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: Video + integrated CDS. CDS Hooks fires during video visit context; provides in-visit decision support.
Documentation flow
1. Visit starts → Encounter resource with status: in-progress. 2. During visit → Observations, Conditions captured (ambient or manual). 3. Visit ends → Encounter status: finished. 4. Post-visit → Task for follow-up if needed. 5. Analytics → visits aggregated via bulk export.
Vendor state (mid-2026)
| Vendor | SMART launch | Encounter sync | Ambient doc | Async |
|---|---|---|---|---|
| Amwell | Yes | Full | Native | Yes |
| Teladoc | Yes | Full | Add-on | Yes |
| Doxy.me | Add-on | Basic | External | No |
| Zoom for Healthcare | Add-on | Basic | External | No |
| Epic MyChart Video | Native | Full | Native (Nuance DAX) | Yes |
Common integration mistakes
1. Video-only, no FHIR sync. 2. No SMART launch — clinician context-switch. 3. Manual documentation post-visit. 4. Missing follow-up task tracking. 5. No integrated CDS during video.
Regulatory considerations
1. HIPAA-compliant video platform. 2. State-specific telemedicine regulations. 3. Documentation completeness for reimbursement. 4. Prescription regulations (DEA for controlled substances).
Telemedicine on FHIR is a mature integration pattern. Choose the pattern that fits your workflow requirements.
