Understanding Asynchronous Telehealth’s Benefits and Barriers to Use

December 21, 2023 - With the unprecedented rise in telehealth utilization during the COVID-19 pandemic, it became increasingly clear that it was not a passing phase. Though usage rates have dropped since the pandemic’s peak, telehealth has become embedded in the healthcare system – heralding a new normal for healthcare delivery in America.  

There are various types of telehealth modalities, including synchronous, asynchronous, and audio-only telehealth. Each modality has its unique advantages, use cases, and challenges. Here, mHealthIntelligence will take a deep dive into asynchronous telehealth. 

WHAT IS ASYNCHRONOUS TELEHEALTH, AND HOW IS IT BEING USED?

Asynchronous telehealth, or store-and-forward telehealth, refers to communication between patients and their healthcare providers that does not occur in real time. This modality often involves secure electronic messaging or sending pre-recorded information or documents that providers review at a later time to diagnose or treat the patient’s condition. It can also be used for provider-to-provider consultations and disseminating patient instructions, education, and decision aids, according to the American Telemedicine Association (ATA).

Asynchronous telehealth involves exchanging various types of data, including clinical data, like images and laboratory results, and self-reported medical history.

Various types of technology enable asynchronous telehealth, the ATA notes. These include digital intake forms, tools loaded with pre-determined questions to collect pre-visit information, check symptoms, and suggest diagnoses and treatment, platforms that conduct adaptive interviews based on patient responses, and solutions that allow patients to share self-recorded vital signs and images with providers.  

According to FAIR Health’s Monthly Telehealth Regional Tracker, asynchronous telehealth is largely used for chronic disease management and mental healthcare. The percentage of asynchronous telehealth claim lines for mental health conditions increased nationwide from May to June 2023, doubling in the Midwest.

In September 2023, hypertension ranked as No. 1 among asynchronous telehealth diagnoses, encompassing 25.3 percent of asynchronous telehealth claim lines. Hypertension was followed by acute respiratory diseases and infections, accounting for 13.9 percent; mental health conditions, making up 6.7 percent; urinary tract infections (UTI), encompassing 4.6 percent; and diabetes mellitus, accounting for 4.4 percent of claim lines.

CLINICAL AND PATIENT EXPERIENCE BENEFITS

Asynchronous telehealth is linked to a wide array of benefits for patients and healthcare providers.

For patients, asynchronous telehealth can enable timely access to specialty care, eliminating inconvenient and arduous travel. The ATA’s Async Telehealth Special Interest Group notes that people with chronic and acute conditions can benefit from this convenient access to care.

For instance, a female patient with a UTI can use an asynchronous telehealth platform to answer clinically appropriate questions. These questions may adapt as she inputs her symptoms. A provider can review this information later and respond, confirming the diagnosis and providing a prescription the patient can pick up at a pharmacy. Within a few hours, the patient could complete a continuum of care that would otherwise take longer.

Similarly, asynchronous telehealth can support non-complex dermatology services. A study published in 2021 shows that asynchronous teledermatology was primarily used for acne management. Of 951 asynchronous telehealth visits at UPMC between March 16 and May 1, 2020, 603 (40.1 percent) resulted in an acne diagnosis and 432 (28.7 percent) in a dermatitis diagnosis.

Further, asynchronous telehealth can enhance care for chronic disease patients in several ways. Patients can share important data with providers through asynchronous methods without traveling for an appointment. For example, respiratory-compromised patients can send regular peak flow meter results to their providers, and those with neurological or rheumatological conditions can complete and send back forms that track symptoms and their severity, the Department for Health and Human Services (HHS) states.

Asynchronous telehealth applications can also help improve clinical values and self-care for diabetes patients, according to a study published in the Journal of Diabetes Science and Technology in 2010. The study assessed 90 publications on asynchronous and synchronous teleconsultation between caregivers and patients with type 1, type 2, or gestational diabetes. More recently, in a fall 2020 survey, many type 1 diabetes patients “expressed feeling that video care was unnecessary because they were in contact with their providers by phone or electronic messaging.”

By allowing patients to bypass the need for in-person or video visits, asynchronous telehealth modalities can help close the digital divide. Patients without access to broadband internet can connect with healthcare providers as needed to treat acute or chronic conditions, according to the ATA.

