Telemedicine in Argentina: Technical Lessons From Building Segimed

Telemedicine in Argentina went from being a niche to a necessity during the pandemic, and it stayed. Today patients expect to have remote consultations, access their medical history online, and find professionals near their location. Segimed is our technical answer to that.

What Is Segimed

Segimed is a comprehensive digital health platform that connects patients with medical professionals. It's not "a Zoom for doctors" — it's a complete system for managing the doctor-patient relationship:

• Real-time video consultations with WebRTC (no installation needed)
• Complete digital medical records accessible anywhere
• Instant doctor-patient chat with Socket.io
• Geolocation of medical centers with interactive maps
• Medical dashboards with clinical data visualization
• Appointment management with automated reminders

The platform was developed and deployed in production as a digital health project.

Decision #1: WebRTC for Video Consultations

The first question was: do we use a video service (Twilio, Daily.co, Agora) or implement WebRTC directly?

We went with native WebRTC for three reasons:

1. Cost: video services charge per minute of connection. For a health platform where consultations last 20-40 minutes, that scales fast. Native WebRTC only requires a TURN server for relay (when direct connection fails), which costs a fraction.

2. Privacy: video data doesn't pass through third parties. In healthcare, this matters due to patient data protection regulations.

3. Control: we can implement specific features like consented recording, screen sharing to show test results, and virtual waiting rooms.

The trade-off: native WebRTC requires more code and testing than a managed service. But for a health platform that will have thousands of consultations, the licensing savings more than justify the initial investment.

Decision #2: PostgreSQL for Medical Records

Medical records have semi-variable structure: there are fixed fields (patient, date, diagnosis) and fields that vary by specialty (a cardiologist records ECGs, a dermatologist records lesions with photos).

We use PostgreSQL with JSONB fields for the variable part:

• Structured fields (patient, doctor, date, type) in standard columns with indexes
• Specialty-specific clinical data in a JSONB field that each specialty defines
• Full-text search on clinical content with tsvector
• Row Level Security so each doctor only sees patients from their practice

This gives us the best of both worlds: structure where we need it, flexibility where demanded, and performance with GIN indexes on JSONB.

Decision #3: Maps With Leaflet + OpenStreetMap

For medical center geolocation, we chose Leaflet with OpenStreetMap instead of Google Maps because:

• No per-view costs: Google Maps charges after a certain volume. OSM is free.
• Full customization: we can style the map to integrate with the platform design.
• Open data: OSM data can be enriched with proprietary medical information (available specialties, hours, ratings).

The map allows searching centers by specialty, viewing availability, and navigating directly to appointment booking.

Decision #4: Socket.io for Real-Time Chat

The doctor-patient chat isn't like a WhatsApp chat. It has specific requirements:

• Persistence: every message is saved in the medical record
• File attachments: patients can send symptom photos, PDF test results
• Medical indicators: the system can insert automatic alerts based on vital data
• Offline-first: if the patient loses connection, messages send when they reconnect

Socket.io gives us WebSockets with automatic fallback to polling, reconnection handling, and rooms to isolate conversations. Combined with PostgreSQL for persistence, every conversation is recorded as part of the medical file.

Challenges Specific to Digital Health

Regulatory

In Argentina, the Telemedicine Law (27.706) establishes requirements for informed consent, data storage, and professional liability. The platform implements signed digital consent before each video consultation and audit logs for every access to medical records.

Availability

A healthcare system cannot go down. We implemented:

• Deploy on Vercel with edge functions for minimum latency in Argentina
• Database with backups every 6 hours and point-in-time recovery
• Monitoring with alerts: if the video system fails, the team is notified in less than 2 minutes

UX for Non-Tech Patients

Many patients are older adults who aren't familiar with video calls. The consultation connection flow is:

1. Click "Join consultation" (a single button)
2. Camera and microphone permission (with clear instructions)
3. Waiting room until the doctor connects
4. Consultation in progress

No apps to download, no meeting codes, no configuration.

Full Stack

Telemedicine as an Opportunity in Argentina

The digital health market in Argentina and LATAM is growing steadily. Clinics and practices that don't offer remote consultation are losing patients to those that do. And existing systems (many legacy, in old PHP or .NET) aren't prepared for current demand.

If you're in the healthcare sector and need to digitize consultations, medical records, or any medical process, let's talk. We have real production experience with Segimed and can adapt the platform or build something new from scratch.

---

By Esteban Aleart, Founder & Lead Engineer at PairProgramming.