Telehealth Infrastructure: A Technical Guide for Medical Practices

Telehealth has transitioned from emergency measure to permanent care delivery channel. Patients expect it. Insurers reimburse it. Regulators have accommodated it.

But many practices implemented telehealth hastily and are now discovering that consumer-grade video calls aren't adequate for sustainable clinical use. This guide covers what you need for reliable, compliant, professional telehealth services.

The Foundation: Network Infrastructure

Bandwidth Requirements

Telehealth is bandwidth-hungry. Plan accordingly.

Per concurrent video session:

• Standard definition: 1-2 Mbps up/down
• High definition: 3-5 Mbps up/down
• Recommended buffer: 50% above calculated need

Example calculation:

• 5 concurrent telehealth sessions × 5 Mbps = 25 Mbps
• 50% buffer = 37.5 Mbps
• Plus other office traffic: 50+ Mbps total recommended

Internet Service Requirements

Business-grade service:

• Symmetric upload/download speeds (or close to it)
• Service Level Agreement (SLA) for uptime
• Static IP address
• Priority support for outages

Why consumer service isn't adequate:

• Asymmetric speeds (upload often much slower than download)
• No uptime guarantees
• Slower repair response
• Shared bandwidth during peak times

Redundancy

Backup internet connection:

• Cellular (4G/5G) as failover
• Automatic failover (should switch without manual intervention)
• Test failover monthly

Why it matters: A dropped video call mid-appointment is unprofessional and potentially harmful if clinical decisions are interrupted.

Network Quality of Service (QoS)

Configure your network to prioritize video traffic:

• Telehealth video traffic gets highest priority
• Voice traffic second priority
• General internet traffic lower priority

This prevents file downloads or software updates from degrading video quality.

Platform Selection

HIPAA Compliance Requirements

Not all video platforms are HIPAA-compliant. Requirements:

Business Associate Agreement (BAA):

• Platform vendor must sign BAA
• Consumer platforms (Zoom free, FaceTime, Skype) generally don't offer BAAs
• Some platforms offer HIPAA-compliant tiers

Encryption:

• End-to-end encryption preferred
• TLS encryption minimum
• No recording without patient consent

Access controls:

• Unique user credentials for each provider
• Waiting room functionality
• Host controls for sessions

Platform Categories

EHR-integrated telehealth:

• Built into your practice management system
• Seamless scheduling and documentation
• Patient accesses through portal
• Examples: Epic MyChart, athenahealth, DrChrono

Standalone telehealth platforms:

• Purpose-built for healthcare
• May integrate with EHR
• Often more features than EHR-integrated options
• Examples: Doxy.me, Teladoc, Amwell, VSee

General video with HIPAA tier:

• Business/healthcare versions of consumer platforms
• Requires proper configuration
• Examples: Zoom for Healthcare, Microsoft Teams (properly configured)

Evaluation Criteria

• BAA availability
• EHR integration capabilities
• Patient ease of use (browser-based vs. app required)
• Provider features (screen sharing, annotation, etc.)
• Technical support availability
• Reliability and uptime history
• Cost structure

Hardware Requirements

Provider Workstation

Computer specifications:

• Modern processor (Intel i5/AMD Ryzen 5 or better)
• 8GB RAM minimum, 16GB recommended
• SSD storage
• Discrete graphics can help with video processing

Display:

• Dedicated monitor for video (separate from EHR)
• Large enough to see patient clearly (24" minimum)
• Proper positioning for professional appearance

Camera:

• External HD webcam (not built-in laptop camera)
• 1080p resolution minimum
• Wide-angle option for exams showing range of motion
• Proper mounting at eye level

Microphone:

• External microphone or quality headset
• Noise-canceling preferred
• Avoid built-in laptop microphones (poor quality)

Lighting:

• Adequate front lighting
• Avoid backlight from windows
• Consistent lighting for professional appearance

Patient-Side Considerations

You can't control patient equipment, but you can:

• Provide clear technical requirements
• Offer pre-visit technology checks
• Have phone backup for audio issues
• Train staff to troubleshoot common issues

Room Setup

Physical Space

Dedicated telehealth space (ideal):

• Private room for confidentiality
• Consistent professional background
• Controlled lighting
• Minimal background noise

Shared space considerations:

• Visual privacy (can't see other patients/staff on camera)
• Audio privacy (confidential conversations not overheard)
• Professional background options (virtual backgrounds as backup)