Additionally, research reveals that mental healthcare services can be effectively provided asynchronously, helping reduce the stigma associated with seeking these services.

The ATA’s Async Telehealth Special Interest Group notes that patients can complete assessments, providing medical, developmental, psychiatric, educational, work, drug and alcohol, and legal history to psychiatrists who can review the information to diagnose the patient and create a treatment plan.

A study published in 2021 in the Journal of Medical Internet Research shows that patients using asynchronous or synchronous telehealth to meet with psychiatrists saw similar improvements. The study included about 184 patients seeking depression or anxiety treatment across five years at three primary care clinics. They received treatment from their primary care providers in consultation with psychiatrists from UC Davis Health using a synchronous or asynchronous telehealth platform.

Researchers found that both “had statistically and clinically significant improvements” in treatment outcomes over the study period.

Americans appear largely satisfied with asynchronous telehealth. A survey that polled 1,301 US adults in February 2022 showed that 69 percent favored legislation to expand access to asynchronous telehealth.

Like patients, a vast majority of healthcare workers (82 percent) indicated high support for expanding asynchronous telehealth.

According to HHS, some key benefits of asynchronous telehealth for healthcare providers include time savings from streamlining patient intake and data collection, scheduling flexibility, and less time and administrative burden in diagnosing, prescribing, and charting for a patient encounter.

Not only that, but asynchronous telehealth can allow primary care providers to connect with other specialists for peer consultations more efficiently, the Center for Connected Health Policy notes. This can reduce the need for specialist referrals, making care delivery more efficient.

ADOPTION AND IMPLEMENTATION BARRIERS

Though asynchronous telehealth has the potential to alleviate numerous care access and delivery burdens, there are several barriers to its use.

One of the most significant is reimbursement. According to HHS, federal law limits asynchronous telehealth coverage to specific projects in Alaska or Hawaii. The Centers for Medicare & Medicaid Services (CMS) includes asynchronous telehealth as a covered benefit on a state-by-state basis, creating a patchwork of laws governing these services.

Thirty-three state Medicaid programs reimburse for asynchronous or store-and-forward telehealth, the Center for Connected Health Policy’s policy trend map shows. The map is based on research conducted between May and September 2023.

This year, Florida, Montana, North Dakota, and Utah were among the states that added reimbursement for asynchronous telehealth. However, some states that cover these services have limitations on what qualifies for reimbursement.

In addition to reimbursement challenges, patients may have reservations about asynchronous modalities.

For instance, a study published earlier this year showed that while patients expressed overall satisfaction with both synchronous telepsychiatry and asynchronous telepsychiatry, patients receiving the latter reported more concerns due to a slower feedback response than after a synchronous telepsychiatry visit.

Further, research published in March 2022 reveals a reluctance among older adults to engage with asynchronous telehealth. The research conducted by the University of Michigan Population Studies Center assessed data for 1,769 older adults from the National Health and Aging Trend Study.

They found that older adults' email and portal message-based telehealth use increased by 5.59 percent from before to after the onset of the pandemic. In comparison, video call use during the same period jumped by 19.99 percent. This difference indicates older adults prefer synchronous face-to-face communication with healthcare providers over asynchronous communication.

Data privacy and security are also critical concerns among patients regarding asynchronous telehealth. Results from a global survey released in 2021 revealed that 52 percent of telehealth providers have patients who refused a virtual visit, citing mistrust in technology or concerns about privacy and data safety.

The survey noted that synchronous telehealth was the most-used modality among participants (51 percent), followed by remote patient monitoring via wearables (41 percent) and asynchronous telehealth (39 percent).

The survey also showed that clinicians have data-related concerns, with 81 percent saying they are uncertain about how patient data from remote care encounters will be used and shared. Many expressed concerns about personal liability in the event of data leaks or mistakes, with 34 percent stating that one or more clinicians in their organization have made a wrong diagnosis because of poor video or photo quality.

Thus, as healthcare provider organizations incorporate asynchronous telehealth services into their care delivery models, they must mitigate patient data concerns, build trust in digital health technologies, and advocate for widespread reimbursement.