Recording a clinical session turns an ephemeral, transient conversation into a durable, highly sensitive PHI artifact that must be governed for its entire lifecycle. The moment you capture a consult, you have created a file that contains identifiable audio and video of a patient discussing their health — among the most sensitive data your product will ever hold.
That creates a chain of obligations. Recording requires explicit consent, and in states with two-party (all-party) consent laws, recording without it is not a product choice but a legal violation. The resulting file must be stored encrypted at rest, behind strict access controls, with audit logging of who replayed it and why. It needs defined retention and deletion schedules so recordings do not accumulate indefinitely, and a clear, enforced answer to who is permitted to access a given recording and for what purpose. These map onto HIPAA's access-control, audit-control, and storage-security expectations under the Security Rule (45 CFR §164.312).
Architecturally, the recorder typically hangs off the SFU or a dedicated recording bridge, because that is where the media is available in the clear to be captured — and every storage hop the recording touches, from the recorder to object storage to any backup, must be covered by a Business Associate Agreement (BAA) when a vendor is involved. This also creates a real tension with end-to-end encryption (E2EE): if only the endpoints hold the keys, the server cannot produce a recording, so teams must choose deliberately between server-side recording and true E2EE. The common pitfall is enabling recording for convenience without solving consent, retention, and access first, leaving sensitive footage ungoverned.
