Cost to build a telehealth app, layer by layer

The cost to build a telehealth app is set by four layers: the core visit (booking, video, payments), prescriptions, EHR integration and compliance. The core alone is a 5-6 week build, and at Zeroic it starts at $12,000 as a fixed-scope MVP. Each further layer adds scope, so ship the core first and add layers once patients pay for visits.

Most telehealth cost guides quote one big range and leave you to guess where you fall in it. The range is wide because “telehealth app” covers everything from a single clinic’s video visits to a multi-specialty platform wired into hospital records. Your budget depends on which layers you need on day one, and most founders need fewer than they think.

Cost to build a telehealth app, by layer

Think of the app as four layers stacked on each other. Each one is a separate scoping decision.

Layer 1: the core visit. Patient sign-up, a doctor profile with availability, booking with reminders, a video room, payment before or after the call, and a visit note. This is what a patient experiences, and it’s enough to test whether people will pay for your care model. It’s also a standard build: we scope this exact set as an MVP Sprint, fixed price, in production in 5-6 weeks.

Layer 2: prescriptions. A prescription is a regulated document. In India it has to follow a set format and drug lists (more below). In the US, sending prescriptions electronically to pharmacies is usually done through a specialist e-prescribing vendor, which brings its own onboarding and contract. Either way, this layer adds legal review on top of engineering.

Layer 3: EHR integration. If your doctors work inside a hospital’s records system, they’ll want visit notes to land there. Epic’s developer program for FHIR apps is free and comes with a testing sandbox, but every health system decides on its own whether to connect your app. The approvals at each customer are the slow part, and they don’t fit into a fixed sprint.

Layer 4: compliance infrastructure. Hosting, logging, backups, access controls and vendor contracts that meet HIPAA in the US or India’s telemedicine rules. This is mostly configuration and paperwork rather than features, but it touches every other layer, so it has to be decided before the first line of code.

The core visit is cheap to run

Founders often overestimate what video costs, and underestimate what payments cost.

Twilio lists video at $0.004 per participant per minute. A 20-minute visit with one doctor and one patient is 40 participant minutes, or $0.16. Recording the visit costs the same rate again. At 1,000 visits a month, live video comes to about $160.

Payments take a bigger slice. Stripe charges 2.9% + 30¢ per successful domestic card payment in the US, so a $75 consultation pays about $2.48 in fees, roughly fifteen times the video cost. In India, Razorpay’s standard fee is 2% per successful domestic transaction, plus 18% GST on the fee: ₹11.80 on a ₹500 consultation.

The lesson for your budget: running costs at MVP scale are small and predictable. Build cost and compliance decisions are where the money goes.

US apps pay a HIPAA premium

If you sell to clinics or provider groups in the US, the patient data your app handles is protected health information, and every vendor that stores or transmits it needs a signed business associate agreement (BAA). That rules out some free tiers and changes which plan you buy.

Two examples from vendors we’d use for a core build:

• Video. Twilio Video is HIPAA eligible, but Twilio signs a BAA only for customers on its Security Edition or Enterprise Edition.
• Database. Supabase requires a signed BAA and the HIPAA add-on for projects holding patient data, plus point-in-time recovery (which needs at least a small compute add-on), SSL enforcement, network restrictions and connection logging.

Every other vendor in the path needs the same check: email, SMS reminders, error tracking, analytics, file storage. A single analytics script that sees a patient’s name on a booking page is a compliance problem. Map where patient data flows before you choose tools, then pick tools that sign. And if your database is Postgres, get the access rules right from day one; our guide to Supabase row level security failures covers the six ways those rules quietly leak rows.

India’s telemedicine rules change the build

India’s Telemedicine Practice Guidelines, released on March 25, 2020, set out what platforms and doctors must do. A review in the Indian Journal of Psychiatry summarizes the parts that turn into product requirements:

• Doctors show their registration number on websites, prescriptions, receipts and invoices. Your doctor profile and prescription template need a verified registration field.
• AI can’t counsel or prescribe. Using artificial intelligence or machine learning applications to counsel patients or prescribe medicines is prohibited. An AI intake form or visit summary for the doctor is fine; an AI that talks to the patient as the clinician is not.
• Drug lists decide the visit type. List O covers over-the-counter drugs. List A drugs need a video consultation before the first prescription. Drugs on the prohibited list (Schedule X and NDPS Act drugs) can’t be prescribed over telemedicine at all. A chat-only MVP can’t issue a first List A prescription.
• Records stay. Doctors have to maintain the trail of conversations and treatment records, so chat logs and visit notes need durable, access-controlled storage.

