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A Comprehensive Guide to Developing a Telemedicine Application in 2021

Dr. Rachael Bailey
by Atlantic.Net (11posts) under HIPAA Compliant Hosting
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Atlantic.Net has over 25 years of experience providing customer-oriented IT Solutions. We are renowned for our HIPAA-compliant cloud services, supported by a security-defined platform architected to the highest standards. Our HIPAA-compliant cloud is available as a managed service or via a self-service offering – the perfect choice for your next Telemedicine project.

The COVID-19 pandemic and its necessary lockdown measures have resulted in the rapid global adoption of telemedicine solutions. Telemedicine tools limit patient and physician exposure to coronavirus while maintaining access to vital healthcare services.

As quarantine measures continue on a global scale, telemedicine looks set to thrive in 2021 as remote patient monitoring and virtual appointments become the norm. With the telemedicine market predicted to be valued at over USD 175 billion by 2026, there has never been a better time to invest in the development of telemedicine apps.

What Makes Telehealth Apps So Popular?

The use of telehealth apps brings countless benefits to patients, physicians, and the healthcare system, including:

1. Improving patient access to healthcare services

Telemedicine has allowed patients to continue to access healthcare services despite the limitations of the current pandemic. Telehealth apps improve access for patients with disabilities, the elderly and vulnerable, and those living in remote locations. Virtual visits also allow patients to consult with their doctors without the need for childcare and time off work.

2. Reduced healthcare costs

Telehealth services can reduce costs for both the healthcare provider and their patient, removing the need for travel and expensive car parking charges. As virtual visits are typically less expensive than in-person consultations, financial barriers to treatment are broken down.

3. Improved quality of care and physician time management

Telemedicine tools allow patients to consult with leading physicians, regardless of their geographical location. These technologies also increase interdisciplinary collaboration and allow patient data to be efficiently accessed and shared. Telemedicine can help to improve patient outcomes by streamlining workflow and data management, allowing physicians to focus on providing their patients with an accurate diagnosis and an appropriate, personalized treatment plan.

4. Streamlined data management

Remote patient monitoring allows vast amounts of informative real-time data to be collected and stored. By using telemedicine apps, physicians and patients can easily and securely share data, informing healthcare decisions.

5. Improved patient engagement and satisfaction

The convenience and effectiveness of telehealth appointments appeal to physicians and patients alike. According to a study of 1000 patients, conducted on behalf of Kyruus in June 2020, telehealth visits resulted in high patient satisfaction, and patients reporting that they were very keen to adopt virtual care in the future.

What Should You Consider Before Developing Your App?

In a rapidly evolving market, your app must stand out among competitors. Healthcare Apps are unique as they are bound by specific laws designed to protect Protected Health Information (PHI). In this section, we discuss the measures you should take into account before developing your telemedicine app.

1. Adherence with regulatory compliance (HIPAA)

Your telemedicine app must adhere to all of the necessary regulatory requirements, such as HIPAA, HITECH, and CCPA. Navigating regulatory compliance can be a bit of a minefield, so you must research the appropriate guidelines and make sure that you fully understand them.

One of the quickest wins is to outsource the app hosting to a HIPAA-Compliant hosting company like Atlantic.Net. The healthcare app will still need to be built upon a HIPAA defined framework, but making sure the hosting platform is compliant is an important first step that can save a lot of time.

2. Security

When developing a telehealth app, another significantly important consideration is how you will maintain the security of PHI. The primary goal of HIPAA compliance is to uphold the integrity of patient data. Both patients and physicians need to be able to trust that shared information remains safe and secure at all times.

Strict security measures should be implemented into your app, including encryption, secure multi-factor authentication measures, and possibly geolocation IP address security to allow only authorized traffic from a predefined IP range (over an encrypted peer-to-peer VPN tunnel).

Some of the key areas that should be at the forefront of a developers mind when it comes to Healthcare App security are:

  • User Controls: Controls must be built in to protect unauthorized access to the application. Data should only be accessible by authorized personnel who have been pre-approved to access ePHI. This includes any in-scope member of the covered entity, typically doctors, nurses, physicians and patients. Numerous administrative controls are required to document who these authorized users are, and what PHI they can access.
  • Permission-based authority: It is an offense for an unauthorized user to access or change PHI; therefore, strict API controls must be implemented (GET/POST/PATCH etc). A good example is a patient website where users can access and view medical test results or request repeat prescriptions. Application writers want the patient to access only data relevant to them.
  • Access Controls: These work hand-in-hand with user authorization, with the key difference that application controls are written to restrict access to flagged confidential information. Code must be implemented that prevents the export of data, such as exporting to an Excel file or PowerShell or simply using copy & paste.
  • Encryption: It is critical to ensure that the application database is encrypted if processing PHI, either in cache or at the database layer. Link sensitive data with a UID instead of a username, or at the least architect your system so data is not traceable back to a single user on a first name, last name basis. In the event the database is exploited, this will prevent hackers from being able to plainly see the data listed in text; the data should be encrypted and need a key to decrypt as created.

