Architecture Decisions Log (ADR)

Decision	Chosen Option	Alternative Considered	Deciding Factor
Backend Framework	Express 5.1.0	NestJS / Fastify	Native async Promise error propagation with zero wrapper boilerplate.
Database	MongoDB / Mongoose	PostgreSQL / Prisma	Flexible subdocument clinical schemas for heterogeneous medical encounters.
Telehealth	Jitsi Meet WebRTC	Twilio Video API	Zero ongoing per-minute licensing costs and peer-to-peer data privacy.