None of this is expensive to build if it’s in the scope from the start. Retrofitting registration checks and prescription formats into a live app is where Indian telehealth projects lose weeks.

When an off-the-shelf tool is cheaper

If you run one practice and need video visits, don’t build an app. Doxy.me has a free version, and its paid plan includes a BAA. That covers a single clinic’s needs for far less than any custom build.

Build when the product is your business: your own booking logic, a subscription or membership model, a care team that works together on one patient, a specific patient experience, or a market the off-the-shelf tools don’t serve. That’s also when owning the code matters, because you’ll be changing it every week.

How to scope your first version

• One clinic, video visits only: buy an off-the-shelf tool with a BAA. Don’t build.
• New care model, need to prove patients pay: build the core visit (Layer 1) only. 5-6 weeks.
• India launch with prescribing: core visit plus the prescription template, registration display and drug-list rules from day one. Budget legal review alongside engineering.
• US launch selling to clinics: core visit plus HIPAA infrastructure (BAAs, logging, backups) from day one. Leave e-prescribing for version two unless your care model needs it on launch.
• Selling to hospitals: core visit first, then EHR integration per customer. Expect the approval cycle at each health system to take longer than the code.
• Want AI in the product: use it for intake, scheduling and note drafts. Keep a clinician on every consultation and prescription.

What we learned building TopUp Care

TopUp Care was a telehealth platform we built for clinicians in Africa, and it’s a good example of a product no off-the-shelf tool covers. Its core wasn’t a patient video visit. Doctors sent anonymous questions to a network of specialists, referred patients on, and talked cases through in chat rooms for each specialty. Six hospitals and clinics across four countries signed on.

Accounts, messaging and forms were the standard part, the kind a senior team can scope to a fixed price. What made TopUp Care work were its rules: both identities stayed hidden in an eConsult so the answer was unbiased, and every question needed at least 50 words of background so a specialist could answer it well. Your care model is where your scoping time should go too. Our notes on fixed-price MVP development explain how to draw that boundary so the first version ships on time. For how we run a health build end to end, see our telehealth app development page.

If you’re comparing build quotes, ask each team which layers their number covers. A quote that doesn’t separate the core visit from prescriptions, EHR work and compliance can’t be compared with one that does.

Frequently asked questions

How much does it cost to build a telehealth MVP?

A telehealth MVP with booking, video visits and payments is a fixed-scope build of about 5-6 weeks. At Zeroic that kind of build is an MVP Sprint, which starts at $12,000. Prescriptions, EHR integration and HIPAA-grade infrastructure are separate layers that add scope, so quote them separately and add them only when the first version proves demand.

How much does video cost per consultation in a telehealth app?

Very little at MVP scale. Twilio Video lists $0.004 per participant per minute, so a 20-minute visit with a doctor and a patient uses 40 participant minutes and costs $0.16. Recording the visit costs the same again. At 1,000 visits a month, live video comes to about $160, which is far smaller than payment fees on the same visits.

Do I need HIPAA compliance for a telehealth app in the US?

Yes, if your app handles protected health information for a covered entity such as a clinic or a provider group. In practice that means a signed business associate agreement with every vendor that stores or transmits patient data, including video, database and messaging. Twilio requires its Security or Enterprise Edition for a BAA, and Supabase requires its HIPAA add-on.

Can an AI chatbot prescribe medicines on an Indian telemedicine app?

No. India's Telemedicine Practice Guidelines of March 2020 prohibit using artificial intelligence or machine learning applications to counsel patients or prescribe medicines. AI can still help with intake, scheduling and summaries for the doctor, but a registered medical practitioner has to run the consultation and issue the prescription, with their registration number displayed.

Should I use an off-the-shelf telehealth tool instead of building an app?

Use one if all you need is video visits for your own practice. Tools like Doxy.me offer a free version and a paid plan that includes a BAA, which covers a single clinic's needs for far less than a custom build. Build when the product is the business: your own booking logic, pricing, care model or patient experience.

References

1. Twilio - Video pricing
2. Twilio - HIPAA compliance and the Business Associate Addendum
3. Supabase - Configuring HIPAA projects
4. Supabase - HIPAA compliance
5. Stripe - Pricing
6. Razorpay - Pricing
7. Dinakaran et al. - Telemedicine practice guidelines of India, 2020: implications and challenges (Indian Journal of Psychiatry)
8. Epic on FHIR - Developer resources
9. Doxy.me - Pricing