3. Availability, reliability, and uptime

After the telemedicine app has been deployed, it must be adequately supported to ensure that users are offered reliable service. Partnering with a reputable and experienced HIPAA-Compliant managed hosting provider will help to ensure that your telehealth app is a success.

Atlantic.Net is a leading and trusted hosting solutions provider, offering a class-leading 100% uptime Service Level Agreement. Our data centers are built to the highest of standards with security and high availability at the forefront of the design process. All of the infrastructure is failsafed and highly redundant. We have dual power feeds from different power grids, redundant cooling and airflow systems, and each server, storage device, or network stack has at least one failover pair (in most cases it’s two or three!)

4. Know your target demographic

Before developing your app, you should spend some time defining your target audience. To ensure that your app is optimized to meet the user’s specific needs, you should consider demographics such as their age, income, and geographical location. You should also make sure that you have a clear and well-thought-through business plan before starting to develop your telemedicine app.

5. Scalability

Many custom telemedicine app developers forget the importance of scalability when building their platform. If your app quickly increases in popularity and your user base grows, the app must be scalable and consistent when rapidly scaling resources.

Scalability should be considered early in the design process of the app to negate the need for a complete rebuild further down the line. The easiest way to achieve scalability is to have an application that can live on multiple servers, commonly broken down into the frontend (a web server such as Apache/Nginx), the mid-tier (this is the programming layer), and the backend (typically a database such as MySQL). Providing the application is architected in a similar way, you can scale up your environment as much as you like.

6. Are you using robust and scalable cloud technology?

Cloud technology delivers a plethora of benefits to healthcare providers, including scalability, enhanced security, data interoperability, and efficient data storage. A cloud-based telemedicine app facilitates the sharing of patient data and enhances accessibility, allowing physicians to provide prophylactic and recovery advice in addition to active treatment.

You should research your choice of cloud provider carefully to ensure that they meet the specific needs of your app. The hosting provider must be HIPAA-Compliant and include all the mandatory administrative, technical and physical safeguards of HIPAA.

7. What is your redundancy plan if something goes wrong?

You have your application up and running, but what do you do if you hit a major outage? Disaster Recovery is referenced directly in HIPAA legislation: “Assess the relative criticality of specific applications and data in support of other contingency plan components”.

HIPAA legislation demands that PHI should be available at all times in the event of a crisis. There are typically two ways to do this. The first is to have a daily backup schedule that protects the integrity of PHI data, this data should be replicated offsite for added protection.

Backups are great, and with cloud providers like Atlantic.Net, the backup recovery times are very competitive, but there might be a better way. Atlantic.Net offers additional managed services that provide disaster recovery capabilities to the platform, enabling the failover of infrastructure to an alternative location if the worst should happen.

Developing a Telemedicine App: What is a Good Tech Stack?

To ensure the best user experience and optimal functionality, you must choose the best app development stack. A good tech stack will ensure that your app is scalable, user-friendly, dynamic, and robust. So, how do you choose the right tech stack for your telehealth app?

A good tech stack for the development of a competitive telemedicine app would include:

1. Managed Firewall

A professionally managed firewall service gives the client peace of mind that each layer of the network is protected to the highest of standards. The network stack should be managed by an experienced network engineering team and should be designed to be logical, robust, and completely secure.

Atlantic.Net offers a fully managed firewall stack connected to the Atlantic.Net network, isolating your traffic from all other traffic. A redundant firewall stack configuration is available upon request; this service is designed with optimal affordability and security in mind.

Our proprietary stateful firewall enables us to provide our clients with customized solutions. One-size-fits-all does not apply here; we strive to go beyond basic security protocols and do more than necessary to keep you secure and in business.

2. Backend Infrastructure

Choosing a PHP framework will help to minimize cost and still allow you to create an effective and powerful telemedicine app. Laravel is one of the most popular and compatible PHP frameworks, favored by telemedicine app developers. With a selection of built-in integrations, Laravel helps to automate repeated procedures, such as authentication, routing, and caching, and to streamline workflow.

Atlantic.Net provides super-simple one-click applications that can help when using the PHP framework. We have LAMP (Apache) and LEMP (Nginx) stacks that start in less than 30 seconds, not only a perfect solution for rapid testing and development, but also a pre-baked, security-enhanced cloud image that handles production workloads with ease.

