Let me take you back for a moment. In 2020, every healthcare organization on the planet suddenly needed telemedicine. Overnight, video visits went from a nice-to-have to an existential requirement. A lot of platforms were built fast, and a lot of them were built badly.
We're now six years past that initial scramble, and the telemedicine landscape looks completely different. The hype cycle has cooled. The venture capital has moved on to AI. And the organizations that are still building telemedicine platforms in 2026 are doing it because they've figured out something important: telemedicine isn't a pandemic stopgap — it's a permanent mode of care delivery that needs permanent, purpose-built infrastructure.
I've been building healthcare software for years, including telemedicine platforms that survived the post-pandemic consolidation. Here's what I've learned about what actually matters now.
The Post-Pandemic Telemedicine Landscape
The numbers tell an interesting story. Telemedicine utilization spiked 78x during the pandemic peak, then settled back down — but not to pre-pandemic levels. Current estimates put telehealth at roughly 15-20% of all outpatient visits, up from less than 1% pre-pandemic. That's a permanent structural shift.
Winners: Integrated Platforms
The telemedicine platforms that survived are the ones integrated into broader care delivery workflows. Standalone "video visit" apps are mostly gone — replaced by telemedicine capabilities embedded directly into EHR systems, patient portals, and care management platforms.
Emerging: Specialty-Specific Platforms
The growth area in 2026 is specialty telemedicine. Behavioral health, dermatology, chronic disease management, and post-surgical follow-up all have unique workflow requirements that generic video platforms handle poorly.
Regulatory: More Clarity, More Requirements
CMS has made most pandemic-era telehealth flexibilities permanent (with some caveats), but the regulatory bar has also risen. State licensing requirements, prescribing rules for controlled substances via telehealth, and audio-only visit reimbursement vary by state and payer.
WebRTC vs Commercial Video SDKs: The Real Comparison
Every telemedicine team asks this question: "Should we build our own video infrastructure with WebRTC or use a commercial SDK?" I've done both.
WebRTC (Build Your Own)
Pros:
- No per-minute video costs (your biggest ongoing expense disappears)
- Full control over the user experience
- No vendor dependency
- Can optimize for healthcare-specific needs
Cons:
- You need a TURN/STUN server infrastructure for NAT traversal
- Scaling beyond peer-to-peer requires a Selective Forwarding Unit (SFU)
- Cross-browser and cross-device testing is your problem
- You're responsible for everything: echo cancellation, bandwidth adaptation, reconnection logic
Best for: Organizations with 10,000+ monthly video visits where per-minute costs become significant.
Commercial Video SDKs
| SDK | HIPAA BAA | Pricing Model | Strengths |
|---|---|---|---|
| Twilio Video | Yes | Per-minute ($0.004-0.01) | Mature, great documentation |
| Vonage (TokBox) | Yes | Per-minute ($0.00395+) | Strong group video, archiving |
| Daily.co | Yes | Per-minute ($0.004+) | Developer-friendly, prebuilt UI |
| Zoom Video SDK | Yes | Per-minute (custom) | Brand recognition |
| Amazon Chime SDK | Yes (via AWS BAA) | Per-attendee-minute ($0.0017) | AWS integration, lower cost |
Best for: Most organizations, especially those with fewer than 10,000 monthly video visits.
Our Recommendation
For most clients, we start with a commercial SDK — usually Twilio or Daily.co — and build a video abstraction layer in the codebase that would allow swapping providers later.
Features That Separate Good Telemedicine From Bad
1. The Waiting Room Experience
This is criminally underinvested in most telemedicine platforms. A good virtual waiting room:
- Shows estimated wait time
- Lets patients complete intake forms while waiting
- Tests their audio, video, and network connection before the provider joins
- Provides a way to message the front desk
- Doesn't make them feel like the call dropped
2. Clinical Documentation During the Visit
Providers hate telemedicine when it means double documentation. Build clinical note templates directly into the telemedicine workflow. Auto-populate from the intake form. Make it possible for the provider to complete documentation before the visit ends.
3. E-Prescribing Integration
If a provider diagnoses a condition during a video visit and can't send a prescription until they switch to their EHR, the workflow is broken. Integrate with e-prescribing networks (Surescripts) so the provider can send prescriptions from within the platform.
4. Remote Patient Monitoring (RPM) Integration
This is where telemedicine is heading in 2026. The video visit becomes one touchpoint in a continuous care relationship:
- Patient uses connected devices at home
- Data streams to your platform between visits
- Algorithms flag concerning trends
- Care team reviews alerts and intervenes proactively
- Video visits are triggered by clinical need, not arbitrary schedules
RPM reimbursement from CMS (CPT codes 99453, 99454, 99457, 99458) has made this financially viable. A practice can bill $120-180 per patient per month for RPM services.
We wrote about the broader shift toward continuous monitoring in our piece on the future of patient care.
Regulatory Requirements You Can't Skip
HIPAA Technical Safeguards
Everything I covered in the 2026 HIPAA Security Rule applies with extra emphasis on:
- End-to-end encryption for video streams — The video content itself must be encrypted
- Encrypted recording storage — Recordings are PHI with access controls and audit logging
- Automatic session termination — No orphaned recordings sitting on a server
State Licensing and Interstate Practice
Your platform needs:
- State-aware scheduling — Verify provider licensing for the patient's state before allowing a visit
- Prescribing rules engine — Controlled substance prescribing rules vary by state
- Consent management — Some states require specific telehealth consent language
Accessibility (ADA/Section 508)
- Closed captioning for deaf or hard of hearing patients
- Screen reader compatibility for visually impaired patients
- Keyboard navigation for patients who can't use a mouse
- Audio-only fallback for patients without video capability
Cost and Timeline
| Component | Timeline | Cost Range |
|---|---|---|
| Discovery & requirements | 2-3 weeks | $10-20K |
| Video integration (commercial SDK) | 4-6 weeks | $25-45K |
| Scheduling, waiting room, & intake | 4-6 weeks | $25-40K |
| Clinical documentation module | 3-5 weeks | $20-35K |
| EHR integration | 6-10 weeks | $40-80K |
| E-prescribing integration | 3-5 weeks | $20-40K |
| Patient & provider mobile apps | 6-10 weeks | $50-90K |
| HIPAA security, testing, compliance | 3-4 weeks | $15-30K |
| Total (full platform) | 8-14 months | $230-425K |
A minimum viable telemedicine platform — video visits, scheduling, intake forms, basic EHR integration — can be built in 4-5 months for $100-160K. Add modules iteratively based on clinical need and patient feedback.
For more detail on the medical app development process, we've written a dedicated guide.
What I'd Do If I Were Starting Today
- Start with a commercial video SDK behind an abstraction layer. Get video visits working in 6-8 weeks.
- Build the scheduling and waiting room first. These determine adoption.
- Integrate with your EHR early. Don't build telemedicine as a standalone silo.
- Add RPM in Phase 2. This is where the clinical value and revenue opportunity really is.
- Budget for compliance from day one. HIPAA, state licensing, e-prescribing regulations, accessibility — these are architectural decisions.
- Plan for mobile. At least 60% of patient telemedicine sessions happen on a phone.
We build healthcare software that treats telemedicine as part of a complete care delivery system, not just a video call with a doctor. If you're building or rebuilding a telemedicine platform, let's talk about what the right architecture looks like for your specific clinical workflows and patient population.