iOS Medical App Development

We build HIPAA-compliant iOS medical applications that integrate with Apple's health frameworks, connect to EHR systems, and deliver real-time telemedicine experiences — all backed by fault-tolerant Elixir Phoenix infrastructure.

Why iOS for Medical Apps?

iOS dominates healthcare. Over 80% of physicians use iPhones, and Apple's health ecosystem — HealthKit, ResearchKit, CareKit, and clinical records — provides a foundation no other platform matches.

Apple's tight hardware-software integration enables:

• HealthKit: Read and write 100+ health data types (heart rate, blood glucose, sleep analysis, clinical records)
• ResearchKit: Build IRB-approved clinical study apps with informed consent, surveys, and active tasks
• CareKit: Patient care plan management with medication tracking, symptom logging, and care team connectivity
• Clinical Records: FHIR R4 access to patient EHR data from participating hospitals

Our Technology Stack

Elixir Phoenix: The Actor Model for Healthcare

We chose Elixir Phoenix for medical app backends because the BEAM VM was purpose-built for systems that cannot go down.

Elixir runs on the BEAM (Bogdan/Bjorn's Erlang Abstract Machine), originally designed by Ericsson in the 1980s for telecom switches. The same technology that achieved 99.9999999% uptime (nine nines — 31.6 milliseconds of downtime per year over 20 years) now powers our medical backends.

How the actor model benefits healthcare applications:

• Process isolation: Each patient session, device connection, and video call runs as its own lightweight BEAM process (~2KB memory). A malformed vital sign reading from one patient's device cannot crash another patient's session.
• Preemptive scheduling: The BEAM scheduler prevents any single process from monopolizing CPU — critical when real-time vital sign processing must never be blocked.
• Per-process garbage collection: GC pauses only affect individual processes (microseconds), not the entire system. No "stop-the-world" pauses that would interrupt real-time cardiac monitoring.
• Supervision trees: Hierarchical process monitoring with automatic restart strategies. If a patient session process crashes, its supervisor restarts it instantly while all other sessions continue unaffected.
• Hot code upgrades: Patch security vulnerabilities in a running telemedicine platform without scheduling maintenance windows or interrupting active consultations.

Phoenix LiveView for Real-Time Dashboards

Phoenix LiveView delivers rich, real-time interfaces with server-rendered HTML over persistent WebSocket connections:

• No JavaScript state management complexity: The server is the single source of truth. No Redux, no stale cache bugs.
• PHI stays server-side: The browser receives rendered HTML, not raw patient data. No client-side data stores to secure.
• Automatic reconnection: If a nurse walks between WiFi access points, LiveView reconnects and re-syncs automatically.
• Proven scale: Phoenix Channels benchmarked at 2 million concurrent WebSocket connections on a single 40-core server.

WebRTC Telemedicine with elixir-webrtc

We use elixir-webrtc, a W3C-compliant WebRTC implementation written in native Elixir by Software Mansion. Unlike JavaScript WebRTC wrappers that require separate media servers (Janus, mediasoup), elixir-webrtc runs media processing in the same application:

• Simulcast: Multiple video resolutions let the server select quality based on bandwidth — hospital workstation vs. mobile device
• Membrane integration: Server-side media pipelines for encrypted HIPAA-compliant session recording
• Nx ML integration: Feed audio/video streams into Elixir Nx for real-time speech-to-text clinical note generation
• Phoenix Channels signaling: SDP offer/answer exchange and ICE candidate trickling over the same WebSocket infrastructure

HIPAA Compliance: Built In, Not Bolted On

Every iOS medical app we build includes:

• Encryption at rest and in transit: AES-256 for stored data, TLS 1.3 for all API communication
• Role-based access controls: Granular permissions for patients, nurses, physicians, and administrators
• Comprehensive audit logging: Every access to PHI is logged with user identity, timestamp, action, and IP address
• Biometric authentication: Face ID/Touch ID with session timeout policies
• Remote wipe: Capability to remotely erase PHI from lost or stolen devices
• Business Associate Agreements: Full BAA coverage with all infrastructure providers

Why Domestic Development Matters for HIPAA

Outsourcing medical app development to overseas teams introduces serious compliance risks that many organizations underestimate:

HIPAA follows PHI across borders, but enforcement does not. HHS Office for Civil Rights has untested jurisdiction over foreign entities. If an offshore business associate breaches data, the US covered entity bears all liability with no effective legal recourse.

Specific risks include:

• Unenforceable BAAs: Business Associate Agreements signed with offshore entities are difficult to enforce in foreign courts
• Data sovereignty conflicts: GDPR, China's PIPL, India's data protection laws may conflict with HIPAA requirements
• Developer PHI access: Offshore teams accessing staging environments with real patient data constitutes PHI access requiring full HIPAA training, BAA coverage, and audit trails
• Breach notification complications: Different countries have different notification timelines (GDPR: 72 hours, HIPAA: 60 days), creating conflicting legal obligations
• Audit trail gaps: Time zone differences and shared workstations in offshore centers make individual attribution difficult

We keep all development domestic with US-based engineers under direct BAA coverage, full audit trails, and enforceable contractual protections.

EHR Integration

We integrate iOS medical apps with major EHR systems:

• Epic: MyChart SDK, FHIR R4 APIs, App Orchard certification
• Cerner: Millennium FHIR APIs, open.epic integration
• Allscripts: Open API platform
• HL7 FHIR: Standard-based interoperability for any FHIR-compliant system
• HL7 v2: Legacy interface engine integration for older systems

FDA SaMD Compliance

If your iOS app qualifies as Software as a Medical Device (SaMD), we support the regulatory pathway:

• Risk classification: Determine Class I, II, or III based on IEC 62304 and FDA guidance
• Quality Management System: ISO 13485 compliant development processes
• 510(k) preparation: Substantial equivalence documentation for Class II devices
• Design controls: Requirements traceability, design verification, and validation
• Post-market surveillance: Monitoring and reporting infrastructure

Our Process

1. Discovery & Requirements (2-4 weeks): Map clinical workflows, define HealthKit data types, identify EHR integration points, assess FDA classification
2. Architecture & Compliance (2 weeks): Design HIPAA-compliant architecture, set up Elixir Phoenix infrastructure, configure encrypted data pipelines
3. Core Development (8-16 weeks): Build iOS app with HealthKit integration, develop Phoenix backend, implement WebRTC telemedicine if needed
4. Integration & Testing (4-6 weeks): EHR integration, penetration testing, HIPAA compliance audit, App Store submission
5. Launch & Support: Ongoing monitoring, security patches, feature development, compliance maintenance