Teletherapy Platform Development

Synchronous video consultation infrastructure built on a WebRTC media stack. We evaluate Twilio Video, Daily.co, and AWS Chime SDK against your compliance requirements, expected session volume, and latency targets before selecting the media layer. STUN/TURN server configuration handles NAT traversal so sessions work reliably when clients are on corporate networks, hospital Wi-Fi, or mobile connections without a stable peer-to-peer path. Simulcast with selective forwarding unit (SFU) architecture keeps video quality adaptive, sessions degrade gracefully on constrained connections rather than dropping.

Waiting rooms hold clients outside the session until the therapist joins, eliminating the awkward join-before-ready problem on general-purpose video tools. Session recording is opt-in per session with explicit consent captured and stored as a timestamped audit event before recording begins, a clinical and legal requirement that most generic platforms cannot document correctly. All media is encrypted end-to-end with DTLS-SRTP; session metadata is encrypted at rest using AES-256. Business Associate Agreements are executed with every infrastructure provider that handles PHI: AWS, Twilio, or Daily.co depending on the selected media stack.

Structured outcome measure delivery built into the session and intake workflow, not bolted on as a PDF attachment. PHQ-9 (Patient Health Questionnaire-9) for depression screening, GAD-7 (Generalised Anxiety Disorder-7) for anxiety screening, and PCL-5 (PTSD Checklist for DSM-5) for trauma-related conditions are administered as conditional digital forms at configurable intervals, at intake, before each session, or on a custom cadence set by the clinician per client. Scores are calculated automatically on submission and stored as FHIR R4 Observation resources against the client record, so the full scoring history is attached to the clinical encounter and not sitting in a separate spreadsheet.

Session-over-session score trends surface in the provider dashboard as a visual progress chart per client: PHQ-9 at intake was 18, at week 4 it is 12, at week 8 it is 7. The clinician sees the trajectory without having to manually compile scores across session notes. Score thresholds trigger alerts, a PHQ-9 score in the severe range (20+) or a specific item-9 response (suicidal ideation) generates a flagged notification to the provider before the next session begins, supporting clinical risk management without requiring the clinician to manually review every submission.

Multi-participant video sessions supporting up to 12 concurrent clients designed for the specific consent and clinical documentation requirements of group therapy, not adapted from a general-purpose conferencing tool. Individual consent capture per participant before the session begins: each group member consents separately, and each consent record is stored as a timestamped event against the group session record. A participant who does not complete consent is held in the waiting room and cannot join until consent is confirmed.

Session management gives the therapist host controls appropriate for a clinical context: participant muting, video disabling for clients who have connection issues, waiting room gating for late arrivals, and session recording toggle that requires re-confirmation of all participant consents before recording starts. Group session notes are structured separately from individual session notes, the group therapy encounter stores the session topic, the group composition, attendance, and the therapist's group-level observations, while per-client notes remain individual and confidential. The data model enforces this separation at the storage level, not just at the UI level.

Encrypted provider-to-client messaging for between-session communication, care plan sharing, and document exchange. All messages are stored within the HIPAA-compliant data layer with AES-256 encryption at rest and TLS 1.3 in transit. Message metadata, sent, delivered, read, and deleted events, is captured in the audit log per HIPAA access tracking requirements. Retention policies are configurable per practice (typically 7 years for PHI) with automated archival.

Providers can attach structured documents to messages: care plan summaries, psychoeducation resources, homework assignments, and intake form links. Clients receive push notifications for new messages on iOS (APNs) and Android (FCM) without exposing PHI in the notification payload, the notification prompts the client to open the app rather than surfacing clinical content on the lock screen. Clinicians can set messaging availability windows so after-hours client messages queue without triggering out-of-hours expectations. Crisis response routing: messages containing flagged content patterns trigger an internal workflow that escalates to the on-call clinician and logs the escalation event.

Provider availability management with configurable working hours, session duration templates (50-minute, 80-minute, group sessions), buffer time between appointments, and blackout dates. Clients self-book from the provider's available slots through a patient-facing booking interface that requires authentication before displaying the provider's calendar. Appointment confirmation emails and SMS reminders are sent at configurable intervals, 48 hours and 2 hours before the session by default, with a direct link to join the video session.

Cancellation and no-show policy enforcement is configurable per practice: late cancellation within the policy window generates an automatic charge or a charge-eligible record for the practice to process. No-show tracking records the missed appointment against the client record and triggers the configured follow-up sequence, a re-booking link, a check-in message, or an escalation to the clinical team for high-risk clients. Waitlist management for high-demand providers: clients can join a waitlist for a specific provider, and when a slot opens due to a cancellation, the first waitlisted client receives an automated booking invitation. Recurring appointment scheduling generates the full appointment series at booking with individual confirmation per session.

CPT code mapping for behavioural health billing: 90837 (60-minute individual therapy), 90834 (45-minute individual therapy), 90853 (group therapy), and telehealth-specific modifiers (GT, 95, and POS 10) applied automatically based on session type and duration. ICD-10-CM diagnosis code lookup integrated into the session note interface so the provider codes during documentation rather than in a separate billing step.

Insurance eligibility verification via Availity or Change Healthcare eligibility API at booking, the system confirms the client's active coverage and behavioural health benefit before the appointment is confirmed, surfacing eligibility issues before the session rather than after the claim is submitted. Claim generation produces a CMS-1500 compatible electronic claim record from the session note and the billing codes applied by the clinician. Integration with practice management and billing platforms, Kareo, SimplePractice, TherapyNotes, and others through their APIs or HL7 FHIR financial resources, routes the claim to the provider's existing billing workflow rather than replacing it. ERA (electronic remittance advice) processing reconciles insurance payments against outstanding claims and updates the client's account balance.