Telemedicine Software Development: Compliance, Features and Cost

The process of a telehealth visit may seem simple to the patient: click a link, enter the video room and talk to the doctor. In fact, there is encrypted video infrastructure, a business associate agreement with every vendor that can access patient's data, EHR integration that should be embedded into a visit which might last for just eight minutes, e-prescription regulations that depend on a state and the class of a prescribed medicine, as well as complex insurance-related payments. It is not difficult to get the interface right; however, it is crucial to understand what it takes to make sure the software is properly compliant, works well within the clinical workflow, and integrates with a variety of systems.

This article discusses the key steps in the process of telemedicine software development, HIPAA compliance requirements for the video call, what features are necessary for the successful solution, the way of EHR integration should be approached, telemedicine e-prescription, insurance and payment handling, what is the cost of such a project, how to find the right development partner, as well as what AI features are applicable to the telemedicine software and why.

What is Telemedicine Software Development?

A telemedicine software solution is usually comprised of a number of components that have to work together, but not in a unified app.

Patient app/portal allows patients to schedule the visit, fill out intake forms and conduct a video visit as well as exchange messages with their doctors after the visit is finished. Provider dashboard provides clinicians with their schedules, access to patient charts, notes, and often a queue of asynchronous messages. Backend is responsible for managing video sessions, scheduling, notifications and integrating with EHR, e-prescription and billing systems. Admin panel allows the practice or the health system to track utilization, compliance reports, manage staff permissions etc.

Sometimes, the organization already has EHR, but lacks visit layer for it; therefore, the development process consists in building a visit layer for the existing platform. Alternatively, the project might be focused on building a stand-alone platform which becomes the main part of the overall digital health solution, in which case the development process resembles custom healthcare software development.

HIPAA-Compliant Video: The Technical Requirements

Video is the single component of telemedicine software that gains or loses trust of the patients the fastest and has the most detailed compliance requirements.

Video session encryption should be provided both in transit and at rest according to current TLS standards; for the media streams, the current standard is SRTP. It is the minimum security requirement for the video vendor, but it has to be verified, not just taken for granted because some general-purpose video SDKs are designed for the consumer use case and did not have any PHI in mind during the development process.

Business associate agreement (BAA) with every vendor that can access PHI (in addition to the video vendor) is not optional for the telemedicine project; the cloud hosting provider, the SMS service and analytics provider also require BAA with the client. According to the HHS telehealth HIPAA guidance, covered health care providers and health plans are required to use technology vendors that comply with the HIPAA Rules and that will enter into a business associate agreement for their video or remote communication products.

Skipping this step is probably the most common mistake that can cause major problems with the telemedicine project, as well as assuming that a popular consumer video app with encryption built-in somehow satisfies HIPAA requirements without any BAA. The same concerns signing of BAA: it has to be done before the contract with the vendor is signed.

Authentication for each visit is another important requirement; it means that no one can join the video session with a guessable link and that a timeout for inactivity should be set; also, after the session is ended, it should terminate at both sides and stop transmitting the audio/video content.

Recoding of the video is forbidden by default and requires a patient's consent (which should be collected explicitly); in addition to it, there should be a set of procedures concerning storage and protection of the recorded videos, including encryption and proper access. The best option is not to implement the recording at all in order to avoid the burden of storing and securing the recordings.

Core Features of a Telemedicine Platform

Scope of features is probably the part of a telemedicine project which easily leads to the increase in its cost; therefore, it makes sense to distinguish the core features from the additional ones.

Must-have features are: video visit (secure video and audio session), scheduling, calendar management, intake forms filled by patients before the visit, secure messaging, visit documentation (both intake forms and notes

created by the clinician), prescriptions writing and basic reporting (compliance and utilization). Patient identity verification is also the necessary feature in case the platform provides e-prescription of controlled substances or some other type of prescriptions which are legally linked to the patient's identity.

Nice-to-have features are: remote patient monitoring integration with connected devices, artificial intelligence-based triage or symptom intake, group visits (for example, therapy sessions), multi-language support, dedicated mobile app (instead of the mobile web). Mobile app development is always worth doing once the platform has sufficient usage volume because it increases the patients' engagement significantly.

What should be avoided is making a long list of nice-to-have features when the must-have features are not really working yet. The sophisticated symptom checker sitting on the top of the unreliable video connection is a poor solution compared to basic reliable video connection.

EHR Integration and Clinical Workflow

EHR integration is a key to a successful telemedicine solution because clinicians will never use any tool which makes their lives harder.

It means that the integration should provide the patient's chart at the beginning or during the video visit so that the clinicians do not need to switch between two systems while talking with a patient. The notes should be written into the patient's chart automatically so that there is no need for a duplicate entry afterwards because this kind of friction quickly kills any software used by clinicians. The scheduling should synchronize visits from both sides in order to prevent conflicts.

All design decisions should be made keeping in mind the limited time the clinicians have; the typical visit is 10–20 minutes, and additional 90 seconds of work per visit turns into significant overhead over the whole workday. The best telemedicine EHR integration solutions are those which are invisible because all data appears where it should appear.

E-Prescription and Pharmacy Integration

There is another set of requirements concerning the e-prescriptions besides the standard e-prescription requirements.

