Case Study: Designing Authentication for a Telemedicine Platform

Telemedicine platforms face unique authentication challenges: patient privacy under HIPAA (or equivalent laws worldwide), clinician workflows, device constraints, and a need for secure API access for third-party integrations. This case study explores how MedConnect (pseudonym) built an authentication system that addressed compliance, UX, and scalability.

Constraints and requirements

• HIPAA compliance for patient data and audit trails.
• Fast patient login — minimal friction for appointments — but strong assurance for clinicians accessing sensitive records.
• Support for third-party integrations (labs, billing) using scoped API access.
• Availability across mobile apps, web apps, and kiosk devices in clinics.

Solution overview

MedConnect chose a hybrid approach:

1. A centrally managed IdP for core authentication, deployed as a managed, compliant provider to meet audit needs quickly.
2. Device-based WebAuthn for clinician logins to provide phishing-resistant auth.
3. Magic links and SMS OTP for patient sign-in with contextual step-up for sensitive operations (e.g., accessing clinical notes).
4. OAuth 2.0 with fine-grained scopes for third-party API access and a gateway to enforce rate limits and token validation.

Key design decisions

Auditability

Every authentication event, token exchange, and admin operation was logged to an immutable audit store with tamper-evident properties. Logs included session metadata, device fingerprint, and MFA status. This made compliance reporting straightforward.

Data minimization

Patient profiles stored only minimal personally identifiable information (PII) in the auth layer. Clinical PHI remained in the EHR backend with strict access controls and per-request authorization checks using ABAC.

MFA & step-up

Clinicians registered hardware tokens via WebAuthn. For patients, the system used risk-based step-up: if the request was from an unfamiliar device or IP or the operation touched PHI, the system required additional verification.

Outcomes & metrics

Within 6 months MedConnect reported:

• 70% reduction in account takeovers (due to WebAuthn for clinicians and reduced password usage).
• 40% improved appointment check-in speed for patients with magic links vs password flows.
• Compliance audits passed with minimal remediation for identity controls.

Lessons learned

• Prioritize logging and retention policies early — retrofitting auditability is expensive.
• Educate users: patients may need guidance for magic links and SMS alternatives to avoid support calls.
• Keep sensitive operations behind additional confirmation even if a session is valid.

Conclusion

Identity in regulated verticals requires balancing usability and assurance. MedConnect's hybrid approach — managed IdP for compliance, WebAuthn for high-assurance users, and passwordless for patient convenience — demonstrates that thoughtful design can meet both ends.

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