How Does Telemedicine Work? Asynchronous vs. Synchronous

Telemedicine Defined

Historically, if you wanted to see a doctor, travel was a necessary part of the process. Either the doctor would have to come to you, or you would have to travel to the doctor’s office or hospital where you could be treated. In some cases, the physical presence of a doctor is necessary, but as internet access and technological capabilities have improved, possibilities have broadened.

For many interactions between a doctor and patient, physical proximity is irrelevant, especially as video calls have made it possible for the doctor to assess the patient visually without sharing a space. Tools such as email, text, messaging and AI technology have allowed for information to be shared instantaneously with providers and patients regardless of location. These circumstances have resulted in the explosion of telemedicine onto the medical scene — to the benefit of both patients and practitioners alike.

Telemedicine is when health care services are delivered remotely via any telecommunications technology. Telehealth, a term that is sometimes used interchangeably with telemedicine, refers to broader remote services, which can include non-clinical services such as medical training and administrative meetings.

There are two primary types of medical assessments using telemedicine: synchronous and asynchronous. 

And while you might not hear these terms day-to-day, they form the backbone of telehealth as we know it today. Both methods have their benefits and drawbacks to patients and providers.

Synchronous Telemedicine

Synchronous telemedicine, sometimes referred to as real-time telemedicine, occurs with live interactions between the practitioner and patient occurring in real-time. This occurs through video-conferencing so that patients and doctors alike can benefit from face-to-face interaction and live discussion. Questions are asked and information is shared through the audio-visual link just as it would be if the appointment were occurring at the doctor’s practice or in the hospital.

Though the patient and doctor are unable to physically interact, examinations may still be completed. Appointments follow the general pattern of in-person visit.

First, providers will likely introduce themselves and give you the opportunity to introduce yourself if you have not already met. If you’re familiar with each other, you will greet each other and interact as you typically would upon meeting for an appointment. They will also probably ask if you are able to hear and see them well enough using the video conferencing technology.

After, doctors might review your recent medical history with you such as any diagnoses you may have. If you’re on any prescriptions, they’ll likely ask if you’re taking them as directed and if you’re having any issues with them. If you’re diabetic, they might ask for your latest blood glucose results.

If you’ve requested the appointment, they may give you the floor to describe what issues you’re having that caused you to schedule the appointment. If they requested it, they may have an agenda they need to follow because they’re searching for specific information regarding your health.

Regardless of who arranged for the appointment, patients will likely be asked if they have tools in the home that can gauge vital signs. This might be a blood pressure machine or thermometer. If these are available, the doctor may ask you to check vital signs such as heart rate, blood pressure, or temperature so that they can record them for your patient file and to better inform their care. If the tools are not available, patients might be instructed on how to take their own pulse.

After vitals are taken, doctors may move on to a physical exam. Although not as comprehensive as an in-person exam, important information can still be conveyed with this means of examination. It’s important to follow your doctor’s instructions during this time as they’re guiding you through exercises and motions designed to assess your health using remote technology.

The doctors will probably start by assessing your physical demeanor. This can mean checking that you appear alert and well-oriented. If you’ve managed to sign on successfully to the video conference for the appointment, you’re probably fine.

They might also check that your voice is clear, your speech is coherent and you’re able to sit comfortably. You may be asked to move your head from side to side and up and down to check your neck’s range of motion.

Patients may be asked to show the doctor areas of skin that are exposed, such as their ankles. They will look to see if these or other areas appear to be swollen. Your physician might ask you to press on your abdomen to see if there are areas of tenderness there.

You may be asked to point your camera at different areas of the body for the doctor to assess, particularly if you’re experiencing pain in certain areas, swelling, or numbness, as these can indicate serious issues. You may be asked to move around the room to demonstrate your ability to move freely without issue.