Identity verification for e-prescribing of controlled substances should be done in a way to satisfy federal regulations and some states might have additional requirements for the prescription of the certain class of drugs via telehealth. Some states require that there was a previous in-person visit between the clinician and the patient before issuing a certain kind of prescriptions via telemedicine. In order to handle the state-by-state requirements variation, the platform should be flexible in terms of e-prescription rulesets.

Prescriptions should be transmitted electronically to the pharmacy of the patient's choosing, drug formulary and interaction checks should be done and there should be a log of the actions done with the prescriptions. There is a large variation in e-prescription requirements among states and drug classes, therefore, it is better to use e-prescription networks which have been already established and are familiar to the clinicians rather than build a new routing logic. Similarly, it is easier to develop MLS integration in the real estate software or carrier APIs in logistics platforms.

Payment and Insurance Claim Handling

Handling the payment is usually a challenge for telehealth visits because most of them use insurance coverage.

The system should recognize the proper billing codes for telehealth visits which are usually different from in-person visits and are subject to periodic changes. Checking the eligibility is also recommended to make sure that the patient would not be frustrated after the visit if he finds out that it will not be covered. It is also a good idea to integrate with the billing system and submit claims to it. The copays or self-payments should be processed via the payment gateway which meets healthcare data handling standards.

The reimbursement rules for telehealth visits have changed several times in recent years and there are differences between states and between payers; therefore, this module should be flexible enough to support it.

Telemedicine App Development Cost

Cost depends mostly on the number of compliance-sensitive integrations, EHR connections, and prescribing workflows rather than on the size of the feature list.

MVP development services for the telemedicine software are a great choice if a health tech startup wants to test a new approach without building the whole platform.

Key factors that influence the above estimates are: number of EHR systems for integration, presence of e-prescribing and controlled substances prescribing workflows, number of supported states, presence of remote patient monitoring devices, as well as the level of security audits required before the release of the solution.

Choosing a Telemedicine Development Partner

Experience in the healthcare industry is a key factor when it comes to telemedicine software development.

Ask for the proof of prior HIPAA-compliant projects, not for a claim about it. It is important to confirm how your vendor is going to sign a BAA with you and how BAA is managed with their subcontractors and cloud vendors because there can be a chain of vendors and the weakest link is critical for the whole compliance. It is also necessary to check the experience in EHR integration standards like HL7 or FHIR which is the specific knowledge usually absent in general web developers. You should ask your vendor how they handled the state-by-state prescribing rules in the previous projects and what kind of security tests (especially pen-tests) is included in the development process.

If a potential partner can describe the negotiation of BAA with you in detail, it is a good indicator of their experience.

AI in Telemedicine: Triage and Documentation

There are some practical use-cases of AI in telemedicine; however, it is necessary to clarify when it is applicable and when it is not.

AI-based triage asks the patient a series of structured questions before the visit and routes him to the appropriate doctor or to some level of care based on the results of the interview. Such systems are effective enough for routing the patients based on their symptoms and finding out the urgency of their condition, but they are not able to replace clinical judgement when the presentation is unclear and serious; for that reason, it is important to include an opportunity for the patients to speak with the clinician regardless of the triage results.

AI-based documentation listens or transcribes the video visit and prepares the draft of the visit note for the clinician to review and approve. This kind of feature is becoming one of the most mature and accepted in the telemedicine software; in fact, it significantly reduces the clinicians' burden of paperwork and helps to relieve their burnout; however, it requires to be mentioned that these notes still need to be reviewed by the clinician before being officially submitted and that there is no guarantee that the transcription is completely accurate.

Conclusion

A successful telemedicine software solution is the one in which the video call feels effortless while there are correct encryption, signed BAAs, proper video session handling and EHR integration underneath. On the contrary, if something is treated as an afterthought, the solution becomes unreliable. The key to a successful telemedicine project is the compliance, clinical workflow and integration planning in the first place and nice features on top of them.

Whether you are a health system expanding its EHR capabilities or a startup developing an innovative telemedicine solution, you can definitely save time and money with proper understanding of what is a must-have and what is nice-to-have.

FAQs

Do I need a separate BAA for every vendor involved in my telemedicine platform?

Yes. Every vendor whose systems can access patient data needs to sign a BAA with the organization. Not doing so is a common mistake that can easily be avoided.

Can I use a general-purpose video conferencing tool for telehealth visits?

Only if it is HIPAA-compliant (has signed BAA with the client) and configured in accordance with HIPAA technical requirements. It should be clarified with the vendor directly.

How long does EHR integration typically add to the timeline?

It depends on the complexity of the integration and it usually takes six to twelve weeks. It is one of the most frequently underestimated aspects of telemedicine software development.

Is AI documentation reliable enough to skip clinician review?

No. Even in mature ambient documentation systems, the generated notes still have to be reviewed and approved by the clinician. Accuracy depends on audio quality and specialty terminology, so these solutions should be considered drafting tools.

Should I build a full platform or start with an MVP?

In case of a new approach or an untested patient population, it makes sense to start with MVP which covers core functionality only. It allows validating the concept before building the rest of the system.