This session explores the potential of asynchronous care models to expand access to healthcare and address disparities, particularly in underserved populations. Participants will learn how to incorporate asynchronous tools into hybrid care models, blending real-time (synchronous) and delayed or store-and-forward (asynchronous) interactions to optimize patient outcomes and operational efficiency. The session provides actionable insights into meeting documentation standards, streamlining workflows, and maintaining high-quality care delivery across both asynchronous and hybrid models. By integrating these approaches, physicians can expand their reach while ensuring timely and equitable care.

Key Learning Objectives

• Understand how asynchronous care differs from real-time telehealth and why it is valuable in modern healthcare.
• Learn how to integrate asynchronous workflows into practice while maintaining compliance.
• Optimize efficiency by using automation and AI-driven tools to enhance triage and documentation.
• Explore real-world applications in chronic disease management, specialty care, and behavioral health.
• Identify key challenges in asynchronous care and develop strategies to overcome them.

Implementing Asynchronous Workflows Successfully

Asynchronous care—also known as store-and-forward telehealth—is redefining how healthcare providers interact with patients. Unlike real-time (synchronous) telehealth, asynchronous care allows patients to submit their health data at any time, enabling providers to review and respond when convenient. This model enhances efficiency, patient accessibility, and provider workflow without compromising care quality.

This module provides a comprehensive, real-world guide to implementing asynchronous care, covering technology, compliance, workflows, and best practices.

Asynchronous care allows patients and providers to communicate without being online at the same time. This is especially useful for routine follow-ups, chronic disease management, and specialty consultations. Patients can submit their information through a secure platform, and providers review the details on their own schedule.

This method increases access for patients, improves provider efficiency, and ensures that lower-acuity cases do not take up unnecessary time in real-time visits.

Key differences between asynchronous and synchronous care:

• Asynchronous care allows flexibility for both patients and providers, whereas synchronous care requires real-time interaction.
• Store-and-forward technology supports structured data collection, whereas live visits rely on direct conversation.
• Triage efficiency improves with asynchronous care by filtering non-urgent cases, allowing real-time visits to focus on higher-priority patients.

Implementing Asynchronous Workflows Successfully

Implementing Asynchronous Workflows

To ensure a seamless experience, the intake process must be structured to collect the necessary patient information up front. This includes symptom descriptions, past medical history, and relevant images or lab results.

Using standardized intake forms helps providers quickly assess cases without needing excessive back-and-forth communication. Automated decision-support tools can further streamline triage by identifying cases that require real-time evaluation.

Integrating asynchronous care into existing workflows requires electronic health record (EHR) compatibility and automated notifications to ensure timely provider responses.

Best practices include:

• Using HIPAA-compliant platforms for secure data exchange.
• Automating structured intake forms to gather comprehensive patient information.
• Setting clear response time expectations for patients.
• Ensuring documentation consistency with SOAP note templates.
• Using AI-driven decision support for case prioritization.

Compliance and Security Considerations

Asynchronous care must meet all regulatory requirements to protect patient privacy and ensure legal compliance. HIPAA compliance is essential for data security, requiring encryption and secure storage for patient-submitted information.

State regulations vary, with some requiring specific patient consent for telehealth services. It is important to verify compliance with state medical board guidelines before implementing store-and-forward technology.

Key compliance steps include:

• Ensuring patients provide explicit consent for asynchronous telehealth.
• Using end-to-end encryption to protect data.
• Restricting access to patient records through secure login and authentication methods.
• Maintaining audit trails for all provider interactions and recommendations.
• Following billing guidelines to avoid fraud or improper claims.

Optimizing Efficiency with Automation

Automation tools help streamline asynchronous care by pre-screening patient submissions, reducing documentation burdens, and flagging urgent cases for immediate attention. AI-powered symptom checkers can guide patients through structured intake questions, reducing the need for unnecessary provider follow-ups.

EHR integration allows for seamless documentation and eliminates the need for duplicate data entry. Automated reminders ensure that patients follow through with necessary tests, medication adjustments, or follow-up appointments.

Strategies for automation:

• AI-driven triage tools to assess symptom severity.
• Auto-generated SOAP notes to standardize provider documentation.
• Smart intake forms that adjust based on patient responses.
• Automated alerts for urgent cases requiring real-time evaluation.
• Integrated workflows with EHR systems to avoid manual data entry.

