Telehealth Architecture

When to use

• Selecting a video platform for synchronous telehealth visits
• Implementing WebRTC with HIPAA-compliant session management
• Building a remote patient monitoring data pipeline and alerting system
• Designing a patient portal with scheduling, messaging, and lab result display
• Implementing store-and-forward workflows for dermatology, radiology, or ophthalmology
• Setting up telehealth CPT billing codes and place-of-service configuration

Core principles

1. BAA before first byte of video — the video vendor must have a signed BAA; the platform being "HIPAA-eligible" is not the same as being covered
2. Waiting room is non-negotiable — sessions without a waiting room allow any link-holder to join before the provider; that is a PHI exposure
3. RPM thresholds are per-patient, not per-population — population averages make terrible individual alert thresholds; configure them per patient condition and history
4. Health literacy beats clinical accuracy in patient-facing UI — a correct lab result displayed in clinical jargon is worse than a slightly simplified one the patient actually understands
5. Telehealth billing changes constantly — verify payer coverage and Place of Service codes at the start of every project; COVID-era expansions have been rolling back

Reference Files

• references/video-consultation-hipaa.md — platform comparison table (WebRTC, Twilio, Vonage, Zoom SDK, Doxy.me), WebRTC implementation with SRTP and TURN, video quality requirements, HIPAA compliance checklist, patient identity verification
• references/rpm-patient-portal.md — supported RPM devices, data collection pipeline steps, clinical alerting with escalation tiers, patient portal core features, WCAG 2.1 AA and health literacy UX requirements
• references/async-telehealth-billing.md — store-and-forward specialties and implementation, provider review queue design, telehealth CPT code table, billing considerations and state regulation awareness