A clinic that can't intake patients because the internet is down isn't a software problem, it's a care problem. Connectivity in many areas is intermittent by default, so the system has to treat offline as the normal case, not the exception.
The pattern that works: local-first writes. Every intake form writes to a local queue immediately and syncs when connectivity returns. The UI never blocks on the network, the patient record exists the moment it's entered, and sync is a background concern.
Conflict resolution is the hard part. Two stations editing the same record offline will diverge. For clinic data, last-writer-wins on a per-field basis covers most cases; for anything critical, medication records, allergies, the system flags conflicts for human review rather than guessing.
Health data raises the stakes. Patient records are sensitive personal information under the Data Privacy Act, which means encryption at rest on the local queue, not just in transit. An offline-first design that stores plaintext on a shared workstation isn't a feature—it's a liability.
The discipline is in the details: queue-based writes with idempotent sync, timestamps on every mutation, and a sync status indicator staff can see. Offline-first isn't a feature you add, it's an architecture you commit to from the first table.
