Healthcare software development
Most telehealth failures are not video failures. A call that connects and holds for ten minutes is the easy part. The parts that determine whether a remote consultation service is usable and defensible are the scheduling logic that matches a patient to the right clinician type, the identity check that confirms who is actually on the call, the structured note that a coded clinical system can accept, the prescribing handoff that routes correctly depending on who is prescribing, and the decision about what happens to the recording afterwards.
We build telehealth platforms for private clinics, digital health providers and NHS services running remote consultation as one channel among several, and we build the operational layer around the video call rather than treating video as the product.
The workflow this replaces
A service that has not invested in a purpose-built platform typically stitches together a generic video conferencing tool, a separate booking calendar, a paper or PDF consent form, and manual entry into the clinical system after the call. Each seam is a place where information is lost or a governance requirement is skipped under time pressure.
Step 01
The booking flow has to know whether the request is a routine follow-up, an urgent same-day slot, or a type of consultation that a particular clinician grade is authorised to run, and match availability accordingly. Generic booking tools treat every slot as identical, so services end up double-booking clinicians against consultation types they are not credentialed for, or leaving urgent slots unfilled because the calendar does not distinguish them from routine ones.
Step 02
A patient arriving early needs somewhere to wait that confirms their session is real and their clinician is running on time, without giving them a raw meeting link that could be forwarded or guessed. Services without a waiting room either let patients into an open room where a previous consultation might still be finishing, or send links by text message that have no admission control at all.
Step 03
A remote consultation cannot rely on the receptionist recognising a face at the desk. Without a deliberate identity step, services either skip verification entirely, which is a safeguarding and prescribing risk, or ask a clinician to interrupt the consultation to check a photo ID, which wastes clinical time and is inconsistently applied across clinicians.
Step 04
Clinicians on generic video tools take notes in a separate window or on paper and transcribe them into the clinical system later, often at the end of a clinic session when detail has faded. There is no structured coding at the point of capture, so the note that reaches the record is free text that a downstream system cannot search, audit or use for recall.
Step 05
When a prescription is indicated, the clinician has to know immediately whether they are prescribing under an NHS route, which goes through the Electronic Prescription Service, or a private route, which produces a private prescription the patient takes elsewhere or has routed electronically. Services without this branching built in either default to one route regardless of context, which is sometimes not lawful, or ask the clinician to work out the correct process manually mid-consultation.
Step 06
Where a service wants to record consultations, for training, dispute resolution or clinical governance, consent has to be captured before recording starts and has to be revocable. Services bolting recording onto a generic conferencing tool frequently record by default, or capture a blanket consent at registration that does not cover the specific session, which is not adequate consent for special category data.
Step 07
A recording that is kept indefinitely because nobody has built a deletion job is a growing liability, not an asset. Services without an automated retention policy either delete manually and inconsistently, or accumulate recordings that make a future subject access request or data breach materially worse.
Step 08
A remote consultation sometimes surfaces a risk that cannot be safely managed at a distance — a safeguarding concern, a deteriorating physical presentation, a mental health crisis. Without a defined escalation pathway built into the platform, the clinician's only options are informal, and the record of why an escalation happened, or did not happen, is undocumented.
None of these steps is exotic on its own. What makes a telehealth platform difficult to build well is that all eight have to work together in real time, inside a single consultation, without adding friction that a clinician working through a full clinic list will route around.
What we build
Diary management by consultation type and clinician grade, urgent slot protection, buffer time between sessions, and rules that prevent a clinician from being double-booked across a video slot and a face-to-face list.
WebRTC sessions brokered through a managed TURN and STUN infrastructure for reliable NAT traversal, adaptive bitrate for variable connections, automatic audio-only fallback, and a telephone dial-in as a last resort.
A pre-session lobby that confirms device and network readiness, displays estimated wait time, and only admits the patient to the clinical session once the clinician is ready.
A photo ID capture and liveness check run before or at the start of the session, with the verification outcome logged against the consultation record for audit.
A templated note editor with SNOMED CT-coded problem, finding and procedure entries, free text for narrative detail, and export in a format the receiving clinical system can accept without rekeying.
Routing logic that directs an NHS prescription through the Electronic Prescription Service and a private prescription through a dm+d-coded private route, with the prescriber's registration status determining which path is offered.
