Over the last year, we have seen significant growth in the use of virtual visits among patients and health care providers. My bet would be that in this past year, you have had at least one virtual visit with a health care provider. While telehealth has been an important tool in continuing timely care delivery during a time of social distancing, it is not a new phenomenon. Technology and health care innovations are natural partners, and each is interdependent on the other for future growth.
 
That is why, this week, I wanted to talk about technology in health care – specifically telehealth. Because I identify telehealth as a key lever for more patient-centered (or, more specifically, patient directed) health services. Technology and time: the great levelers.
 
But the purpose of this article is not to “wax poetical” about the opportunities of telehealth as a means of (among other things) empowering individuals to engage with health care providers on a more level playing field. My objective today is more prosaic; and that is to simply introduce some important terms and define them clearly so that we, as consumers and informed citizens, can engage in the important debates around this issue.
 
Telehealth v. Telemedicine
 
When dealing with complex issues like technology and health care, it is imperative that we all speak the same language. So, to borrow a rule from Voltaire, let’s start at the beginning and define our terms.
 
Telehealth is an umbrella term that encompasses a variety of telecommunications technologies to deliver health-related services and information. These technologies can be in service of providing clinical services directly to patients, supporting the coordination of a patient’s care (known as, “care coordination”), automating administrative activities, or offering health education. Telemedicine, on the other hand, is specific to when medical information is exchanged from one site to another through telecommunications technologies for the purpose of improving a patient’s clinical health status (aka remote clinical services). Consequently, telemedicine is only provided by, or under the supervision or direction of, a physician or other advanced practice practitioner.
 
You may ask, are the definitions and distinctions really that important? Yes, yes, they are – at least when it comes to important details such as regulatory requirements, whether it is reimbursable by health insurance and how and when it can be offered. And those are determinative details when it comes to adaptation in the health care delivery landscape. For example, Medicare has traditionally imposed restrictive circumstances on when and where telemedicine can be reimbursed. This restrictive application has been a primary obstacle to the wider adoption (and standardization) of telemedicine. Whether a service or modality is “telehealth” or “telemedicine” can carry different rules or standards or (eligibility for) compensation. Since telehealth services do not have to be clinical in nature this means a wider range of professionals can offer or be involved with those services. As a result, they are generally defined differently than telemedicine services. This means they may – or may not – be reimbursed by insurers. A really great resource for understanding the myriad of policies, regulations, and laws is the Center for Connected Health Policy, which serves as the National Telehealth Policy Resource Center.
 
Synchronous v. Asynchronous
 
Another important qualifier or descriptor of the various telehealth applications is whether the modality is synchronous or asynchronous. You can likely puzzle out what these terms imply. Synchronous communication requires that both the patient and health care provider be present at the same time through the use of a telecommunications platform that permits real time interactions. These are your “virtual visits.” This type of interaction generally does not require the parties to be in any particular location.
 
Asynchronous communication, on the other hand, does not require the parties to be present at the same time and may never result in a patient-to-provider interaction; though the option to communicate with a provider must be available. If you have ever used a mobile application that guides you through an AI-run screener, resulting in recommended next steps but not direct communication with a health care provider, you have used an asynchronous platform. Asynchronous communication can also be known as, “store and forward”: the initiating party is entering or uploading (read: storing) information in the platform that is sent to (read: forwarding) to the receiving party to review and act on when they are able. This use of asynchronous communication is used often for provider-to-provider consultations, or when receiving lab results from your provider through your patient portal account.
 
But, Wait there’s More (of course there is)
 
Two more modalities for you to know. The first is Remote Patient Monitoring (RPM). Through this modality, a device is used to remotely collect and send data to a health care provider, perhaps a home health agency or testing facility, in order to keep track of certain vital information for a patient. Perhaps it is monitoring blood glucose, heart ECG, or even for a fall. Next is mobile health or mHealth. This is what most consumers are familiar with. It is a mode of care that includes monitoring and sharing of health information via mobile technology (mHealth) such as wearables and health tracking apps.
 
Conclusions
 
Telehealth generally, but mobile health in particular, is a game changer for individuals and communities in achieving their best health and wellbeing. While there has been significant adoption of mHealth capabilities by individuals, as well as by employers, insurers, and providers, there remains significant potential to expand use of such technology. To do so, we need to understand the enablers and barriers to do so and what can be addressed to remove the barriers.
 
Next Steps:

On May 6th, Atromitos will host an Insightful Discussion titled: There’s an App For That: Opportunities and Obstacles in Health Technology. To register to attend, click here.
 
 
Michealle Gady, JD, is Founder and President of Atromitos, LLC, a boutique consulting firm headquartered in Wilmington, North Carolina. Atromitos works with a variety of organizations from health payers and technology companies, to community-based organizations and nonprofits but their work reflects a singular mission: creating healthier, more resilient, and more equitable communities. Michealle takes nearly 20 years’ experience in health law and policy, program design and implementation, value-based care, and change management and puts it to work for Atromitos’ partners who are trying to succeed during this time of dramatic transformation within the U.S. healthcare system. Outside of leading the Atromitos team, Michealle serves as a Board Member for both the Cape Fear Literacy Council and A Safe Place and is a member of the American College of Healthcare Executives and American Health Law Association.