The Differences Between Synchronous And Asynchronous Visits
A complete guide to real time vs. store-and-forward
With the rapid adoption of telehealth across hospitals, clinics and even employers, you’ve likely been offered the chance to seek medical attention virtually versus going into a healthcare facility. You’ve probably also had the choice between how you wanted to receive that virtual care - synchronously or asynchronously. The same goes for providers.
Whether you’re a clinician delivering virtual care or an organization vetting out the best ways to offer telemedicine to the patients, customers or employees you serve, it’s important to understand the pros and cons that come with synchronous and asynchronous visits. Both have their place and their advantages to consider.
You may recall that we briefly touched on these terms in our Telehealth Dictionary blog a couple of months back. In this post, we’re going to dig deeper into all the key considerations around synchronous versus asynchronous telehealth visits. So, let’s get into it!
Starting with the basics
Before we dive into the difference between synchronous and asynchronous telehealth, let’s begin with telehealth as a whole. Telehealth, as defined by The Center for Connected Health Policy (CCHP), is “a variety of telecommunications technologies and tactics to provide health services from a distance”. It’s essentially an overarching term for all the technologies and services that go into providing virtual care.
There are several use cases where telehealth is particularly convenient, including when:
treating patients with chronic conditions that require constant monitoring or data capture
traveling to onsite facilities is a challenge (eg. rural areas, mobility issues)
performing regular, proactive wellness visits (think value-based care models)
triaging patients for urgent care, especially during a pandemic like COVID-19
in-person care is simply not a requirement for receiving quality treatment
Because of the instances we just outlined, there are several fields of medicine (including specialty areas) tapping into telehealth for their optimum care delivery. These are:
Mental & behavioral health care for telepsychiatry and virtual counseling
Geriatrics and Orthopedics for assisted living or skilled nursing facilities
Addiction medicine and cessation services
Endocrinology for hormone and testosterone therapy
Fertility treatment
Clinical trials across prevention, screening and treatment
Telepharmacy and prescription management
Pre-op, post-op, and post-surgical follow-ups
Dermatology to examine skin, hair and nail problems
Cardiology for remote cardiac monitoring thanks to advances in wearables
Ophthalmology for screenings, triaging and performing at-home vision tests
Gastroenterology for dietary counseling and the review of lab & imaging results
Outside of the benefits to providers, we’re also seeing a large trend in patient satisfaction with virtual care for the top three reasons:
Flexibility - Telehealth allows you to be seen anywhere you are. Patients could be at home, at work, on the beach… even on the other side of the globe. The convenience is undeniable.
Speed - Telehealth cuts down on travel and time-off work. Since patients can be seen anywhere, they don’t need to carve out commute time to and from the doctor’s office. It also eliminates the added worry of finding childcare.
Safety - Telehealth means less of a chance of getting or transmitting a virus. Telehealth visits are a perfect way to keep your distance, avoid hospital and clinic waiting rooms and decrease your likelihood of getting sick.
Now that we’ve covered the basics of telehealth and why the demand for virtual care services is skyrocketing across patients and providers, let's dive into what you’ve been waiting for - the scoop on synchronous versus asynchronous visits.
Synchronous telehealth - What is it?
Synchronous telehealth is the most well-known delivery method and the form most people think of when they hear ‘virtual visit’. According to the United States Department of Health and Human Services, “synchronous telehealth happens in live, real-time settings where the patient interacts with a provider.”
Patient benefits
Get real-time care: This is especially beneficial in an emergency situation as the doctor and patient can visually see each other. The doctor can ask all the questions they need to make a diagnosis or build a treatment plan, oftentimes right on the call. So, real-time care is a huge benefit for patients that need a diagnosis or medication immediately.
Establish a patient/provider relationship: Another pro of synchronous telehealth visits is building a strong relationship across the provider and the patient. Although it is in a virtual format, being able to interact in real-time allows you to build trust and maintain the familiar feel of a typical in-person visit.
Provider benefits
Reduce late arrivals and no-shows: Synchronous telehealth allows patients to take less time out of their day for the visit. This means patients are more likely to show up on time and keep their appointments.
Increase reach and exposure: With synchronous virtual care, you can still catch up with your regular patients, while also gaining the added reach beyond your neighborhood, city or state. This provides more exposure to different patient populations and health concerns that could be valuable knowledge to gain.
Potential drawback
Longer time to connect: Since synchronous visits most closely resemble in-person ones, you may still have to wait a bit for the appointment depending on the provider’s schedule. More often than not, this will still be quicker than having an onsite visit.
Asynchronous telehealth - What is it?