Doctors may ask for additional tasks from patients to help give them a fuller picture, and patients may ask doctors to look at specific places on the body or movements of body parts if they’re troublesome, just as in a typical physical exam. Although the doctors cannot touch you, they can still make a quality assessment of your health with this kind of examination.

Likewise, you may be given instructions for follow-up appointments or prescriptions that need to be filled. Follow the instructions of your practitioner just as you would with an in-person appointment.

Benefits of Synchronous Telemedicine

There are many benefits of synchronous telemedicine that range from the practical to the emotional.

First and foremost, the patient and practitioner are able to see each other when video conferencing is used. A key part of a doctor’s assessment occurs by being able to see firsthand the condition and symptoms of a patient. Doctors have been trained to recognize symptoms visually, and they may be able to use this visual assessment to give better treatment to their patients, recognizing cues from the patient’s physical demeanor that they might otherwise miss if they were not able to see the patient.

It isn’t limited to what a patient’s body might indicate to the doctor, either. A patient’s voice quality, word choice and tone can also have a big impact on a doctor’s ability to understand exactly what the patient is going through. When a doctor and a patient interact in a synchronous manner, whether in person or through a video conference, the patient is giving information to the doctor about his or her condition through physical appearance and through self-expression, making it easier for doctors to fully understand a patient’s situation since they’re getting the information through two different mediums.

Many patients find synchronous interaction with their doctor to be most comfortable because they benefit from the person-to-person interaction. This can be for a number of reasons.

They might feel unable to describe their illness or condition using written text. A sense of urgency might be leading them to want the instantaneous feedback they receive from a synchronous appointment. They might feel safer being able to interact directly with their doctor because it feels less clinical and they believe the doctor will be able to view them more as a whole person and not just a list of symptoms on a page. Being distrustful of technology can also play into this.

Many therapists use synchronous telemedicine, as therapy often involves individuals in crisis who need immediate responses to help guide them through difficult events. Even in regularly scheduled, non-crisis therapy, synchronous telemedicine is a preferable approach since therapy is in essence a conversation and difficult to manage if you aren’t able to interact back and forth in real-time.

Drawbacks of Synchronous Telemedicine

Synchronous telemedicine requires patients to be able to meet with their doctors at certain times when they’re both available. For some who work or have other obligations, this isn’t possible as their hours might not align with those of the doctor. Doctors might also have obligations that pull them from appointments.

For those with difficulty navigating technology and no one to assist them, synchronous telemedicine may prove too difficult to manage. Likewise, language or cultural barriers may keep synchronous telemedicine from being an appropriate means of interaction if there is no one available to interpret in real-time.

Though it’s possible for physicians to instruct patients on practices like checking their own pulse, without the right tools and technology readily available, patients are unable to provide important information to doctors, which can help inform doctor assessment. If there are no additional telehealth services implemented, this can result in an incomplete picture of a patient’s health.

Asynchronous Telemedicine

Asynchronous telemedicine, sometimes called store and forward, is simply treatment that is not in real-time. You don’t meet your practitioner over a video call or in person, so your schedules never need to overlap.

Asynchronous communication between doctors and patients has been commonly used throughout time. Letters, for instance, were a common way of communication between doctors and patients and still are for some things: updates on testing needed, results, reminders to schedule appointments and other transfers of information.

Now, though, the vast capabilities of our modern technologies allow for effective treatment to be achieved using a variety of mediums to transfer information and communicate. Email, text, chat and AI technology have broadened the possibilities for asynchronous communication, allowing doctor/patient interactions to become more efficient and less restrained by time and location.

Asynchronous telemedicine can look different depending on what kind of care is being provided. Popular uses of asynchronous telemedicine are dermatology, radiology and pathology.

Because asynchronous telemedicine is a self-service type of interaction, it usually starts with patients filling out an assessment designed by their physician or specific to that medical field detailing pertinent information that providers need to initiate the process and make their initial assessment.

