When Realtime Breaks, Virtual Care Breaks.
Here’s the hard reality of telehealth: when infrastructure cracks, care collapses. A missed chat ping or delayed check-in notification isn’t just a glitch, it’s a broken line of communication between a provider and a patient. That can be the difference between timely diagnosis and uncertainty, between trust and frustration.
Doxy.me runs over 250,000 virtual visits every day. Their core product delivers browser-based telemedicine that works without downloads or installations. But behind the scenes, one part of the stack had become a chronic liability: realtime infrastructure.
It wasn’t just fragile - it was feared. VP of Engineering, Ben Anderson-Dukes recalled their engineering team viewing it as a “black box.” Over time, that black box became a bottleneck. Small issues like ghost check-in chimes and out-of-order messages became symptoms of deeper instability. Lag was unpredictable. Full-day outages were a looming threat. Worse still, this fragile infrastructure had become the second-largest operating expense after video delivery.
That wasn’t sustainable. But replacing their realtime provider wasn’t a simple procurement problem. It required a mindset shift from seeing realtime as a necessary evil to treating it like a core product surface that deserved strategic investment.
A Strategic Overhaul, Not Just a Quick Fix.
That partner was Ably. Unlike previous vendors, Ably took a collaborative, hands-on approach from day one, offering architectural guidance and flexible support throughout the migration.
“We needed a partner who could not only help us rebuild realtime into something reliable, scalable, and secure, but one that was developer-friendly and of a similar mindset to doxy.me.”
With support from external dev agency Walter Code, doxy.me and Ably planned a phased migration away from their existing realtime provider to Ably’s modern WebSocket-based infrastructure. The process was methodical: time it right, plan it right, implement it right. Nothing was rushed.
“Initially, we thought this would take a year. But with Ably, we went from design to 100% migrated in under six months.”
Despite handling more than 250,000 calls a day, the migration was completed with zero downtime. The transition not only modernized their infrastructure but also demystified it. Engineers gained new visibility into system behavior, and the team collectively regained confidence.
“They helped us not only get there, but raise the bar in internal education about realtime as well.”
Real Results, Not Just Promises.
Post-migration, the transformation was visible across both technical and business metrics:
• 65% reduction in realtime infrastructure costs
• 95% fewer patient queue issues
• 99% drop in app crashes caused by signaling issues
• 100% elimination of ghost check-in chimes
But beyond metrics, the real value came from stability. doxy.me’s CTO, initially skeptical, came to view realtime as a stable part of core infrastructure. The engineering team moved from firefighting to forward planning.
“Support tickets dropped, realtime errors disappeared, and our Datadog logs became clean and readable.”
The financial impact was just as compelling:
“We saw a full ROI in under six months, despite using an external team to handle the migration. That’s unheard of.”
“For me personally, it’s been a really great win. It’s bolstered Engineering’s reputation internally. There was much kudos served all-round.”
Looking Forward: Realtime as Innovation Engine.
With Ably in place, doxy.me isn’t just maintaining a stable stack, they’re building on top of it. New use cases are now in scope, including advanced presence, session orchestration, and collaboration tooling designed to make virtual care more intuitive and human.
“Even now, we’re exploring roadmap innovations together.”
One of doxy.me’s largest customers, accounting for nearly 30% of realtime traffic, now operates smoothly with no degradation in performance. Internally, engineers have better observability, faster diagnostics, and more freedom to innovate.
“Ably is helping us push realtime beyond the basics, into new opportunities that let providers be with their patients more reliably and securely.”
At its core, doxy.me is about connection - between patient and provider, between care and access.
“We believe that providers are the real heroes, and that doxy.me is their superpower.”
With Ably behind the scenes, that superpower now has a reliable, resilient realtime engine built for scale.
“Ably has helped us turn realtime from a liability into a strategic asset.”
Doxy.me built this on top of Ably Pub/Sub, the core messaging product in the Ably platform. Please see our docs if you're interested in the technical details.
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