Synchronous care is care that happens in real time: the patient and the clinician are present on the same audio or video channel at the same moment, exactly as in a face-to-face visit compressed onto a screen. The mechanism is a live media session, almost always built on WebRTC (the open standard browsers and apps use for real-time audio and video), in which both sides exchange a continuous stream rather than uploading something to be reviewed later.
This real-time nature inherits the hardest engineering constraints in the whole field. One-way latency above roughly 300–500 milliseconds starts to break natural conversation; people talk over each other and clinical rapport suffers. More seriously, a call that drops in the middle of a consultation is a clinical event, not a mere inconvenience — a clinician may have been mid-assessment of a worsening symptom. That reframes reliability work (automatic reconnection, graceful degradation to audio-only when bandwidth collapses, clear connection-state signaling) as part of the clinical safety bar rather than a nice-to-have.
For a telemedicine product team this means investing in measured quality of service — jitter, packet loss, and latency monitoring — and in honest failure behavior. A common pitfall is optimizing only for the happy path on good Wi-Fi while ignoring the patient on a weak cellular connection at home, which is precisely the population telemedicine is meant to reach. Synchronous care also carries the full HIPAA load: the live media must be encrypted in transit, and any recording must be handled as PHI.
The handbook · 7 volumes
Fora Soft Video Engineering Handbook
Synchronous care is the live video consult, where latency, reliability and audio clarity decide whether the visit counts. Our seven-volume handbook covers the whole video stack; for synchronous care start with Volume 3: WebRTC, real-time media, QoE monitoring and delivery economics. Volume 2 covers network transport; Volume 7 covers live captions and AI in calls. Written by Nikolay Sapunov, CEO at Fora Soft.
Building live synchronous care visits that hold up on patients' home networks?
We will design the call stack, reconnection and quality monitoring for your consults and give you an architecture with latency and cost targets. 250+ video products shipped since 2005.
