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The United States is on the brink of a catastrophic shortage of doctors. It is forecasted that by 2032, there will be a shortfall of 46,900 to 121,900 physicians. 

This doesn’t account for other healthcare disciplines such as mental health professionals. It is estimated that there are approximately 30 psychologists per 100,000 people and 15 psychiatrists per 100,000 people. 

What do these alarming statistics have to do with telehealth apps, you ask?

Telehealth holds the promise of mitigating the impact of this lack of supply of healthcare professionals and diminished access to healthcare services.

It opens doors for new possibilities where healthcare providers can extend their coverage and make a more meaningful impact on the population with immediate results.

telehealth appTraining a new doctor can take up to 18 years. Telemedicine eliminates this waiting period for patients in communities with limited access to healthcare professionals by linking them to other physicians from all over the country, on-demand. 

This has not gone unnoticed by the healthcare industry. We are seeing rapid adoption of the technology. As of 2018, telehealth had an estimated global market value of $49.8 billion in 2018.

By 2026, barely 7 years from today, its market value is expected to grow to a staggering $266.8 billion!


Language barriers

language barrier

Some communities are composed of people who don’t have a perfect command of English. 

This can negatively impact their access to quality healthcare services. This is not because care providers are inefficient, but because patients are unable to communicate their conditions and symptoms accurately as a result of the language barrier.

Technology now exists that can translate communication in real-time so both the doctor and the patient can understand each other in their own native language. 

This would drastically improve the safety of each patient and safeguard against misdiagnoses, wrong prescriptions, and mismanagement. 


Choosing your platform

Before you commission your designers and start coding, you need to decide which platforms to build for. iOS and Android for mobile, web and native for desktop. Your target geography and app functions will direct your choices. 

If you remember our recent article about making health apps for the iPhone, we discussed why an iOS only approach only works best for the USA, and an Android-first approach for the rest of the world. 

For the sake of this article, we’re focusing on the US market.


Mobile: iOS or Android?

ios vs android

The iPhone makes up for 55% of the total smartphone user base in the USA with Android accounting for the remaining 45%. 

These statistics may sway you to build an iOS-only version of your telehealth app because iOS users are known to spend up to three times more than Android users. 

But at 45%, Android users are too many to be ignored so you need to factor this into your long-term planning.

Naturally, React Native is almost always the most sensible platform to begin with, given the likely need to cater for both iOS and Android devices. 


Desktop: Native or Web

You will need a web app for patients who cannot access an iOS or Android device, as well as for physicians to manage their workflows and patient files.

The cost of building a web app and a native app is almost the same. In fact, a web app can be converted into a native desktop app that works on Mac, Windows, and Linux using tools like Electron.

Slack is an example of software built with Electron. 


Related: Mobile Native vs Progressive Web App? Still the Big Question in 2019


hipaa compliantDo you need to be HIPAA Compliant?

Yes. As with every covered entity, you’re going to be handling Protected Health Information. You’ll need to be HIPAA compliant at all stages.

 

Imaging such as MRIs and CT scans, doctor’s notes, lab results are all PHI. As such you need to use HIPAA-as-a-Service hosting services provided by companies like AWS and GAE.

 

Why not just use Skype instead of a Telehealth app?

Skype has not signed a BAA and does not require the encryption of protected health information. As such, it is not HIPAA Compliant.

A hacker can potentially listen in and steal PHI, creating a serious scandal for your organization. We do not recommend the use of Skype in place of a secure telehealth app.


Choosing between Saas and custom build

saas or custom app?A Saas solution does not give you the liberty to personalize the front-end experience beyond a logo and name change. Other than that, the app is identical to all their other customers’ apps.

If you want to control exactly how your app looks and functions, you’ll need a custom-built solution.

A custom-built app is developed using open source or paid APIs. This gives you granular control over your entire app. By using TURN servers and protocols such as WebRTC to handle your videotelephony, we can create a truly customized app that works just the way you want it.


Is Saas cheaper than a custom build?

Saas solutions typically come with a monthly subscription fee and can be deployed fairly quickly because there is little to no programming involved. The monthly fee is usually adjusted according to user volumes. This is an overhead you have to maintain indefinitely.

Saas may initially appear to be the cheaper option, but it can become the more expensive choice once you outgrow the capabilities of your Saas product. When you reach that stage, you’ll be back on the search for a custom solution to meet your growing business needs.

Also, you have no control as to when or what changes your Saas provider makes to your app. They can remove features and update policies on a whim. And because they have to support many clients, this may lead to some uncomfortable compromises for everyone. 

Yes, a custom-built app may be more expensive in the short term because of development and maintenance costs, but you get more value out of it in the long run.

Carefully weigh the cost-to-benefit ratio and product-market fit before deciding which way to go.

A custom-built app offers absolute authority over every aspect of your app, including branding. 


Designing the perfect telehealth app

User Experience Design

ux designThe user experience design is the most important aspect of the entire app design phase. 

A lot of entrepreneurs come up with great app ideas and build apps that work very well from a technical standpoint but end up failing because the user experience is out of touch with the target audience. 

It is not enough to have the right technology. You need to understand the people you are trying to help.

The UX design stage is where this can be prevented.

You will be designing two sides of your app – a provider backend and a front-facing patient side.

Be sure to simplify the onboarding process as much as possible by limiting the number of screens to a maximum of three. Too much information and you could make it difficult for your users. The copy must be written in 3rd grade English. Everyone can understand that level of English. You’re not trying to impress users. You want them to do exactly as you say without second-guessing.

Time spent on every call will be charged so strive to make the app as easy to use as possible. The provider and patient need to concentrate on the consultation, not trying to figure out how to navigate and use your app.