Common Asynchronous Use Cases

Asynchronous care offers a broad range of use cases that go well beyond weight loss management and aesthetics. Here’s a deeper dive into how you can leverage this approach across different areas:

Common Use Cases for Store and Forward Telemedicine

1. Chronic Disease Management

• Diabetes & Hypertension:
  Patients can log daily blood sugar readings, blood pressure measurements, and related symptoms. You can review these trends over time, adjust medications, and fine-tune lifestyle recommendations without waiting for the next in-person visit.
• Heart Failure & COPD:
  As patients track weight, oxygen saturation, or symptom fluctuations, you can catch early signs of deterioration and proactively modify treatment plans.

2. Remote Patient Monitoring

• Digital Check-Ins:
  By utilizing apps and connected devices, patients send periodic updates on various health metrics—like heart rate or glucose levels—which you can assess at your convenience.
• Data-Driven Decisions:
  Continuous remote monitoring helps in early intervention, reducing emergency visits and hospital readmissions.

3. Aesthetic and Cosmetic Medicine

• Pre-Procedure Evaluations:
  Patients submit images and complete questionnaires about their aesthetic goals. You can assess these materials, determine treatment eligibility, and prescribe pre-procedure instructions asynchronously.
• Post-Procedure Follow-Up:
  After treatments, patients can share recovery updates and images, allowing you to quickly spot any complications and adjust aftercare protocols as needed.

4. Behavioral and Mental Health

• Self-Assessment Tools:
  Patients complete standardized questionnaires on mood, anxiety, or sleep patterns. These assessments help you monitor progress and adjust pharmacotherapy when necessary.
• Ongoing Check-Ins:
  Secure messaging allows you to follow up on patient concerns, provide encouragement, and make timely modifications to treatment plans.

5. Orthopedics and Musculoskeletal Care

• Symptom and Mobility Tracking:
  Patients can report pain levels, range-of-motion limitations, and functional status through digital surveys. You can use this information to tailor rehabilitation plans or modify prescriptions for pain management.
• Wound and Fracture Monitoring:
  Follow-up photos and patient-reported outcomes enable you to monitor healing after injuries or surgeries, ensuring timely interventions if issues arise.

6. Post-Surgical and Rehabilitation Follow-Up

• Recovery Monitoring:
  After surgery, patients send updates on wound healing, pain levels, and mobility. This allows you to detect early signs of complications and intervene without requiring a clinic visit.
• Rehabilitation Check-Ins:
  As patients progress through rehabilitation, periodic updates help you assess recovery, refine therapy regimens, and adjust medications as needed.

7. Medication Management

• Side Effect Reporting:
  Patients can communicate any adverse reactions or concerns related to their prescriptions via secure messaging. This enables you to promptly adjust dosages or switch medications when necessary.
• Adherence Tracking:
  Regular asynchronous updates on medication adherence help you identify patterns, provide educational feedback, and ensure treatment effectiveness.

8. Remote Second Opinions and Imaging Reviews

• Asynchronous Consultations:
  You can receive diagnostic images, lab reports, and detailed patient histories from other facilities. Reviewing this information on your own schedule makes it easier to provide expert second opinions and confirm treatment plans without logistical hurdles.

9. Preventive Health and Routine Screenings

• Home Testing:
  Patients can complete at-home test kits (for things like colon cancer screening or cholesterol checks) and submit their results for your review. This streamlines preventive care and keeps patients engaged in managing their health.

Why This Model Works for You

• Flexibility:
  You’re able to review and respond to patient data when it best fits into your schedule—reducing time pressures and allowing for more thoughtful care.
• Efficiency:
  With information delivered directly to your digital dashboard, you can quickly identify trends, adjust care plans, and reduce the need for extra appointments.
• Enhanced Patient Outcomes:
  By catching issues early and maintaining continuous communication, you ensure that patients receive timely, personalized interventions, leading to better overall results.

Collecting Data through Questionnaires

Asynchronous care provides flexibility for both patients and providers by allowing health information to be shared and reviewed at different times. However, incomplete or irrelevant data collection is one of the biggest barriers to its success. Without real-time interaction, providers risk misdiagnosing conditions, requesting excessive follow-ups, or missing critical information.

The key to overcoming this challenge is replacing outdated static intake forms with dynamic questionnaires. Dynamic questionnaires adjust in real time based on patient responses, ensuring that providers receive accurate, structured, and clinically relevant information without unnecessary back-and-forth.

This module explores how to implement intelligent intake forms, optimize clinical workflows, and ensure higher-quality patient data collection in asynchronous care.

