01
Video and audio visits
Browser and app video visits with an audio-only fallback when bandwidth drops, plus screen share and in-call notes.
FIG 01 · Telemedicine App Development
Telemedicine app development built for 2026 rules
Video and audio visits, async care, e-prescribing, remote monitoring and EHR integration for clinics, provider groups and digital health teams, designed around the dated rules.
See how it works
FIG 02 · Quick answer
What is telemedicine app development?
Telemedicine app development is building the software for remote care: video and audio visits, async messaging, e-prescribing, remote patient monitoring and EHR integration. Elgrith builds telehealth apps on BAA-eligible video and cloud services, connects them to EHRs with FHIR and SMART on FHIR, and designs for current Medicare, DEA and ONC rules.
- EHR integration with SMART on FHIR launch
- FHIR R4
- Projects delivered since 2015
- 1,000+
- Clients across the USA, UK and India
- 250+
- Your code, repository and IP
- 100%
FIG 03 · Why it matters
Telehealth is routine. The rules still have end dates.
From KFF, the Federal Register and CDC’s National Center for Health Statistics, read on 23 Oct 2026.
01
80.0%
Of office-based physicians used telemedicine in 2024
CDC/NCHS: “Telemedicine use among office-based physicians was lower in 2024 (80.0%) than in 2021 (86.5%)”. Still the norm, so patients expect it to work.
Source: CDC/NCHS, Health E-Stat 120 (June 2026)(opens in a new tab)02
31 Dec 2026
DEA flexibilities end, unless extended again
The DEA’s fourth temporary extension for prescribing controlled medications by telemedicine is “effective January 1, 2026 through December 31, 2026”. No fifth extension or final rule was found as of 23 Oct 2026.
Source: Federal Register, DEA fourth temporary extension (31 Dec 2025)(opens in a new tab)03
31 Dec 2027
Medicare telehealth flexibilities run to end-2027
KFF: after the Consolidated Appropriations Act, 2026 (signed 3 Feb 2026), the Medicare telehealth flexibilities “will remain in effect through December 31, 2027”.
Source: KFF, Medicare coverage of telehealth (19 Mar 2026)(opens in a new tab)
FIG 04 · Rules and dates
Rules and dates: what your telemedicine app is designed around
Telehealth rules change on fixed dates. This is the dated view we design from, checked on 23 Oct 2026 at the sources linked on this page. We re-check it on 1 Jan 2027, when the DEA dates move.
| Rule | Who it affects | Date | What it means for your software |
|---|---|---|---|
| Medicare telehealth flexibilities (Consolidated Appropriations Act, 2026) | Medicare patients and the practitioners who bill for their visits | Through 31 Dec 2027 (KFF, 19 Mar 2026) | Visits from the patient’s home and audio-only fallback stay in scope; record modality and place of service on every visit |
| DEA fourth temporary extension (Federal Register doc 2025-24123) | Practitioners prescribing controlled medications by telemedicine | 1 Jan 2026 to 31 Dec 2026 | Keep any in-person visit requirement behind a feature flag, so the app can change with the rule on 1 Jan 2027 |
| ASTP/ONC HTI-4 (final) and HTI-5 (proposed) | Certified health IT and the apps that connect to it | HTI-1 to HTI-4 final; HTI-5 proposed (page updated 29 Apr 2026) | HTI-4 covers e-prescribing, real-time prescription benefit and electronic prior authorisation; plan FHIR-based integrations around it |
| HIPAA Security Rule changes (RIN 0945-AA22) | Covered entities and business associates | Still proposed; final action listed for July 2027 | Build to the current Security Rule and track the proposal; don’t treat it as law yet |
| NHS England DTAC (updated form) | Digital health suppliers to the NHS in England | Published 4 Mar 2026; full transition by 6 Apr 2026 | Use the updated form and guidance for any NHS assessment |
General guidance from public sources, not legal advice; your counsel confirms what applies to you. Sources: KFF (19 Mar 2026), Federal Register (31 Dec 2025), ASTP/ONC HTI rules page, the federal regulatory agenda entry for RIN 0945-AA22 and NHS England (4 Mar 2026).
