Client: Regional Health Network
Timeline
14 weeks from kickoff to production launch
Team
6 engineers (2 frontend, 2 backend, 1 DevOps, 1 QA)
Industry
Healthcare
Regional Health Network operated twelve outpatient clinics and two urgent care facilities spread across a 200-mile rural corridor. Patients routinely drove 45 minutes or more for routine follow-up appointments, prescription renewals, and specialist consultations. No-show rates hovered around 32 percent, costing the network an estimated $2.4 million annually in lost revenue and wasted provider time. For patients with chronic conditions such as diabetes and hypertension, gaps in care between in-person visits led to preventable emergency department visits and hospital readmissions.
The network had previously attempted to adopt a commercial telemedicine product, but the platform suffered from poor video quality on rural broadband connections, lacked integration with their existing Epic-based electronic health record system, and required patients to download a separate application that many older patients found confusing. Provider adoption stalled at under 15 percent after six months, and the project was shelved.
Beyond the technology failures, the organization faced strict regulatory requirements. All patient data had to remain within HIPAA-compliant infrastructure, video sessions needed end-to-end encryption, and the platform had to support audit logging for compliance reviews. The network also required e-prescribing capabilities that integrated with major pharmacy chains and a patient portal that could surface lab results, upcoming appointments, and care plan documents.
The executive team approached Cozcore with a clear mandate: build a telemedicine platform that works reliably on low-bandwidth connections, integrates natively with their EHR, and is simple enough for elderly patients to use without technical assistance. The system needed to be operational within four months to meet a state funding deadline tied to rural healthcare access grants.
We began with a two-week discovery phase that included shadowing physicians during patient consultations, interviewing front-desk staff about scheduling pain points, and conducting usability sessions with a group of 20 patients ranging in age from 28 to 84. This fieldwork revealed that the primary barrier to adoption was not technology resistance but rather workflow friction: patients did not understand how to prepare for a virtual visit, and providers lacked a streamlined way to document encounters within their existing EHR workflow.
Based on these insights, we designed an architecture that prioritized three principles: zero-download access via WebRTC in the browser, adaptive video quality that gracefully degraded on slow connections, and a provider experience that embedded directly within the Epic workflow through SMART on FHIR integration. Rather than asking providers to switch between applications, the telemedicine session launched from within the EHR and automatically populated encounter notes with visit metadata.
We adopted a phased delivery approach aligned with the funding deadline. Phase one delivered the core video consultation platform with scheduling, waiting room, and basic encounter documentation in eight weeks. Phase two added e-prescribing integration with Surescripts, lab result viewing, and the patient self-service portal over the following six weeks. Phase three, delivered post-launch, introduced asynchronous messaging, care plan management, and remote patient monitoring device integration.
Throughout development, we maintained a continuous feedback loop with a pilot group of four physicians and fifty patients. Bi-weekly demos allowed clinical stakeholders to validate that workflows matched real-world practice patterns. We also engaged the network compliance officer early, conducting two formal security reviews during development to ensure HIPAA requirements were addressed architecturally rather than retrofitted.
The delivered platform consists of three primary components: a patient-facing web application optimized for mobile browsers, a provider-facing clinical interface embedded within Epic via SMART on FHIR, and an administrative dashboard for scheduling management, analytics, and compliance reporting.
The patient experience begins with an SMS or email appointment reminder containing a single-click link to join the virtual waiting room. No app download, no account creation for the first visit, and no complex setup. The WebRTC-based video engine automatically adjusts resolution and frame rate based on available bandwidth, maintaining acceptable quality even on 1.5 Mbps connections common in the rural service area. If video quality drops below usable thresholds, the system gracefully falls back to audio-only with a shared document viewer for lab results and care plans.
On the provider side, physicians launch the telemedicine session directly from the Epic schedule. The encounter note is pre-populated with patient demographics, active medications, recent lab results, and the reason for visit. During the consultation, providers can share their screen to walk patients through test results, annotate images, and generate e-prescriptions that are transmitted directly to the patient pharmacy of choice via Surescripts. After the visit, the encounter note is automatically filed to the patient chart with the video session duration, diagnosis codes, and any prescriptions issued.
The infrastructure runs entirely on AWS within a HIPAA-eligible environment. Video streams are encrypted end-to-end using SRTP, and all patient data at rest is encrypted with AES-256. The system implements role-based access control aligned with the network organizational hierarchy, and every data access event is logged to a tamper-proof audit trail. Automated monitoring through CloudWatch and PagerDuty ensures the operations team is alerted within 60 seconds of any service degradation.
Measurable outcomes delivered for Regional Health Network
60% reduction in patient wait times
Average time from appointment booking to consultation dropped from 12 days for in-person visits to under 48 hours for telemedicine appointments. Urgent follow-up consultations were typically completed same-day, eliminating the multi-week delays that previously led to gaps in chronic disease management.
50,000+ patients served in first 12 months
The platform facilitated over 50,000 telemedicine encounters in its first year of operation, with adoption growing 18 percent month-over-month. Provider adoption reached 89 percent within three months of launch, compared to the 15 percent ceiling of the previous commercial solution.
99.9% platform uptime maintained
The AWS-hosted infrastructure delivered 99.9 percent uptime across the first year, with zero unplanned outages affecting patient care. Planned maintenance windows were conducted during off-hours with zero-downtime deployments using blue-green deployment strategies.
4.8 out of 5 patient satisfaction score
Post-visit surveys returned an average satisfaction score of 4.8 out of 5 across all patient demographics. Notably, patients over 65 rated the platform 4.7 out of 5, validating the accessibility-first design approach that eliminated app downloads and complex authentication flows.
$1.8M annual savings from reduced no-shows
No-show rates dropped from 32 percent for in-person appointments to 8 percent for telemedicine visits. The convenience of joining from home eliminated transportation barriers, childcare conflicts, and work schedule constraints that drove the majority of missed appointments.
The technologies powering this solution
Frontend framework for the patient portal, provider interface, and administrative dashboard with component-based architecture enabling rapid feature development.
Backend API server handling authentication, appointment scheduling, encounter management, and real-time WebSocket connections for the virtual waiting room.
Peer-to-peer video and audio communication with adaptive bitrate streaming, SRTP encryption, and graceful fallback to audio-only on constrained connections.
Primary relational database for patient records, appointment data, encounter notes, and audit logs with row-level security enforcing access control policies.
HIPAA-eligible cloud infrastructure providing auto-scaling compute, managed database, encrypted object storage for documents, and global CDN for static assets.
Healthcare interoperability standard enabling seamless embedding of the telemedicine interface within the Epic EHR and bidirectional clinical data exchange.
E-prescribing network integration enabling providers to send electronic prescriptions directly to patient pharmacies during telemedicine encounters.
In-memory data store powering real-time session management, waiting room queues, and caching of frequently accessed patient summary data for sub-100ms response times.
Cozcore understood that this was not just a technology project but a fundamental change in how we deliver care to our community. Their team spent time in our clinics, talked to our patients, and built a system that our 70-year-old patients use as easily as our 30-year-old ones. The platform has become the backbone of our rural access strategy, and the quality of the engineering gives us complete confidence in its reliability and security.
Dr. Sarah Mitchell
Chief Medical Officer, Regional Health Network
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