Asynchronous telehealth, also known as store-and-forward, is the other common delivery method of virtual care. As defined by the National Institutes of Health (NIH), a “patient or physician collects medical history, images and pathology reports and then sends it to a specialist physician for diagnostic and treatment expertise”. In other words, the patient and provider do not interact in real-time via video or audio. There is usually a time delay in communication between the two parties.
Asynchronous also includes communication between providers. For example, if a patient comes in for an in-person visit and the doctor needs to consult another physician about the case, this is considered asynchronous telehealth. The patient information is sent in a virtual format, as well as the communication between the providers. This feedback loop is referred to as electronic consultations (eConsults) and it eliminates the need to refer the patient to a specialist by going directly through the primary care provider.
Patient benefits
Increase access to specialty care: Generally, getting an appointment with a specialist can take weeks to months. If you’re in a rural area, potentially even longer. With asynchronous care, patients can submit their health concerns and necessary data or documentation without an excessive wait time or lengthy commute.
Overcome language and technology barriers: The store-and-forward delivery method allows patients to address their healthcare needs without actually speaking to a doctor directly. This eliminates difficulties patients may experience with synchronous telehealth like low bandwidth, choppy audio, lagging videos and the need for a translator to be present.
Gain convenience: Rather than having to schedule an appointment virtually or in person, patients can initiate the consultation whenever they like. There is no moving around your schedule to squeeze in an appointment or figuring out who is going to watch the kids while you are on your visit.
Provider benefits
Schedule flexibility: A huge added benefit for providers is also the convenience store-and-forward visits provide. With all necessary background information readily available, providers can review patient files and cases whenever they have free time. This also gives them the flexibility to consult with peers before following back up.
Increase in efficiency: Everything is well documented for the clinician. This makes it easier to review cases and refer back to the information at any time, making asynchronous telehealth ideal for evidence-based care cases.
More patients seen: Providers are able to review more patient cases through asynchronous telehealth than any other form. With all the information they need already submitted and in the patient’s EHR, they can easily go through each case and make a diagnosis or treatment plan. They also maintain complete control over their schedules by being able to conduct these visits any time or any day.
Potential drawback
Loss of personal touch: Choosing the asynchronous route means minimal to no face-to-face interaction across the provider and the patient. Not having that personal touch and connection may not be for everyone or for every type of condition. Creating that connection is oftentimes critical to sharing essential information and establishing trust. In some cases like having a minor cold where the patient just needs a prescription, it’s less of a priority.
As you can see, there are many benefits to asynchronous telehealth for both the providers and patients, especially when it involves a case that relies on evidence-based care, as mentioned earlier. With all the information supplied to the provider electronically, they are able to analyze the data and make a more efficient diagnosis. There can be drawbacks, like the loss of personal touch and connection with the provider, but that is a case-by-case scenario and up to the patient if they feel comfortable with not having that personal interaction.
We should also highlight the fact that there are a few specialties that use asynchronous care more than others...
Radiology: Asynchronous visits and eConsults are especially helpful for physicians in rural communities. They are able to send X-rays or MRI scans to specialists at larger medical centers to look over and provide them feedback.
Dermatology: Patients can easily take pictures of their skin and the areas they are concerned about and send them to a dermatologist for review. This allows the dermatologist to determine if the patient needs treatment, what treatment they may need, or if they need to come into the office to take a closer look.
Ophthalmology: Diabetic retinopathy, a disease that can lead to blindness among diabetic individuals, can be captured during eye screenings using retinal cameras. These images can be immediately sent to a specialist for review and is a huge step in preventing vision loss or blindness in patients with diabetes.
Summary
In summary, telehealth is bringing many benefits to caregivers and recipients across the world, regardless of the form it takes. There are certain use cases where asynchronous care beats out synchronous care and vice versa. It’s important to do your homework and ask for guidance if you’re hung up on the best method for you. Some helpful tips to remember when serving patients virtually, whether it’s as a provider or running the telehealth service:
Be patient. Although most patients now are a lot more comfortable with virtual services, we are still in the transition period. Being patient and walking through step-by-step how the visit is going to go can make a huge difference for the patient and could be the deciding point on whether they want to seek your service again.
Answer questions thoroughly. Patients more likely than not, are going to ask a lot more questions than what you may normally see in a traditional in-person visit. Whether they aren’t as comfortable with the virtual format or they are nervous seeing a provider they don’t know, they will likely be asking more questions about next steps and clarifying questions about the care they received. The best way to make them feel comfortable and walk away from the visit feeling confident is to over-explain and continually make sure they understand the information you are giving them.
Telehealth is still a new concept in the world of healthcare and as always, delivering high-quality patient care is the number one priority. Making sure the virtual care they receive, whether it’s an asynchronous or synchronous method, is organized and well-executed is the best way to ensure that happens.
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