Asynchronous health care 101

Under the umbrella of telehealth, asynchronous tools, ranging from remote patient monitoring to medical image sharing, and chatbot-based applications are playing an increasingly important role in interactions between patients and health care professionals. These asynchronous tools are ubiquitous in multiple types of health care settings including mental health, primary care, emergency medical care, and many more.

The American Telemedicine Associationopens in new window defines asynchronous health care as “the exchange of information that does not occur in real-time, involving the secure collection and transmission of a patient’s medical information, education, and resources to support families or clinicians/providers.”¹

Asynchronous health care allows the storing and forwarding of medical information so that health care providers can review without being present, which can allow providers to focus on the time with their patients. Synonymous terms to describe asynchronous health care include “store and forward” and electronic visits (e-visits).²

• Clinical data (e.g., laboratory results, medical reports)¹
• Patient’s self-reported medical history
• Provider to provider consultation¹
• Educational tools for patients

• Remote patient monitoring (RPM). RPM involves transferring patient data and clinical information from digital medical devices to the provider for the provider to review. Examples of digital devices patients can use include wearable devices and smartphone sensors.^3,4
• Secure text messaging. Compliant text messaging allows patients and health care providers to exchange health-related communications.²
• Web-based portals. Asynchronous communication about medical information between patients and providers can be sent through a secure web-based platform, such as a patient portal.⁶
• Medical image sharing. Providers can capture and share medical images with each other to remotely review and diagnose patient symptoms that require visual inspection.²
• Chatbot-based applications. AI chatbot platforms may help in the day-to-day progress of patient treatment. For example, a chatbot can help reinforce goals including the promotion of healthy lifestyles and treatment adherence.⁴
• Virtual reality simulations. Virtual reality (VR) simulations can provide asynchronous training and learning opportunities for providers/trainees within a VR-based medical simulation environment.⁵

• Efficiency. Asynchronous health care can promote efficiency and time-saving for providers by streamlining administrative and scheduling tasks. Asynchronous communication also allows faster responses and reduces response time to urgent requests, giving the provider more time to focus on patient needs.²
• Flexibility. Providers can have more options on when and how to review patient information.^2,7

• Convenience. Time and costs associated with traveling to see a provider or specialist can be alleviated, contributing to higher satisfaction rates for patients. Also, with asynchronous health care, patients can complete online medical forms when it fits into their schedules.⁸
• Flexibility. Patients can complete online forms and schedule e-visits if going in-person is not an option.

The types of asynchronous mechanisms continue to evolve. One area that has garnered more research attention lately is the potential effectiveness of message-based psychotherapy. Message-based psychotherapy is delivered through exchanging text, audio, and visual messages between a patient and licensed mental health provider through a HIPAA-compliant digital mental health platform, via a mobile device.^9,11

Many randomized controlled trials on message-based psychotherapy have shown success in treating functional impairment in the following mental health conditions:

• Major depressive disorder^9,10
• Generalized anxiety disorder^9,10

In addition to affordability, convenience, and flexibility, benefits unique to messaged-based psychotherapy include increased reduction of symptoms for patients compared with nontreatment, and the ability for patients to look back on conversations with their mental health provider and reflect on the discussion.^9,10,12 Messaged-based psychotherapy can be an effective and accessible alternative treatment modality for those who may not be able to engage in video-based psychotherapy or face-to face services.