Asynchronous Telemedicine

Asynchronous telemedicine is the poster child for patient access. And yet it’s the ugly fat stepchild of telemedicine. And telemedicine is the Osama Bin Laden of healthcare.

No matter how much people will hate on telemedicine, it’s here to stay and it’s only going to grow. No specialty will escape it, not even pathologists. I personally happen to love telemedicine because I believe it bridges the patient-doctor relationship and provides access.

Medical boards hate telemedicine as much as they hate medical marijuana. Any innovation in medicine, in fact, is hated on by the medical boards. They are even rather hostile towards women in medicine and slap more female providers with “incompetency” than male doctors.

Telehealth

A lot falls under the telehealth umbrella these days; forwarding a patient’s chart to a specialist for a second opinion or management, for example.

Store-and-fordward

Store-and-forward is the common term used for when the information is gathered, stored, and then forwarded to another clinician. Think teleophthalmology or teledermatology.

DTC

In telemedicine, another name that comes up is Direct to Consumer telemedicine. This is when a company advertises their services to a patient with whom they have no previous relationship.

Teladoc and DoD and AmWell are such examples. If you already have a patient panel and add telemedicine into the mix, many of these rules don’t apply to you; you’ve already built the patient-doctor relationship.

Video

Many states require that in telemedicine a new patient-doctor relationship be established through a live video interaction. A phone call doesn’t count and a text-based interaction is also unlikely to qualify.

Phone

We’ve been calling our patients for years. Maybe to relay lab results to them or discuss their follow-up. Many state medical boards aren’t okay with this as a sole method of forming the patient-doctor relationship.

And recording an audio bit and forwarding it to your doctor…. nope, that’s considered asynchronous and is frowned upon by many state medical boards.

Asynchronous vs Real-time

Imagine that a patient records a video or audio recording and sends it to you. “Hey doc, I’ve been taking this vitamin OTC for hair-loss and I started noticing that my tongue has gotten more brown. Any thoughts?”

The medical boards believe that patients are too stupid to reach out to a clinician for self-management options. That’s why they want to regulate the shit out of telemedicine and have criminalized the patient-doctor relationship.

So let’s talk about what’s amazing about asynchronous telemedicine and why real-time is the granny panties of the 1950’s.

Asynchronous Telemedicine

You’re a busy doctor who has been recruited by a large medical group in Washington. You work in Seattle as a Hospitalist for Family Medicine doctor and keep quite busy.

But you have frustrating downtimes which you’d happily fill with patient care. Especially if you knew that you’d be offering access to patients who live remotely in WA or have 7.5 children and working 3.5 jobs.

The mom send you a text message through a telemedicine platform and asks whether she should be worried about some pelvic cramping she’s been having and a few days of a missed period.

Or a parent sends you a picture of a classic chickenpox rash on their 2.5 yo, asking if it’s bug bites and what they should do about it. Do they need to drive their child 90 miles to a nearby clinic, which often is overrun with patients?

Or a patient contacts you after a recent hospital discharge where they were admitted for dehydration and AKI. They were heavily hydrated and have been doing well but worried about subsequent swelling of their arms and legs. Over the next several days you are their doc-in-a-pocket. You can remotely monitor them and answer any questions they might have about their fluid retention, which is common after aggressive IV hydration.

Schedule Coordination

A busy doctor and an even busier patient are going to have a hell of a time coordinating their schedules. The patient has to hop online at the exact same time as the doctor. And both have to have enough free time to share the necessary information to complete the visit.

During an asynchronous telehealth visit, the physician can get back to the patient on their own terms. And the patient can respond when they have the necessary headspace to answer the questions.

This kind of schedule freedom even allows the physician to attempt certain home remedies for the patient. They can instruct them to try fiber for constipation, or do a HPT, or try a steroid cream for a rash.

Scheduling conflicts such as this are referred to as friction by this great article on asynchronous telehealth from mHealth Intelligence.

Imagine how many diabetic patients you could manage on an asynchronous telemedicine platform. How many primigravids could you oversee? How many CHF exacerbations could you manage outpatient in order to avoid costly bouncebacks?