A per-session consent capture for recording, separate from general terms of service, with a visible indicator during the call and a revocation mechanism that stops and discards a recording mid-session if withdrawn.
A policy-driven scheduler that deletes recordings and transient session artefacts at the end of the configured retention window, with a deletion log kept for audit purposes independent of the recording itself.
A structured pathway a clinician can trigger mid-consultation to flag risk, book an urgent face-to-face slot, and notify a duty clinician or safeguarding lead, with the trigger and outcome written to the record.
Integrations
Prescribing and medicines
Clinical coding and records
Identity and access
Video and communications
Storage and hosting
Where a service is NHS-facing, the prescribing and records integrations are constrained by the principal supplier's IM1 terms and by which national services the deploying organisation is onboarded to; we confirm exact scope during discovery rather than assuming full access.
Data and compliance
Architecture note
The video layer sits on a managed WebRTC infrastructure provider rather than self-hosted media servers, because reliable TURN and STUN relay across the range of networks patients connect from is an operational specialism in its own right. The clinical workflow — scheduling, waiting room, identity check, note capture, prescribing and consent — is built as a distinct application layer that orchestrates the session rather than being embedded inside the video vendor's product.
Session state, consent records and the audit trail are held independently of the media stream, so that a recording can be deleted on schedule without touching the consultation record it relates to, and a consent withdrawal can stop a recording without terminating the clinical session itself.
The structured note captures SNOMED CT codes at the point of entry using a constrained value set relevant to the service, rather than a full unrestricted terminology browser, which keeps clinician data entry fast while still producing codes the receiving clinical system can use.
Prescribing logic is isolated behind an interface that returns a single routing decision — Electronic Prescription Service or private prescription — based on prescriber registration and patient eligibility, so that a change in either can be updated without touching the consultation workflow.
Timeline
Weeks 1–4
Consultation types, clinician grades, prescribing routes in scope, and the initial DCB0129 hazard identification workshop.
Weeks 5–10
Clinician diary management, booking rules, and the identity verification flow integrated ahead of any video work.
Weeks 11–16
WebRTC session engine integration, waiting room, fallback modes for degraded connections.
Weeks 17–22
SNOMED CT-coded note templates and the Electronic Prescription Service and private prescription routing logic.
Weeks 23–26
Consent capture, recording pipeline, and the automated retention and deletion engine.
Weeks 27–30
Escalation workflow build and completion of the clinical safety case report ahead of go-live.
Weeks 31–36
A single clinician cohort runs live consultations before the service is opened to the full clinician panel.
Indicative cost
Bands assume a UK-hosted deployment with one primary integration route for prescribing and records; additional national service onboarding is scoped separately.
Where this sits
Questions
For many presentations yes, but the clinician needs a safe way to escalate when it cannot. We build explicit escalation paths into the consultation flow — a red-flag checklist, a one-click route to book a face-to-face slot, and a record of why the escalation was triggered — rather than leaving that judgement undocumented in a free-text note.
We typically build on a WebRTC infrastructure provider that manages TURN and STUN relay at scale, rather than operating our own media servers, because the operational burden of NAT traversal and codec handling at scale is not where the client's value sits. What we build is the surrounding clinical workflow: scheduling, waiting room, identity check, note capture and consent — the parts that are specific to your service.
It depends on the prescriber's registration. NHS-registered prescribers issuing NHS prescriptions route through the Electronic Prescription Service and the Spine; private prescribers issue a private prescription referencing dm+d codes, which the patient takes to any pharmacy or which is routed to a nominated pharmacy electronically where the pharmacy supports it. We build the branching logic so the correct route is selected automatically from the prescriber's registration status.
No. Recording is opt-in, requires explicit consent captured before recording starts, and the retention period is set by policy rather than left indefinite. We build the deletion job as part of the platform rather than as a manual housekeeping task, and the patient can be told, on request, exactly when their recording will be deleted.
The platform falls back to audio-only automatically when the video bitrate cannot be sustained, and to a telephone dial-in as a final fallback where the network will not support any WebRTC session at all. The clinical note captures which modality the consultation actually happened in, because that is a governance-relevant fact, not a technical footnote.
Send the problem, not a brief. We will tell you whether it is a project we should be involved in.
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