The Problem with Static Questionnaires in Asynchronous Care

Why Static Questionnaires Fail

Static questionnaires use a fixed set of pre-written questions that do not change based on patient responses. While they may seem efficient, they often fail to gather complete and relevant information because they:

• Ask irrelevant or redundant questions, frustrating patients.
• Fail to adapt based on symptom severity or risk factors.
• Require providers to follow up manually, delaying diagnosis and treatment.
• Increase the likelihood of misdiagnosis due to missing information.

A static questionnaire for chest pain, for example, may ask every patient the same questions—whether their symptoms are mild acid reflux or an acute cardiac event. This lack of specificity forces providers to sift through unnecessary data or request further details, making asynchronous care inefficient.

The Power of Dynamic Questionnaires

What Are Dynamic Questionnaires?

Dynamic questionnaires use conditional logic to adjust questions in real time based on patient responses. Rather than following a one-size-fits-all approach, these forms intelligently adapt, ensuring that:

• Patients answer only clinically relevant questions.
• High-risk cases are flagged and escalated.
• Providers receive complete and structured data, reducing follow-ups.

How Dynamic Questionnaires Work

Dynamic questionnaires follow branching logic, meaning that a patient’s response determines the next question.

• If a patient reports chronic back pain, the system asks about injury history, location, and previous treatments.
• If a patient reports sudden-onset chest pain, follow-up questions screen for red flag symptoms like shortness of breath, dizziness, or radiation to the arm—indicating a possible heart attack.

By automatically adjusting based on patient input, dynamic questionnaires ensure providers get the right information upfront, reducing the need for unnecessary follow-ups.

Comparing Static vs. Dynamic Questionnaires

Real-World Example: Static vs. Dynamic Intake in Asynchronous Care

Scenario: A patient reports a headache through an asynchronous telehealth platform.

• Static Form Approach: Asks every patient the same set of generic headache-related questions, regardless of risk factors or severity.

  • How long have you had the headache?
  • Have you taken pain medication?
  • Have you had headaches before?

• Dynamic Questionnaire Approach: Adjusts in real time based on patient responses.

  • If the headache started suddenly and severely, the form screens for stroke symptoms (blurred vision, slurred speech, weakness) and flags the case for immediate escalation.
  • If the headache is mild and chronic, it asks about migraine history, triggers, and response to past treatments before sending a treatment plan.
  • If the headache is associated with sinus pressure and congestion, it asks about recent colds or allergies before directing the patient to a sinus treatment pathway.

This personalized intake process ensures that providers get the right information without unnecessary back-and-forth.

How Dynamic Questionnaires Improve Asynchronous Workflows

1. Automating Triage and Risk Stratification

• Cases with mild, self-limiting symptoms can be handled asynchronously.
• Cases with moderate severity can be routed to a scheduled video consult.
• Cases with urgent red flag symptoms can be flagged for immediate escalation to emergency care.

2. Reducing Provider Burden

• Instead of reviewing incomplete or irrelevant submissions, providers receive structured, clinically relevant data in an easy-to-read format.
• AI-driven SOAP note generation ensures faster documentation.
• Automated questionnaires ensure that follow-up questions are answered upfront, reducing unnecessary outreach.

3. Improving Patient Experience

• Patients feel like they are being asked the right questions for their symptoms, improving engagement.
• The process is shorter and more intuitive, increasing completion rates.
• Clear explanations help guide patients to the right care pathway without frustration.

How to Implement Hybrid Models

Hybrid telemedicine model is designed to offer the right type of care at the right time, balancing virtual and in-person visits. Instead of forcing all patients into a one-size-fits-all approach, hybrid models offer multiple pathways for patient interaction, improving accessibility and efficiency.

The Three Pillars of a Hybrid Model

Asynchronous Care (Store-and-Forward)

• Used for routine follow-ups, medication refills, chronic disease management, and specialist consults.
• Patients submit health data, images, or videos for providers to review later.
• Reduces unnecessary live visits by addressing low-acuity and non-urgent cases.

Synchronous Care (Real-Time Telemedicine)

• Used for acute conditions, complex medical cases, mental health sessions, and urgent triage.
• Live video or audio visits allow for direct provider-patient interaction.
• Best for situations requiring immediate provider input or physical examination through video.

In-Person Care

• Used for procedures, diagnostics, physical exams, and high-risk cases requiring hands-on evaluation.
• Necessary when remote diagnosis is not possible or when escalation is required.
• Works alongside virtual care to provide continuity and comprehensive treatment plans.

