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Since Counsel’s inception in 2023, asynchronous chat has always been the backbone of our product and care model. By November 2024, message volumes had surged and it was clear that we had to re-architect our infrastructure for scale, reliability, and performance. ‍ This blog post is a behind-the-scenes look at how we rebuilt our chat platform. If you’re building anything chat-related, especially in healthcare, we hope you can learn from our experience. We built our original chat system on Twilio Conversations, mainly for its cross-platform SMS support, which is critical for reaching our patients. But the more we scaled, the more issues we found: ‍ ‍ In short, our chat infrastructure met the demand of our early users, but it didn’t reflect the quality of care we always strive to provide. We rebuilt our chat system around three key principles: control, observability, and fault tolerance. ‍ One of our trickiest bugs was handling messages that were “sent” locally, but never made it to Twili

Scaling Our Chat Infrastructure for AI Healthcare | Counsel Health Blog > Team insights > Scaling our chat infrastructure Scaling our chat infrastructure Team insights Scaling our chat infrastructure Written by: Jaisal Friedman Reviewed by: Published: Apr 24, 2025 Updated on: February 13, 2026 copied Table of contents Table of Contents Have a medical question? Get an instant personalized answer now. Ask Counsel KEY TAKEAWAYs Since Counsel’s inception in 2023, asynchronous chat has always been the backbone of our product and care model. By November 2024, message volumes had surged and it was cl

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