicine apps will require common component functions like encrypted peer-to-peer video calling, a live chat window alongside the video call, and an in-app messaging function that operates similarly to email for delivery of prescriptions and other secure messages. For most applications, it would be too expensive and time consuming to build these types of components from scratch, especially because elegant, cost-effective solutions already exist in the form of third-party API and SDK products.
With solid API or SDK foundations to build on, your engineering teams spend less time getting the fundamentals right and instead focus on the features that differentiate your product from its competitors and create a great user experience. When evaluating APIs and SDKs, be sure to prioritize proven, highly scalable solutions. White labeling should also be a baseline requirement — you’ll find that some existing telemedicine giants sell their own APIs to developers but retain rights to branding and design, effectively putting their API customers at a competitive disadvantage. Here are the types of core APIs you’ll want to evaluate, making sure that your choice of foundation in each category is compatible with your choices in the other categories:
Video Calling APIs
On its own, live video chat presents a number of development challenges. A video calling feature needs to be compatible with the wide variety of camera hardware available on users’ systems, then encode and transmit video and audio in a format that can automatically optimize the balance between quality and compression based on available bandwidth. For the most advanced video calling experience, we recommend APIs built on the WebRTC protocol.
Best-of-breed video calling solutions will also automatically filter out background noise while enhancing the clarity and loudness of speech. On top of that, all data in transit needs to be encrypted to ensure that patient information stays secure. To build this type of secure, real-time HD interaction capability into a telemedicine app with these problems already solved, consider starting with a solid WebRTC-backed foundation like Dolby.io's interactivity APIs.
Chat & Messaging APIs
As with video calling, reliable and secure telemedicine chat solutions are difficult to build from scratch and can be more easily integrated into your app using an existing API or SDK. Today’s users have become accustomed to leading chat apps like WhatsApp, Slack, Facebook Messenger, and iMessage, so they expect a feature-rich chat experience.
Advanced chat features aren’t just for show, either: In the context of a healthcare visit, time is limited and intangible elements like human connection and trust can greatly influence outcomes. Advanced in-app chat features like typing indicators and read receipts can help to foster that feeling of connection and reduce patients’ anxiety while waiting for their provider’s response. Other advanced features like threads keep conversations on topic and organize responses to multiple questions.
In healthcare, the stakes for reliability and performance are too great to rely on an unstable chat experience. A highly customizable chat API like Stream’s takes the guesswork out of building this feature and ensures that your in-app chat will just work, with lightning fast response times ensuring peace of mind for your users.
Developing for Scalability & Reliable High Performance
One of the most common and most consequential planning mistakes we see — even from veteran engineers and product managers at massive corporations — is the failure to build scalability into an initial MVP design. A team will develop a nicely functioning app, only to realize that with 5,000 or 20,000 concurrent users, it gets unacceptably buggy or slow or crashes completely. This problem can be a nightmare to fix, often requiring a complete rebuild of the initial codebase.
Scalability requires a deliberate architectural commitment from day one, with dev teams thinking beyond the initial MVP scenario and designing their code to accommodate retroactive tweaks and expansions as needed. It also requires a thoughtfully configured, highly available, and highly resilient infrastructure setup — for most teams, this means turning to one of the major cloud infrastructure-as-a-service (IaaS) providers: AWS, GCP, or Azure.
As your telemedicine app grows, a dedicated DevOps team should handle scaling, maintenance, and troubleshooting of your pipeline and production infrastructure. Response times to deploy scalable infrastructure, such as automatically spinning up a new server in advance as loads increase, can be further minimized by automating repetitive DevOps tasks in an infrastructure-as-code approach.
Key Telemedicine App Features to Consider
Some functions of a telemedicine app are relatively obvious, like the live video chat feature discussed above. Others work behind the scenes to keep everything synchronized, and still other more advanced features can be integrated to enhance the user experience. Any telemedicine feature overlooked in the initial planning stage can be a headache to add later on, especially if the product wasn’t initially designed to accommodate it. For this reason, it’s important to list all core features and functions, whether simple or complex, in one place ahead of development.
It’s also worth noting that the main problem solved by a telemedicine app (virtual doctor visits) is really the sum of a set of smaller problems for which good technological solutions already exist. The main challenge in building a good telemedicine app, then, is thoughtful and effective integration of these component features to create a product that is secure, easy to use, and highly scalable. No single component is revolutionary on its own, but the way they’re combined, synchronized, and packaged can be.
Core Features for a Minimum Viable Product
Consider these features required to build even the most basic usable telemedicine app.
A patient portal handles basic registration paperwork and administers pre-appointment symptom questionnaires, collects medical history via forms, and redirects emergency patients to the appropriate resources. This is where the patient can view information about upcoming and past appointments and launch the live visit interface. The patient portal should also include a secure payment gateway, with more advanced versions integrating directly with insurance systems so patients can avoid the process of paying out of pocket then later seeking reimbursement.