Wider patient or clinician app? Healthcare app developmentFIG 05 · What you get
Telemedicine and telehealth platforms we build
Telemedicine software development for the whole visit, from booking to the follow-up message. One patient record and one visit record run through every feature.
02
Virtual waiting room
Check-in, intake forms, consent and device checks before the clinician joins, with queue status for staff.
03
Async care (store-and-forward)
Secure messages, photos and questionnaires reviewed by a clinician later, for dermatology, follow-ups and refills.
04
E-prescribing
Prescriptions sent through an e-prescribing network, with controlled-substance rules handled by an EPCS-capable product.
05
Remote patient monitoring
Readings from connected devices, thresholds set by clinicians and alerts that reach the care team.
06
Scheduling and availability
Clinician calendars, time zones and the patient’s location captured at booking, so the right licensed clinician sees them.
07
Payments and eligibility
Self-pay, copays and insurance eligibility checks before the visit, with receipts after.
08
Clinician and admin consoles
Visit queues, notes, referrals and reports for clinicians and practice managers.
Deliverables
11
deliverables, in writing
Included in every build, written into your fixed quote before work starts.
FIG 06 · Integrations
EHR integration: FHIR R4, SMART on FHIR and HTI-4
A telemedicine app that doesn’t write back to the chart creates double work. We integrate with FHIR R4 and SMART App Launch through each EHR’s published developer programme, using your organisation’s access. We claim no partner status with any EHR or video vendor.
- EHR (Epic, Oracle Health)
- E-prescribing network
- Monitoring devices
Your telemedicine platform
- Patient app
- Clinician console
- Billing and payments
HL7 FHIR R4 and USCDI
- Data
- Patients, encounters, problems, medications, allergies and observations, mapped to USCDI elements
- How
- Read and write through the EHR’s FHIR APIs, with scopes limited to what the visit needs
SMART App Launch
- What it does
- Opens your app inside the EHR with the patient and user already in context
- Where
- Epic, Oracle Health and other EHRs that support SMART on FHIR
E-prescribing and HTI-4
- Scope
- E-prescribing, real-time prescription benefit and electronic prior authorisation
- How
- Through an e-prescribing product connected to the national networks; we integrate it, we don’t replace it
RPM devices
- Data
- Blood pressure, glucose, weight and pulse oximetry readings
- How
- Device clouds, Bluetooth and the phone’s health data stores, with patient consent
Payments
- Data
- Copays, self-pay visits, subscriptions and refunds
- Where
- Your payment provider, kept separate from clinical data
FIG 07 · Video
Video stack choices
The video layer is the part patients judge first, and the part where health data leaves your servers. Choose it on quality, cost per minute and whether the vendor will sign a BAA for the exact product and plan you use.
05principles
WebRTC, self-hosted
Most control and no per-minute vendor fee, but you run the media servers, TURN relays and scaling yourself.
Video SDKs
Twilio, Zoom Video SDK, Vonage and Amazon Chime SDK handle media servers and scale; confirm each vendor’s BAA terms for your plan.
Audio-only fallback
A phone-quality path when video fails, so a visit isn’t lost to a weak signal.
Recording and data handling
Recording off by default; if you turn it on, storage, retention and access are set in your own cloud account.
FIG 08 · E-prescribing
E-prescribing and controlled substances (status Oct 2026)
The DEA’s fourth temporary extension lets practitioners prescribe controlled medications by telemedicine “through December 31, 2026”. As of 23 Oct 2026 we found no fifth extension and no final special-registration rule. We build so the app can follow whichever rule applies next.
04principles
Feature flags for in-person rules
Any in-person visit requirement sits behind a flag, so it can switch on without a rebuild.
EPCS through a capable product
Controlled-substance prescriptions go through an e-prescribing product that meets DEA’s EPCS requirements, with its own identity proofing and two-factor signing.
