How doxy.me turned realtime from a liability into a strategic asset

Doxy.me is a global telemedicine platform that enables healthcare providers to connect with patients simply and securely - no downloads, no installs, just a browser. With over 250,000 virtual visits daily and more than 9 million minutes of care delivered each month, it’s one of the most widely used platforms for virtual healthcare.

For Ben Anderson-Dukes, Vice President of Engineering, reliability was non-negotiable. “We’re a global telemedicine platform used by hundreds of thousands of providers and patients every single day,” he explained. “Making virtual healthcare accessible without the need for downloads or apps is at the heart of what we do.” But for years, the company’s realtime infrastructure had been a major source of friction, cost, and risk.

Realtime connectivity isn’t just a component of doxy.me, it’s the foundation of the entire experience. Every patient-provider interaction relies on presence updates, chat delivery, and session signaling. If any part of that breaks down, care is disrupted.

As doxy.me scaled and began building Apollo, its next-generation platform, the cracks in their existing provider, became impossible to ignore. “The cost of both using and supporting our existing provider was becoming unjustifiable,” Ben said. “We were seeing many issues related to realtime - ghost patient check-in chimes, chat messages arriving outta sequence or not at all, intermittent application lag, even full outages lasting 24 hours.”

Internally, the situation had become just as frustrating. Realtime had become a psychological burden. “Our engineers were so afraid to touch this part of the stack,” Ben admitted. “It had become this scary black box that was like a house of cards.” The infrastructure was fragile, the documentation was patchy, and the vendor relationship felt increasingly transactional. Over time, realtime became not just the most failure-prone part of the system, but the single biggest operating expense after video delivery.

Doxy.me needed more than a new provider. They needed a long-term partner who could help them rebuild trust in their realtime stack, and empower the team to work confidently with it again.

The team wasn’t just looking for a quick fix. “We needed a partner who could not only help us rebuild realtime into something reliable, scalable, and secure,” Ben said, “but one that was developer-friendly and of a similar mindset to doxy.me.”

They found that in Ably. Unlike previous vendors, Ably’s team took a collaborative, hands-on approach, offering architectural guidance, technical support, and flexibility from day one. “We needed a partner that could be both patient and flexible.” Ben explained, “Not bound by corporate red tape or pressure to rush contracts. Just a team that would support us every step of the way.”

The migration required a complete overhaul of the realtime stack. Working closely with Ably, and with support from external dev agency Walter Code, the team started building the strategy to migrate from their existing solution to Ably’s modern WebSocket-based infrastructure.

Ben said the team knew they couldn’t rush the transition. “It needed to be timed right, planned right, and implemented right. Ably really understood that,” he said. “They helped us not only get there, but raise the bar in internal education about realtime as well.”

The original estimate for the migration was 12 months. In the end, the entire project from planning to full production took less than six. “We migrated everything to Ably’s WebSocket-based realtime,” Ben recalled. “Initially, we thought this would take a year. But with Ably, we went from design to 100% migrated in under six months.”

That included zero downtime, despite doxy.me handling more than 250,000 calls a day. “For a platform handling that volume, to migrate core infrastructure in six months without downtime was pretty incredible,” Ben said.

What had once been the most fragile part of their architecture was now a modern, scalable foundation the team was proud of. “It’s been the most successful external technical partnership we’ve had,” Ben added.

The benefits were immediate. “Support tickets dropped, realtime errors disappeared, and our Datadog logs became clean and readable,” said Ben. “We even saw a modest jump in our net promoter score.”

Perhaps most meaningfully, realtime was no longer seen as a risk. “Our CTO, who was skeptical at first, now sees realtime as a stable part of our core infrastructure,” Ben said. “Everyone’s expectations have been blown away - and most importantly, we have happier providers.”

The financial outcome was just as impressive. “We saw a full ROI in under six months, despite using an external team to handle the migration. That’s unheard of.”

The technical gains were just as tangible:

• A 65% reduction in realtime infrastructure costs

• 95% fewer patient queue issues

• 100% elimination of ghost check-in chimes

• 99% drop in app crashes caused by signaling issues

• 99% reduction in patients getting stuck in the waiting room

Beyond the metrics, the team now had better observability and control. For the first time, they could monitor WebSocket state changes in real time, enabling faster, more precise diagnosis of connectivity issues. 

The new setup has also proven its resilience at scale. One of their largest customers, with up to 10,000 patients per day, now accounts for nearly 30% of doxy.me’s realtime traffic without any performance degradation.

“Ably has also had a positive, but hard to measure impact on customer churn, retention, and overall patient satisfaction,” Ben said. “For me personally, it’s a really great win. It’s bolstered Engineering’s reputation internally. There was much kudos served all-round.”

With a stable foundation in place, the doxy.me team is now focused on the future. “Even now, we’re exploring roadmap innovations together,” Ben said. Ably remains a key partner as doxy.me expands its use of realtime into advanced use cases, including presence, session orchestration, and collaboration tooling that makes virtual care more frictionless and human.

“Ably is helping us push realtime beyond the basics,” Ben explained, “into new opportunities that let providers be with their patients more reliably and securely.”

At its core, doxy.me is about connection - between providers and patients, between care and accessibility. “We believe that providers are the real heroes,” Ben said, “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,” Ben said - a transformation that’s laid the stable foundation for what comes next.

Want to understand what made that transformation possible? Explore Ably Pub/Sub: developer-first APIs and enterprise-grade WebSocket infrastructure built to power critical realtime experiences at scale.