Creating an e-commerce HIPAA-compliant telehealth platform built to scale for tele-visits and prescribing.
  • Tono’s approached us to define, design, develop, and deliver an e-commerce telehealth platform to connect patients with specialty tele-medical care.

  • Presence conducted a comprehensive review of e-commerce platforms with Tono, and we selected the best fit for industry relevance and e-commerce capabilities that included order history management, flexible user account management, ease of ordering, robust documentation, and SSO.

  • We evaluated existing HIPAA-compliant platforms and decided to create a custom build using Node and React, with Auth0 for authentication.

  • After considering custom-built alternatives, we moved forward with Amazon Chime for embedded video call and chat solutions.

  • Tono’s platform was architected and developed to meet the evolving needs of Tono and its patents and now serves over 3000 skin conditions

Patients suffering from debilitating skin conditions struggle to access expert care. For example, over 3.5 million patients suffer from Hidradenitis suppurativa (HS), but only 22% see a dermatologist and even less see a dermatologist that specializes in HS. This leads to troubling statistics like patients on average experiencing 3 misdiagnoses before receiving real answers.

Dr. Mondana Ghias, a dermatologist resident and co-founder of Tono, and co-founder Bryson Tombridge recognized that a new delivery platform, powered by technology, was needed to meet today’s demand for expert-level care for dermatology conditions. They founded Tono to set out on the ambitious journey to make first-class specialty care accessible to all patients who need it. 

Of the existing telehealth tools, none provided a comprehensive, virtual-first experience for serious skin conditions. In order to deliver truly exceptional specialty care, Tono needed a HIPAA-compliant platform that was designed to augment expert providers’ ability to treat patients at scale. They envision Tono empowering patients to feel  enthusiastic about taking control of their health. fuseproject and Presence helped build the Tono platform to reflect this patient-centered philosophy, by streamlining doctors’ workflow, so they can help more patients. 

Built on AWS and React/Node.js using Next.js, the patient portal takes the disconnected in-person and online/on-the-phone patient experience and creates a structured online process that expands and improves patient care.The provider portal mirrors the patient portal, but is aimed at helping the specialists do their work more efficiently. Once the Presence team reviewed the needs and design for Tono’s provider portal, they determined that none of the out-of-the box solutions would provide what was needed. 

Tono’s platform combines the comforting parts of the patient-doctor relationship with features that provide more efficient triage and give patients tools to document their symptoms in order to more effectively manage their disease. For example, to maintain the familiar parts of the experience, Presence integrated the Amazon Chime video conferencing tool into both the patient and provider portals so that patients and providers can still meet face-to-face as needed.

The Tono platform sends patients clinically relevant, validated assessments via the patient portal to document quantifiable outcome measures that their doctors can easily interpret. Patients can even take photos of their skin to track progress over time. Traditionally, patient symptoms are only captured during in-person appointments, giving providers a snapshot every few months. Now, doctors can get a better understanding of patients’ day-to-day experiences. 

Presence often encounters unique challenges that require creative problem solving. Tono is working to address the unmet need for care to treat serious skin conditions - a problem well known to the patients who experience it, and the doctors who treat it. By creating solutions for these problems, the Presence team engaged deeply with the people who know it best – the patients and doctors themselves. The collaboration between Presence, fuseproject, and Tono’s co-founder, Dr. Ghias and her colleagues served a crucial role in designing and building a product that both delights patients, and advances care delivery. 

To learn how Presence can help your organization, email us at or call 415-970-5770.