Why Asynchronous Telehealth Has Been a Boon for Patients, Providers 

Necessity is the mother of invention. In the case of telehealth, it is also the mother of adoption.

The COVID-19 pandemic drove care into the virtual arena with both providers and patients quickly getting on board. But now that telehealth use has entered the mainstream, providers must determine the best modality for different types of care, be it video-based, audio-only or asynchronous.

Asynchronous telehealth, as opposed to synchronous telehealth, refers to a visit where the patient and provider are not interacting in real-time. It usually involves a patient entering their information and symptoms into a platform or application and the provider looking at it at a later time and then providing a diagnosis and recommended treatment plan.

Though it cannot be applied to all specialties, for the ones where it can be used, asynchronous telehealth has proved to be quite useful — like in dermatology, for example.

Several health systems around the country have implemented an asynchronous telehealth service to supplement video- and phone-based visits, including Des Moines, Iowa-based UnityPoint Health. According to Matt Warrens, managing director of innovation at the health system, the service has been largely beneficial for patients and providers alike, affording both stakeholders more flexibility and offering a way to effectively triage patients and ensure they receive the appropriate level of care.

How UnityPoint Health's asynchronous telehealth works

For UnityPoint Health, asynchronous telehealth includes the use an artificial intelligence-powered questionnaire that assesses the patient before a provider even gets involved.

"Essentially, asynchronous visits are a way for a patient to walk through a series of questions that an algorithm is running behind, which knows to intuitively ask them the appropriate next question, and then tees off a recommendation of the diagnosis and treatment," said Warrens in a phone interview.

The provider can accept, reject, or modify the recommendation. Once the provider takes action, the patient receives a message through the platform on next steps, which can range from being told that a prescription has been sent to their pharmacy of choice or being asked to participate in a video or in-person visit.

In November, UnityPoint Health launched asynchronous visits through a company called Bright.md in one of its nine markets.

The pros and cons of asynchronous telehealth

The upsides of asynchronous telehealth for patients are fairly obvious. For one, the service gives patients more flexibility regarding how and when they interact with their physicians.

"In my own personal experience, the handful of times I've used a virtual visit, there was really no reason for us to be on a video call together," Warrens said. "And I personally don't really want to be on the video call if I'm not feeling well, probably."

It also helps improve patient experience as it enables patients to navigate the health system and get the appropriate level of care. For instance, though UnityPoint's asynchronous telehealth platform is set up to provide diagnosis recommendations for low-acuity conditions — like upper respiratory infection, urinary tract infections, strep throat, and the common cold — it can help triage a patient that requires a higher level of care through its treatment plan recommendation.

"I mean, that's the problem today, right? People don't know — okay I have these symptoms. Should I go to the ED? Should I make an appointment tomorrow with my primary care provider? Should I go to a retail clinic? Or can I do a video visit?" Warrens said.

The asynchronous service not only offers more convenience for patients, and therefore a better experience, but also for providers.

"From a provider side, the pros are my ability to basically be teed up with…what the patient's chief complaints are, observations, recommended diagnosis, and treatment, versus me sit[ting] there as a provider and ask[ing] you those questions through a video — tremendous time saving," he said.

Saving providers' time is particularly helpful for healthcare organizations facing staffing crises as a result of the COVID-19 pandemic. Around 18 percent of healthcare workers have quit their jobs during the pandemic, while another 12 percent have been laid off, according to data from data intelligence company Morning Consult.

UnityPoint Health's asynchronous platform significantly increases productivity and is user-friendly — a boost for clinicians and health systems alike, said Warrens.

Though Warrens believes that asynchronous telehealth is by and large a boon, there is at least one downside.

The inability to talk to or see patients in real-time could lead to cues being missed. In some cases, this could even lead to delays in care — which makes the triage aspect of the platform that UnityPoint uses all the more important.

The future of asynchronous telehealth at UnityPoint Health

The health system plans to expand its asynchronous telehealth service in 2022.

Currently, UnityPoint Health's service mirrors its retail clinic strategy. This means, the providers in its retail clinics are the ones that are responding to the inbound requests for asynchronous virtual care.

"As we scale this platform, our plan would be to centrally monitor it," Warrens said. "So have providers monitoring these [requests] in a call center type setting, so that that's the only function they're performing their entire shift. That will really optimize or maximize the number of patients that a single provider can care for in a day."

Another capability that the UnityPoint team is exploring is whether patient portal messages could be used to link patients with asynchronous telehealth services.

For example, a phrase about respiratory infections in a patient portal message could potentially be linked to the asynchronous service that would walk the patient through initial questions and tee up recommendations for the provider.

As telehealth use continues to grow and technology develops, Warrens believes asynchronous services will be widespread and could be used to treat even higher acuity conditions.

"I personally believe that we'll see a day where the volume of these visits will outpace virtual visits," he said. "I believe that because I think that a consumer preference will be created to do this versus video. I also think that the platform is expanding every day. It's learning. Right?"