Acoustic Considerations

• Minimize echo (add soft surfaces if needed)
• Reduce background noise
• Consider sound masking in adjacent areas
• Test audio quality in the room

Ergonomics

• Camera at eye level (not looking up or down)
• Natural posture while viewing screen
• EHR accessible without turning away from camera
• Comfortable for extended use

Clinical Workflow Integration

Scheduling

• Clear identification of telehealth vs. in-person visits
• Automated patient instructions with appointment
• Technology check reminders
• Buffer time between telehealth appointments

Pre-Visit

Patient communication:

• Clear joining instructions (browser, app, link)
• Technology requirements
• What to have ready (insurance card, medication list)
• Environment recommendations (private, quiet space)

Technology verification:

• Pre-visit tech check option
• Staff available to troubleshoot before appointment
• Alternative contact method if video fails

During Visit

Workflow considerations:

• Virtual waiting room management
• Documentation concurrent with visit
• Screen sharing for education
• Prescription and order handling

Contingency procedures:

• Protocol if video fails (switch to phone, reschedule)
• When to convert to in-person visit
• Emergency protocol if patient in distress

Post-Visit

• Documentation completion
• Follow-up instructions delivery
• Next appointment scheduling
• Patient satisfaction feedback

Security and Compliance

HIPAA Technical Requirements

Access controls:

• Unique user IDs for each provider/staff
• Automatic session timeout
• Role-based access

Audit controls:

• Logging of access to telehealth platform
• Recording consent documentation
• Session records if applicable

Transmission security:

• Encrypted video transmission
• Secure link generation
• No unauthorized access to sessions

Patient Consent

Document and obtain consent for:

• Telehealth services generally
• Specific limitations of telehealth
• Privacy considerations (patient environment)
• Recording (if applicable)

Staff Training

Required training topics:

• HIPAA requirements for telehealth
• Platform operation
• Troubleshooting common issues
• When to escalate technical problems
• Documentation requirements

Peripheral Devices for Enhanced Care

Remote Patient Monitoring

Devices that can transmit data:

• Blood pressure monitors
• Glucose monitors
• Pulse oximeters
• Weight scales
• Heart rate monitors

Integration considerations:

• EHR integration capabilities
• Patient ease of use
• Data transmission reliability
• Cost (patient or practice bears)

Examination Aids

For providers:

• Digital stethoscope (for audio transmission)
• High-resolution camera for skin examination
• Annotation tools for patient education

For patients (if practice-provided):

• Otoscopes for ear examination
• Dermatoscopes for skin examination
• Thermometers with app connectivity

Troubleshooting Common Issues

Video Quality Problems

Symptoms: Pixelation, freezing, lag

Causes and solutions:

• Bandwidth: Reduce other network usage, upgrade service
• WiFi: Move closer to router, use wired connection
• Computer performance: Close other applications, upgrade hardware
• Platform issues: Check service status, try alternative platform

Audio Problems

Symptoms: Echo, static, unable to hear

Causes and solutions:

• Echo: Use headset, mute when not speaking
• Static: Check microphone connection, reduce gain
• Can't hear: Check speaker/headphone selection, volume settings

Connection Failures

Symptoms: Unable to join, frequent disconnects

Causes and solutions:

• Browser issues: Try different browser, clear cache
• Firewall blocking: Configure firewall exceptions
• Internet problems: Check connection, switch to backup

Implementation Roadmap

Phase 1: Foundation (Weeks 1-2)

• Assess current network capacity
• Upgrade internet service if needed
• Implement backup connectivity
• Select telehealth platform

Phase 2: Setup (Weeks 3-4)

• Configure platform and EHR integration
• Set up provider workstations
• Configure rooms for telehealth
• Develop workflows and protocols

Phase 3: Training (Weeks 5-6)

• Train all staff on platform
• Practice sessions among staff
• Develop patient instructions
• Create troubleshooting guides

Phase 4: Launch (Weeks 7-8)

• Pilot with select patients
• Gather feedback and refine
• Scale to full availability
• Monitor and optimize

Getting Help

Telehealth infrastructure touches networking, hardware, software, compliance, and clinical workflow. Few practices have all this expertise in-house.

Layth Solutions has been supporting healthcare practices in the NYC area for 30 years. We've helped practices implement telehealth infrastructure that's reliable, compliant, and sustainable—not just a quick fix.

Request a telehealth infrastructure assessment to evaluate your current capabilities and develop a plan for professional-grade telehealth services.