Project overview
A regional health network needed to scale virtual care rapidly while meeting HIPAA and provincial privacy requirements and integrating with an existing Epic EHR.
CodeQube delivered patient and clinician applications on web, iOS and Android, a WebRTC-based video service, scheduling and a FHIR integration layer.
Business problem
Where the client started.
Off-the-shelf video tools lacked EHR integration, forcing clinicians to document in two systems.
No unified scheduling; patients booked by phone and no-show rates exceeded 20%.
Strict PHI handling requirements ruled out most consumer-grade platforms.
Patient population included many older users with low digital confidence and limited devices.
Proposed solution
What we proposed, and why.
A patient app (React Native) and clinician web console (React) sharing a single design system and accessibility standard.
A WebRTC video service with SFU media servers deployed in-region to keep PHI within Canadian data residency.
HL7 FHIR integration with Epic for appointments, encounters and clinical notes, so visits documented once.
Automated reminders, one-tap join links and a low-bandwidth mode that reduced no-shows.
Architecture
How the system is put together.
Client apps connect through an API gateway to a set of domain services (scheduling, video, messaging, records) on Kubernetes. Video media flows through in-region SFU clusters; clinical data is exchanged with Epic via a FHIR façade.
Technology stack
Backend, frontend, data and cloud.
Challenges faced
What got in the way, and how we dealt with it.
Challenge
Many patients joined from rural areas over congested mobile networks.
Resolution
Simulcast with adaptive bitrate, audio-priority fallback and a pre-call network test that recommended the best mode.
Implementation details
How delivery was sequenced.
- 1
Discovery & compliance design (weeks 1–6)
Privacy impact assessment, threat model, FHIR resource mapping and clinical workflow co-design.
- 2
Core platform (weeks 7–18)
Identity, scheduling, video signalling and SFU deployment; patient app alpha to 50 pilot users.
- 3
EHR integration (weeks 19–30)
Appointment, encounter and document exchange with Epic; clinician console beta across two clinics.
- 4
Regional rollout (weeks 31–38)
Phased rollout across 40 clinics, on-call support and performance tuning to 10k daily visits.
Non-functional requirements
Security and scalability considerations.
Security
- PHI encrypted at rest with customer-managed KMS keys and in transit with TLS 1.3 / DTLS-SRTP for media.
- MFA for clinicians, device-bound sessions for patients, and comprehensive access logging to satisfy HIPAA audit controls.
- All infrastructure within Canadian regions; no PHI processed by third-party analytics.
Scalability
- SFU clusters autoscale on concurrent room count with pre-provisioned headroom for morning peaks.
- Stateless services on EKS scale horizontally; scheduling database read replicas absorb reporting load.
- Load-tested to 3,000 concurrent video sessions.
Results & business impact
What it delivered.
Business impact
- Virtual visits grew from 4% to 31% of outpatient volume.
- Clinician documentation time per virtual visit fell by 40% due to single-entry records.
- Platform extended to remote patient monitoring in a follow-on phase.
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