Reference build 01 · Healthcare
Telehealth Platform
Remote consultation with append-only audit trails and FHIR interoperability from day one.
What we'd be solving.
A clinic network wants remote consultations without losing the audit position it holds for in-person care. Every record access must be provable years later, the platform has to exchange data with an existing EHR, and a dropped video call cannot lose the clinical note.
The approach
Four decisions that shape everything else.
- 01
Separate the audit store from the app database
Access events are written to an append-only log that the application has no permission to update or delete. The operational database stays fast and mutable; the audit record becomes evidence rather than data.
- 02
A translation layer, not a shared model
FHIR R4 resources are mapped at the boundary into an internal domain model. Letting FHIR shapes leak into application code is what makes these systems impossible to change later.
- 03
Notes persist independently of the call
Clinical notes autosave to durable storage on a separate path from the WebRTC session, so a network failure costs the video and nothing else.
- 04
Consent modelled in the schema
Access is derived from an explicit consent relationship with validity windows and delegation, evaluated in the query layer rather than checked in controllers.
What we rejected
The alternatives, and why they lost.
Anyone can list the technology they chose. What tells you whether a team can be trusted with your system is whether they can explain what they didn't choose.
Storing audit events in the primary Postgres instance
The application would hold UPDATE and DELETE on its own audit trail, which undermines the point of having one.
Building video transport in-house
WebRTC infrastructure is a specialism with real operational cost. A managed provider with a signed BAA is the better trade.
Using FHIR resources as the internal domain model
FHIR is an interchange format. Modelling the application on it couples every feature to a spec you do not control.
Other reference builds
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