The provider portal will be more complex than its patient-side counterpart, allowing the healthcare provider to navigate between different patients, begin and end their appointments, and view the paperwork and medical history provided by the patient. The provider also needs a way to enter diagnoses and prescribe treatments. Many successful telemedicine apps go beyond these functions with advanced capabilities like EHR integrations discussed in more detail below.
Video chat with high-quality video and audio and low latency. Data must be encrypted in transit to protect patient privacy.
Live chat with text alongside the video call helps avoid frustration if the video connection is poor or gets interrupted. Text chat also helps resolve differences in pronunciation and helps healthcare providers make sure complex words and concepts come across clearly.
Direct messaging functionality is similar to an email client nested securely within the patient and provider portals for communication before, after, and in between live visits. Leading apps trigger an email to the patient’s regular email address when a secure message from a provider is received, prompting the patient to log in and view the message. In an MVP telemedicine app without a separate module to handle prescriptions, the direct messaging feature could be used to deliver prescriptions as file attachments. Secure direct messages are also a good way for providers to send written instructions for things like aftercare, medication usage and tapering, or physical therapy exercises.
A database & associated services on the back end should store patient information, medical history, visit records and diagnoses, and related lab work and imaging, at a minimum. These services should be enough to support one-off visits, but an app that replicates the experience of visiting a traditional primary care physician will need to be more complex.
A calendar with appointment scheduling capabilities should be securely integrated to allow patients to select times available on the provider’s calendar. An alternative approach avoids scheduling appointments in advance, instead pairing patients with the next available provider in real time. This type of queuing function will require a greater investment to build.
User authentication & access control features verify that both the patient and the provider are who they say they are and have been granted access to view whatever information they are trying to view. You’ll need a user directory as part of the back-end database and a way to authenticate against it. On the provider side, it may be helpful to have multiple user permission levels for privileged access management. This way, an administrative assistant could be given permission to direct message patients but not necessarily access their medical info, for example.
Advanced Features to Consider
With leading telemedicine apps already offering a high-quality experience and users expecting the above features, further customization will likely be required to stand out against the competition. The right combination of the following advanced features can make the entire process of scheduling, attending, and paying for an appointment easier, helping a new or redesigned telemedicine app appeal to patients and providers alike.
Deeper insurance integrations and sophisticated payment gateways remove administrative friction for both patient and provider, automating the process of submitting a visit’s cost to the patient’s insurer. Ideally, this type of system automatically determine’s a patient’s copay amount (if any) and applies the correct billing codes for the services rendered. Given the array of healthcare systems available worldwide and the nuances of different policies and coverage within each, any app that succeeds in simplifying this process will have a significant advantage over others. This is one reason many insurance providers are investing in building their own telemedicine apps or creating one-off integrations with existing apps, such as amwell for Cigna.
A library of doctor profiles lets a patient view a provider’s credentials and areas of expertise alongside their headshot, giving the patient more choice in the type of care they’ll receive. These profiles could also include ratings and reviews from other patients, which would in turn require a way to keep reviews fair and accurate. (If your solution is designed primarily to connect established providers with their regular patients, supported by traditional scheduling and billing systems, this feature may not be necessary).
Group chat and group call functionality can be useful for both patients and providers when a one-on-one visit isn’t enough. A provider can securely add nurses, technicians, and other colleagues to discuss lab results, treatment plans, and other evaluations. A patient may want to include a family member or other trusted caregiver for support or to help with listening to and remembering details.
Electronic health record (EHR) system integrations help telemedicine providers access and contribute to a patient’s medical history. Many telemed apps currently operate like urgent care facilities, treating relatively low-risk health issues at flat rates without needing to access the patient’s full record, but a solution that provides more comprehensive recordkeeping functionality could help telemedicine providers offer better personalized care.
Computerized physician order entry (CPOE) integrations (or a proprietary version of this type of system) take your app’s database a step further, providing a centralized location for healthcare providers to add treatment orders and visit notes to a patient’s medical record and track changes made to that record by others.
Psych-field-specific features make telemedicine more practical for uses like therapy and psychiatric evaluations. Leading apps for virtual talk therapy allow a patient to see the same therapist consistently, building trust and a personalized plan for progress. Some even use enhanced video features like AR/VR to create a more comforting environment or simulate somatic exercises the provider may want to employ. Learn more about developing for psych-specific use cases in our technical guide to building a psychotherapy app with video and chat.
Dedicated prescription systems go beyond delivering a PDF as a direct message attachment, instead allowing the patient to select the pharmacy or care provider (as with PT), of their choice and virtually “dropping off” the prescription for them. As with insurance and payment infrastructure, this is another area where even established telemedicine apps are seeking to innovate and offer a simpler experience.
