Telemedicine software integrated with FHIR-based EHRs uses five patterns. Understanding them shapes both purchasing and integration. **Pattern 1: SMART on FHIR launched telemedicine app.** App launched from EHR patient chart; SMART provides patient context; app writes visit outcomes back. Pattern 2: External telemedicine platform + FHIR sync. Video visit on platform (Zoom, Doxy.me); metadata synced to FHIR as Encounter; clinical notes in EHR post-visit. Pattern 3: Ambient documentation during telemedicine. Voice-recognition captures visit; extracts to Observation, Condition; writes to FHIR. Pattern 4: Async telemedicine (store-and-forward). Patient submits data (photos, symptoms) via SDC Questionnaire; clinician reviews and responds asynchronously. Pattern 5:…

EHR development is inherently complex, but five patterns cut avoidable complexity substantially. Adopting them lets teams ship faster. Pattern 1: FHIR-native storage. Skip proprietary internal + FHIR facade duplication. FHIR resources are the internal model. Lower long-term cost. Pattern 2: SMART Backend Services for internal integrations. SMART auth for internal service-to-service too, not just external. Consistent auth model. Pattern 3: Reference implementations before custom. Use LHC-Forms instead of building form renderers. Use Inferno instead of building conformance tests. Pattern 4: Declarative over imperative. StructureMap for transformations. ConceptMap for translations. Application code stays cleaner. Pattern 5: Conformance in CI. Automated Inferno…