Patient location at visit time
Location captured at the start of each visit, so state licensure and prescribing rules can be checked.
Audit trail
Who prescribed what, when and under which rule, kept with the visit record.
FIG 09 · Medicare
Designing for Medicare telehealth through 2027
KFF reports the Medicare telehealth flexibilities “will remain in effect through December 31, 2027”. That gives a fixed window to design for, and a date to plan the next change around.
04principles
Home as the originating site
Visits from the patient’s home supported end to end, including identity and consent checks.
Audio-only fallback
Audio-only visits recorded as such, for the cases where the rules allow them.
Place of service and modality
Each visit stores where the patient was, the modality used and the clinician’s location, for billing and audit.
A plan for 1 Jan 2028
Settings, not code, decide which visit types are offered, so a rule change is a configuration change.
FIG 10 · Beyond video
Remote patient monitoring and async care
Much telehealth happens between visits. Remote monitoring and store-and-forward care cut calls that didn’t need to happen and catch the ones that did.
05principles
Device readings
Connected cuffs, glucose meters, scales and oximeters feeding one patient timeline.
Thresholds and alerts
Clinician-set thresholds that alert the care team, with escalation if no one responds.
Store-and-forward
Photos, questionnaires and messages reviewed by a clinician within the times your service promises patients.
Patient apps
iOS and Android apps for visits, messages and readings; Apple’s guideline 3.1.3(d) covers payment for real-time person-to-person services such as medical consultations.
App developmentYour cloud account
Hosted in your own cloud account on services the provider lists as HIPAA-eligible.
Cloud deployment
FIG 11 · UK and India
Serving patients in the UK or India?
Different countries, different rules. We design the records and flows each market asks for, and leave regulatory sign-off with your organisation and its advisers.
04principles
UK online primary care
Services providing regulated activities in England generally register with the CQC; check current CQC guidance for online providers.
NHS DTAC
NHS England published an updated DTAC form on 4 Mar 2026, with full transition by 6 Apr 2026.
Healthcare app developmentIndia: consultation modes
India’s Telemedicine Practice Guidelines (2020) describe video, audio and text consultations; your counsel confirms the current rules.
FIG 12 · Process · 6 steps
Design the visit, pilot one clinic, then scale
A free call, a fixed written quote, then sprints with a demo every week: discovery, a clickable visit flow, a pilot with one clinic or service line, and rollout. You own the code, the data and the IP.
- Step 01
Free call
Tell us who your patients are, which visit types you offer and which systems must connect. We ask about clinical workflow, not just screens.
- Step 02
Discovery and rules check
Visit flows, EHR and e-prescribing integrations, states or countries served and the rules your counsel says apply, mapped before design.
- Step 03
Prototype and fixed quote
A clickable visit flow tested with clinicians, plus a written scope and a fixed quote, before any build starts.
- Step 04
Pilot
One clinic or service line built in sprints, with a demo every week. Test data only until your production accounts and agreements are in place.
- Step 05
Launch
App store releases, clinician training and a staged rollout to more services or states.
- Step 06
Support and rule changes
Rule updates such as the DEA date, new visit types and features, covered under terms agreed in your written scope.
FIG 13 · What you get
Everything included
Written into your fixed quote, so you know exactly what you are paying for before work starts.
11items
- Written scope and fixed quote
- Visit flow prototype tested with clinicians
- Patient app for iOS and Android, and a web app
- Clinician and admin consoles
- Video integration with audio-only fallback
- FHIR R4 and SMART on FHIR EHR integration in scope
- E-prescribing integration through your chosen product
- Feature flags for rule-dependent visit types
- Audit logs, access controls and encryption
- Deployment in your own cloud account
- IP assignment: code and data are yours
FIG 14 · Tech & tools
The tools behind the work
Proven, well-supported tools, chosen for your project and set up in accounts your business owns.