After your UX wireframes are completed, you need to set up a focus group and conduct user testing. Get their feedback, revise the design according to their recommendations. Repeat the process until you are satisfied.

Once this stage is complete, you’re ready for the next one – User Interface Design.

User Interface Design

ui design

The User Interface Design stage adds skin to the UX wireframes. Colors, buttons, fonts and all other visual aspects of the app come to life in this stage. 

Different colors and button sizes needed to be tested. User behavior is affected by colors and the position of components on a screen. The UI must then be converted into a working prototype using a process similar to our rapid prototyping process and also subjected to user testing.

Like the UX stage, revisions must be made as needed until you are satisfied.

Please note that this is but a brief glimpse of the whole design process. For a deeper look, please read our 7-Step Ultimate Guide to Mobile App Design. I highly recommend that you check it out.


What functions do you need and what tools can you use?

In order for your app to deliver complete telehealth services you need to have the following basic features on your app:

  • Secure Video Calling:

This is the most important service of the app. Patients and providers need to see and talk to each other in real-time. Visual cues make a big difference in identifying signs of illness. The video needs to be of high quality with low latency.

  • Peer-to-Peer chat:

Providers and patients must have the ability to send rich messages to each other to exchange information before, during and after a call. This is a useful tool for healthcare providers to give written instructions and reach their patients when not able to call. Also, patients can write information that can’t be easily understood during a call due to differences in pronunciation or interruptions in network connectivity.

  • Backend database:

A secure repository for patient information, medical history, labs, and imaging. This will also handle user authentication.

  • Appointment Scheduling:

An appointment tool so patients can book appointments with their chosen provider.


APIs you can use to integrate above features into your app

Building a telehealth app in the absence of market-ready APIs can easily take 1 to 2 years. But with the components now readily available in the market, a telehealth app can be built in 3-6 months.

This doesn’t diminish from the fact that it is still a very difficult and time-consuming task to make the APIs work as desired.

Let’s take a look at some of the leading ones:

Vsee SDK

VSee SDK is a rich telemedicine API that integrates end-to-end encrypted video calls into your mobile app for iOS and Android, as well as native apps on Mac and PC.

It’s HIPAA compliant and has its own server client so you don’t need to provision a server to set it up. It drastically reduces the technical workload, allowing you to focus on user experience and interface design.

The drawback, however, is that it’s not open source and there’s a significant cost barrier to get the customizable codebase. Access to the codebase can cost as much as $20,000. Failure to get that would mean you have to settle for their Saas option which provides no personalization besides a name and logo. 

Vidyo

This API allows you to integrate real-time communication capabilities into your app on multiple platforms including Windows, Mac, Linux, iOS, and Android. 

It has built-in text chat so you don’t need to use a separate text chat API. It also supports screen share as well as multiparty video calls for group video conferencing.

Vidyo’s not an open-source product. It offers very little customization because they emphasize embedding their software into your app. That makes it similar to a Saas product with similar limitations to customization.

WebRTC

WebRTD is a free and open-source platform that enables real-time communication in web and native apps. It has simple APIs that have been optimized to transmit audio, video, and data. Supported browsers are Firefox, Opera and Chrome on desktop and Android.

Native support is also available for Android and iOS. macOS and Windows are not supported.

The set up of this API is more involving than the others, but it’s very customizable.

OpenTok

OpenTok is a cloud-based WebRTC platform. While WebRTC is an open-source, the software that powers OpenTok is not. With that being said, it offers all the customization potential you’d have on your own WebRTC deployment.

Owned and developed by TokBox, OpenTok also allows you to integrate video, voice, text messaging, and screen sharing into your app on the web, iOS, Android and Windows. It doesn’t support macOS.

OpenTok supports HIPAA compliant app development. The developer building your app is responsible to configure the app in accordance with HIPAA requirements. 

Twilio 

Dr+ On Demand is powered by Twilio Programmable Video API. It works on all browsers without users having to install any plugin, and on both iOS and Android.

It integrates with platform APIs like iOS CallKit, ARKit and more. This makes it very versatile with many possible functionalities you can add to your app. It’s extremely agile and can easily be scaled from starter to enterprise instantly. 

Twilio boasts a lower latency than all other available platforms, claiming up to 50% better video quality.

Twilio also has APIs for SMS messaging, voice calls, text chat, email, fax, and even WhatsAppOf all platforms, Twilio is the most robust and offers the best integration options. 

Acuity

Acuity has been designed to support the needs of the healthcare industry and as such is HIPAA compliant. You’ll need a Powerhouse plan in order for you to enter into a BAA with Acuity Scheduling. 


How do you select the right APIs?

This depends on your choice of platform and what functions you need. The best combination, however, is using React Native as your platform, Twilio for video and chat. The chat must be encrypted with Virgil Security’s end-to-end encryption SDK.


Onboarding users

user onboardingGetting a patient from the sign up to talking to the right doctor is no easy feat. Also, ensuring that the doctor’s time is spent wisely and efficiently requires that you provide all the patient information upfront. 

This may mean that you need to integrate your app with an EHR so that doctors can pull up labs, imaging, and patient history information. If the information is not available, you have to figure out how to guide the patient to provide this information as accurately as possible so that the e-consultation is a success.

There will be a need for persistent data sharing across devices and, possibly, institutions. There are technical as well as legal considerations to be made in order for that to happen.


Conclusion

At TopFlight Apps, we specialize in building health apps for iOS, Android and the web. We’ve proven our salt’s worth and helped health startups like Xzevn, Smarter Symptom Tracker and RingRx create successful businesses by building robust apps that meet and exceed their needs. 

Do you have a telehealth app project? We’d like to help you with it. Get in touch here.

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