3. Front-end Infrastructure

App development can be a long and difficult process, so you should choose a front-end framework that makes this as easy as possible. The Javascript-based, open-source React and React Native frameworks help to build a high-performing and scalable app.

If you prefer using NodeJS instead of React, Atlantic.Net has you covered, we feature a one-click NodeJS base image that will launch in seconds, we also feature a number of beginner to advanced users in our technical blog.

4. Cloud-Based Services

Employing cloud-based services in the development of a telemedicine app addresses data security concerns, improves data accessibility, and ensures high performance and seamless scalability.

The cloud platform empowers your developers to focus on writing code instead of battling the infrastructure, and the flexibility of a cloud service gives engineers the ability to conduct rapid testing and development in an agile environment.

5. Programming Languages

Various programming languages can be used in the development of a telehealth app, including Java and Kotlin (Android), and Swift (IOS).

What Other Technologies Are Used in Telemedicine App Development?

Additionally, your app may include tech used for the development of specific features, such as:

  • WebRTC

WebRTC is an enabling technology for both web browsers and mobile apps, using basic application programming interfaces (API) to allow real-time communication, with features such as video and voice calling.

  • Electronic Health Record (EHR) integration

Patients’ EHR and Electronic Medical Record (EMR) may be securely stored in digital form using technology, such as Rails and GraphXL.

  • Geolocation

Embedding the Google Maps platform into your app will give access to real-time data for a patient’s location and the location of their nearby healthcare services.

  • Secure payment gateway

To allow ease of payment, you will need to integrate suitable and secure international and national payment gateways into your apps, such as Stripe, Authorize.Net, PayPal and ApplePay.

  • AI

Implementing AI into your telemedicine app can improve a patient’s diagnosis and treatment recommendation. AI can also be used to automate administrative tasks, helping to maximize physicians’ time. You should consider building an AI chatbot into your app to provide rapid and clear answers to your user’s questions.

  • VR/AR

Mixed reality technologies can also help to improve diagnoses by providing physicians with access to real-time patient data. Health sectors where this technology may have particular benefits include mental health and sports rehabilitation.

  • Automatic Logout

A key design decision is to include an automatic logout function. This may seem like common sense, but setting a timeout is required for compliance. Hospitals do not want strangers accessing PHI simply because a user forgot to log out of a terminal. After being timed out, typically between 30 seconds and 3 minutes of inactivity, the user will need to re-authenticate using Multi-Factor Authentication.

Steps to Take When Building Your Telemedicine App

In the section below we give a summary of the steps involved in telemedicine app development, a process that can be broken down into two distinct stages – discovery and development.

1. Discovery

Before reaching the development stage, it is vital that you carefully evaluate your proposal, researching the telemedicine market, and finding out as much as you can about your competitors.

You should start by defining your target audience – will your app focus on a specific demographic, such as the elderly or those with a chronic health condition?

You should also think about what your telemedicine app will do. The majority of telemedicine apps help to facilitate remote appointments between a physician and their patients. However, as you will be entering a highly competitive space, you will want your app to stand out amongst its competitors. So, how is your app going to be different from others already available on the market? What is the Unique Value Proposition (UVP) of your app?

Once you have carried out your preliminary research, you need to form a clear business plan, including details about costs, revenue, and required resources.

The final part of the discovery stage is creating a low-fidelity prototype of your app to fully understand its functionality and test for any bugs. Following this, you can move on to developing a UX design and finally a high-fidelity prototype.

2. Development

As the name suggests, this stage is where the app development finally begins. During this phase, multiple software development experts will work together in the deployment of your app. Detailed quality assurance and testing will be carried out on various devices and the ongoing support and maintenance of your app will be considered.

How Much Does It Cost to Build and Maintain a Successful Telemedicine App?

It is difficult to define how much it will cost to develop a telemedicine app, as this depends on:

  • Choice of the technology stack
  • Cost of the development team
  • The complexity of the app’s features and functionality
  • Cost of any third-party services, such as Google Maps
  • Length of time it takes to develop the app

When working out the cost of your telemedicine app project, you should consider what parts of the development you can complete yourself and what you would need to outsource. You should research your options for a HIPAA-compliant cloud hosting provider carefully to ensure value for money – Atlantic.Net always strives to be the most cost-effective hosting partner.

Partnering With Atlantic.Net

With over two decades of experience, Atlantic.Net is a global cloud services provider that has formed strong partnerships with a significant number of leading healthcare clients.

As you embark on your telemedicine app development project, Atlantic.Net can offer you market-leading services, including HIPAA-compliant dedicated and cloud hosting. Contact our sales team today to find out how Atlantic.Net can help you.

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