Asynchronous (store-and-forward ⁱⁱ) is the oldest form of telehealth technology. It refers to the transmission of images or information from one provider to another. For example, if your doctor sends digital images of an X-ray to a radiologist for analysis, they are leveraging store-and-forward telehealth technology. This is one of the most common uses, but images and information of any type can be transmitted in this matter. One thing we should point out, however, is that store-and-forward telehealth is not always covered by state telemedicine reimbursement laws, even in states that require parity for real-time communication. 

Store-and-forward telemedicine is collecting clinical information and sending it electronically to another site for evaluation. Information typically includes demographic data, medical history, documents such as laboratory reports, and image, video, and/or sound files. 

The health professional may use a desktop computer or a mobile device, such as a smartphone to gather and send the information. Information is transmitted by electronic mail, uploaded to a secure website, or uses a private network. 

Benefits of store-and-forward consultations include: 

• The patient, physician, and specialist do not have to be available at the same time—improving efficiency and convenience
• They do not need to travel—participants can be located anywhere
• Waiting times are reduced—specialist reports are often received within a few hours of the request
• Second opinions can be quickly obtained
• Outpatient appointments are freed up for patients that need them most
• Unnecessary prescriptions and surgical procedures are minimized

A disadvantage of store-and-forward consultations is that the specialist does not examine the patient directly. It may be necessary to arrange an in-person or video consultation at a later date. 

Store-and-forward activities include: 

• A specialist radiologist or physician reviewing X-rays taken at a remote location or after hours (teleradiology)
• Images of a wound taken by a junior doctor in the emergency department and sent to his consultant for advice
• Digital images of a patient’s skin condition sent by a physician to a dermatologist for diagnosis and treatment advice (teledermatology)
• Nurse-led skin lesion and mole mapping clinics providing high-quality images to skin cancer specialists (teledermatoscopy)
• Images of diabetic retinopathy taken by a technician and reviewed by an ophthalmologist (retinal screening)
• Pathology images used for a multidisciplinary meeting (telepathology)
• Patient portals allowing communication between a patient and their physician