After this initial evaluation, doctors might request additional details or information. If your chief issue is a rash, for instance, the doctor might require a picture or video of the affected area to better assess it. They might also have follow-up questions in response to your initial answers.

If a specialist is needed, your doctor can then forward information and any documentation necessary to them for their own assessment. Once that’s done, your primary caregiver can use the information they’ve compiled on your person and condition to inform decisions based on the suggestions of specialists.

Benefits of Asynchronous Telemedicine

Asynchronous telemedicine allows patients to get the help that they need and doctors to deliver it on their own timelines. Much of what might go on behind the scenes or otherwise take up precious time and resources can instead occur via digital transmission.

Asynchronous telemedicine is frequently used when specialists are needed. The practice is especially common in radiology, dermatology and ophthalmology. If a patient has a growth they are concerned about, for instance, their primary caregiver can get pictures of the area to be transmitted to a dermatologist to review. Because retinal cameras can be used digitally for eye screenings looking for diabetic retinopathy, the results of the screening can be sent to a specialist to assess.

All of this can be done at the discretion of the patient and practitioners, so schedules do not have to be arranged nor specialist appointments scheduled months out for a simple consult that could be completed using telemedicine. In areas where there are shortages of medical specialists, this is especially true. Instead of having one person working on a patient issue one step at a time, all related information can be available to the parties involved, allowing for easier and speedier assessment, and possibly treatment as well.

Many primary caregivers find this beneficial because traditional practices involving specialist referrals can result in care directed by the specialist without the consultation of the primary doctor who will likely be better acquainted with patient history and have a more well-rounded view of the patient and their condition. This way, patients can get the input of the specialists while still being under the direct care of their primary caregiver.

Other data can be sent to physicians for a consult, as well. This might include X-ray scans, MRIs, photos, videos and audio recordings from patients and patient data.

Asynchronous telemedicine can also help overcome language barriers since there is no real-time interaction spent trying to interpret. Instead, information can be given or received in a native language thanks to the availability of interpretation resources that can be applied outside of face-to-face communication.

Patients living in rural areas can benefit from medical attention they may not have access to through the use of asynchronous telemedicine. A practitioner at a smaller hospital might forward an MRI to a medical center where specialists are better equipped to interpret the results, getting patients direct access to the kind of medical opinions they wouldn’t have access to otherwise.

Drawbacks of Asynchronous Telemedicine

Because it doesn’t occur in real-time, some patients might have to wait for responses or results that they wouldn’t have to if they were meeting with a doctor face-to-face.

Telemedicine in General 

There are some benefits and drawbacks to telemedicine that both synchronous and asynchronous telemedicine benefit and suffer from, respectively.

Benefits of Telemedicine

Telemedicine’s goal is to provide better access to patients while minimizing cost. It’s especially beneficial to those in rural areas where there are fewer doctors on average and fewer major medical centers capable of handling specialized problems. This results in longer wait times for those needing specialist care, something that can be effectively reduced through the use of telemedicine in general but especially asynchronous.

Costs incurred through the process of referrals, time-intensive medical evaluations, and the running and maintenance of doctor’s offices can be reduced through the use of telemedicine. Shortened wait periods to see specialists also lead to quicker treatment, which results in fewer resources spent in managing illness and issues in the intervening time periods. The technology used to communicate with patients and other members of the medical field in telemedicine is relatively inexpensive and can result in less money spent for patients and doctors alike.

In studies vetted by the NCBI on telemedicine’s use in dermatological and other medical specialties, patients reported high levels of satisfaction with their telemedicine consultations.

Drawbacks of Telemedicine

Telemedicine in general can be unrealistic for those who live in areas with poor internet infrastructure or access to technology.

The transmission of personal information electronically could potentially result in data breaches in which hackers collect private data.

Insurance companies are covering telemedicine services more often, but there are still some services that might not be fully covered.

Regardless of how it’s being used, telemedicine is here to stay — to the benefit of countless doctors and patients.

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