- WebRTC
- Twilio Video
- Zoom Video SDK
- Vonage Video API
- Amazon Chime SDK
- HL7 FHIR R4
- SMART on FHIR
- Swift
- Kotlin
- React Native
- Flutter
- Next.js
- Node.js
- PostgreSQL
- AWS
- Google Cloud
- Azure
FIG 15 · Who it’s for
Telemedicine software for the people who deliver care remotely.
Clinics, provider groups and digital health teams in the US, UK and India, each with different rules and systems.
3 audiences
Clinics
Virtual visits that write back to your EHR.
Video visits, waiting rooms and follow-ups for practices and provider groups, connected to the chart through FHIR and SMART on FHIR.
- EHR write-back
- Virtual waiting room
- Audio-only fallback
- Clinician scheduling
Digital health
A telehealth product, built on rules with dates.
Direct-to-patient and specialty telehealth products with async care, e-prescribing and subscriptions, designed so dated rules can change without a rebuild.
- Async care
- E-prescribing
- Feature flags for rules
- Subscriptions and payments
RPM
Readings that reach the care team.
Remote patient monitoring for chronic care: device data, thresholds, alerts and time tracking for the care team.
- Device integrations
- Clinician thresholds
- Alert escalation
- Patient timeline
FIG 16 · Working with us from the USA and UK
Built in New Delhi. Run on your hours.
Every project gets a point of contact in New York or London and an engineering team in New Delhi. Here is how today’s working days line up, live.
New York
North America
--:--ET
New Delhi team Your working day- Shared working time
- ≈ 3 hours today
- New Delhi is
- 10.5 h ahead
- Live calls, your time
- 9 a.m. to 12 p.m. ET
London
UK & Europe
--:--UK
New Delhi team Your working day- Shared working time
- ≈ 4.5 hours today
- New Delhi is
- 5.5 h ahead
- Live calls, your time
- 9 a.m. to 1:30 p.m. UK
Three ways to work together
- 01
Fixed-scope project
A written scope, one fixed price and a dated plan. Suits websites, apps and MVPs.
- 02
Dedicated team
Designers and engineers on your roadmap every month, billed monthly.
- 03
White label
For US and UK agencies: our work, your brand, unbranded deliverables.
Every engagement
- Fixed quote in USD, GBP or INR after a free 30-minute call
- NDA before discovery. You own all code, designs and content
- A working demo every sprint, not status slides
- Reply within one business day, calls inside your hours
Book a call
Calls on ET or UK hours
FIG 17 · Definitions
Telemedicine software vs telehealth software
People search for both terms. The software overlaps, but the scope differs.
| Telemedicine software | Telehealth software | |
|---|---|---|
| Scope | Clinical care at a distance: diagnosis, treatment and prescribing | All remote health services, including education, monitoring and admin |
| Typical features | Video visits, e-prescribing, clinical notes, EHR write-back | All of those, plus RPM, patient education, care coordination and scheduling |
| Users | Patients and licensed clinicians | Patients, clinicians, care coordinators and admin staff |
| Rules to plan for | Licensure, prescribing (including DEA rules) and payer rules | The same, plus device, data-sharing and privacy rules for non-clinical features |
In practice most products need both: a telemedicine core for visits and a telehealth layer for everything around them.
Budgeting? Healthcare app development cost guideFAQ
Frequently asked questions
Straight answers about Telemedicine App Development with Elgrith.
We don’t publish prices, because cost depends on scope: visit types, platforms, EHR and e-prescribing integrations, RPM devices, the video vendor and how many states or countries you serve. Our telemedicine app development cost guide lists third-party prices such as video minutes. After a free call you get a written scope and a fixed quote.
FIG 18 · Related
Keep exploring
Free 30-minute call
Build a telemedicine app that’s ready for the next rule change.
Tell us who you care for, where and how. After a free call you get a written scope and a fixed quote, starting with one clinic or one service line.
Pick a day for your call
OpenPick a day. You'll choose a time in your own time zone on the next step.