How Hybrid Models Optimize Patient Care

By blending asynchronous, synchronous, and in-person care, hybrid models provide:

• More efficient provider workflows by reducing unnecessary real-time visits.
• Faster patient triage by routing cases to the appropriate level of care.
• Better patient outcomes by ensuring timely interventions without overburdening providers.
• Cost savings for both providers and patients by minimizing unnecessary in-person visits.

Best Practices for Implementing a Hybrid Model

Optimizing Patient Flow with Hybrid Telemedicine

A successful hybrid model requires a structured workflow to ensure patients receive the right type of care at the right time.

Example Hybrid Workflow

1. Patient Initiates Care Request

   • Patients submit a symptom questionnaire through a secure portal.
   • AI-driven triage assesses urgency and suggests the appropriate pathway.

2. Automated Triage Determines Next Steps

   • Asynchronous Care: If symptoms are mild, patients receive guidance, prescriptions, or specialist referrals without a live visit.
   • Synchronous Care: If symptoms require real-time evaluation, the patient is scheduled for a video or phone consultation.
   • In-Person Care: If the condition requires an in-person exam or procedure, the patient is directed to a physical clinic.

3. Provider Reviews Case & Delivers Care

   • Asynchronous cases are batch-reviewed at designated intervals, saving time.
   • Synchronous visits are scheduled efficiently, reducing provider downtime.
   • In-person visits are reserved for high-priority cases, improving clinic efficiency.

4. Follow-Up & Care Coordination

   • Patients receive post-visit instructions and monitoring tools via telehealth.
   • Automated reminders ensure continuity in chronic disease management.
   • Hybrid scheduling allows seamless transitions between virtual and in-person follow-ups.

When to Use Asynchronous vs. Synchronous vs. In-Person Care

This structured decision matrix ensures that providers maximize efficiency while maintaining high-quality care.

How Hybrid Models Reduce Provider Burnout

Hybrid models reduce strain on providers by ensuring that real-time interactions are reserved for the highest-need patients. Key benefits include:

• Decreasing administrative burdens by automating documentation through asynchronous care.
• Allowing for better schedule control by balancing live and non-live interactions.
• Reducing cognitive overload by automating triage and case sorting.
• Providing work-life flexibility by enabling remote patient management through a mix of virtual and in-person services.

Worksheets for Improvement

To be issued shortly.  

Handout 1: Compliance & Documentation Workbook for Asynchronous Care
Ensure safe and effective asynchronous care with this interactive workbook. This guide covers key compliance standards, documentation best practices, and risk mitigation strategies, helping you maintain regulatory alignment while delivering high-quality patient care.

Handout 2: Workflow Optimization Workbook for Asynchronous and Hybrid Care
Streamline your practice with a structured approach to integrating asynchronous care. This workbook provides a decision-making framework, workflow planning exercises, and messaging templates to help you balance efficiency, compliance, and patient satisfaction.

Research and Evidence-Based Sources

American Telemedicine Association. Asynchronous Care: Reaching the quintuple aim of healthcare Transformation - ATA. ATA. Published November 11, 2022. https://www.americantelemed.org/resources/asynchronous-care-reaching-the-quintuple-aim-of-healthcare-transformation/

Deshpande A, Khoja S, Lorca J, et al. Asynchronous telehealth: a scoping review of analytic studies. Published June 2, 2009. https://pmc.ncbi.nlm.nih.gov/articles/PMC2765770/?utm

Díaz MR, Locock L, Keen A, Melvin M, Myhill A, Ramsay C. Implementation of a web-based asynchronous consultation service in a hospital in Northeast Scotland: a multi-method multi-lens assessment (Preprint). Journal of Medical Internet Research. 2024;26:e48092. doi:10.2196/48092

Digital Empathy 2.0: Connecting with patients using the written word | Telehealth and Medicine Today. https://telehealthandmedicinetoday.com/index.php/journal/article/view/433/1033

HealthSnap. Synchronous vs. Asynchronous Healthcare: What’s The Difference. HealthSnap, Inc. Published March 17, 2023. https://healthsnap.io/synchronous-vs-asynchronous-healthcare-whats-the-difference/

Leighton C, Cooper A, Porter A, Edwards A, Joseph-Williams N. Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review. BJGP Open. 2023;8(1):BJGPO.2023.0177. doi:10.3399/bjgpo.2023.0177

Nguyen OT, Tabriz AA, Huo J, Hanna K, Shea CM, Turner K. Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health care Delivery: Systematic review. Journal of Medical Internet Research. 2021;23(5):e27531. doi:10.2196/27531