Automated chatbots can serve as a help desk alternative, answering common patient questions about how to use the interface. Some telemedicine apps are even using HIPAA compliant chatbots to make pre-appointment form fills and questionnaires more interactive.
Video recording functionality allows a patient to securely play back their visit, alleviating the pressure to remember spoken details and instructions.
SMS or push notifications give patients flexibility to be up and around their homes while waiting for a visit to begin. Virtual waiting rooms can also provide a fun interactive experience for kids that doesn’t require them to switch contexts when their pediatrician or other healthcare provider becomes available.
Remote lab integrations facilitate the return of test results to providers, automatically attaching incoming results to a patient’s profile inside your app. Using an additional screen sharing feature, the healthcare professional can then go over visual documents like x-ray results with the patient without ever leaving the main telemedicine app. A third innovation in the remote lab area allows lab organizations to mail test sample collection kits directly to patients, who then mail the kits back for analysis. An integration with this type of service allows the provider to authorize and send a test kit from within their telemedicine portal.
Security & Compliance Requirements
Setting the universal standard for healthcare compliance requirements, the U.S. Health Insurance Portability and Accountability Act (HIPAA) of 1996 regulates security provisions and data privacy for electronic protected health information (ePHI). In other words, it requires that patients’ data be stored, transmitted, and accessed securely and only by appropriate parties.
At a minimum, all data will need to be encrypted in transit and at rest. True end-to-end encryption, while not officially required, is a good idea. On top of that, appropriate identity management measures like role-based access control (RBAC), multi-factor authentication (MFA), and password complexity and rotation requirements ensure only the right people can decrypt private data.
When it comes to more granular requirements, we recommend assessing each component feature of your telemedicine app in its initial planning phase, rather than assessing the entire app’s compliance standing later on as a whole. Here’s more detail on how to build a HIPAA compliant chat app, for example, and you’ll want to research similar guidelines for record storage and the other features listed above.
Though HIPAA may be the most familiar healthcare compliance standard, it isn’t the only security benchmark telemedicine app developers need to plan for and meet. Additional compliance frameworks designed to regulate other industries may also apply here, and while many of their criteria will overlap with HIPAA, it’s important to complete a careful assessment for each. Other relevant standards like SOC 2, ISO 27001, and GDPR, for example, may go into more or different technical detail about how security practices must be configured and monitored.
Estimating the Cost to Build a Telemedicine App
The total cost to develop a telemedicine app can range widely — from tens or hundreds of thousands to even millions of dollars. While a hobbyist or single developer may be able to code a bare-bones app that more or less functions, any solution designed to meet compliance requirements and scale to compete in the market will skew toward the higher end of that spectrum, requiring some form of advance funding and a team of developers.
An accurate cost estimate for this type of solution must first weigh each of the decisions outlined in the sections above, especially with regard to desired feature depth, which platforms to support, and anticipated user counts. A product manager’s calculation will then factor in the number of developers and distinct developer skill sets required, their salaries, and the labor hours the project will take them.
The decision to build or buy component solutions will also greatly influence the total development cost. As discussed above in the section on APIs, it rarely makes sense to sink a significant amount of developer time into reinventing something like chat, email, video calling, or appointment scheduling when cost-effective modular solutions are readily available from vendors. With the right APIs purchased, your dev team can then focus on the integrations and decisions that differentiate your telemedicine app from the rest.
For a more detailed breakdown of the build vs. buy dilemma, plus a much more granular walkthrough of how to estimate the cost of a significant development project, check out Building vs. Buying In-App Chat: The Ultimate Decision Guide.
As a relatively young technology with the potential to transform healthcare worldwide, telemedicine presents an incredible opportunity for traditional healthcare firms and tech-first companies alike. It’s no small feat to build a telemedicine app that effectively competes with existing solutions or genuinely disrupts the healthcare market, but with the right planning and resources, it can be done. Careful analysis of the factors above should help to reduce risk by more accurately forecasting costs and time to market.
Early stage decisions like where to invest development resources can make or break an app’s success. Above all else, avoid wasting development bandwidth to reinvent an existing technology like secure messaging or video calling and instead focus on building the unique features that differentiate your telemedicine app. To ensure reliable, scalable performance and reduce build time from years to months, build on top of the best APIs for in-app chat and video calling, and build integrations with the most popular medical records systems and other types of established electronic health solutions. Consider security a cornerstone of your business, creating opportunities for security and user convenience to complement each other instead of opposing each other. Succeed in creating an intuitive, trustworthy experience for patients and healthcare providers alike, and your app could play a role in solving some of the most complex challenges in modern life.