Store-and-forward telemedicine provides new ways to interact with patients. Some of these ways may cause workflow conflicts with existing systems used by clinics. Many clinics have a doctor-on-call after hours. If a patient has a question or concern, they can reach the on-call service when the practice is closed. (This, by the way, is a classic example of real-time telemedicine.)  Some existing patients may use the on-call system to receive care for new conditions. For example, a patient with itching bug bites may call and get a prescription from the on-call provider. In most cases, clinics do not charge for their on-call service. The provider could, at their discretion, ask the patient to come into the office instead of providing treatment directly over the telephone. 

So, for clinics that may use patient-initiated store-and-forward telemedicine, the patient seeking non-urgent medical treatment after hours could do so simply by starting a visit from the clinic’s website. From a financial perspective, the medical practice will likely make more money if their patients use virtual store-and-forward telemedicine instead of using the on-call number. But, from a patient satisfaction standpoint, some patients may want the option to speak with a real live doctor. In addition, most patients know that on-call services are free, so why would they ever agree to pay for a store-and-forward telemedicine visit? There is no easy solution here. Practices that come across this issue will need to take steps to resolve this conflict so that they offer consistent service and pricing across all of their care models. 

Another patient interaction system commonly employed by clinics is a messaging system, typically via a patient portal. Technically this type of interaction is considered store-and-forward telemedicine of the simplest type—simple messages that may or may not provide enough medically relevant information to the provider. From our experience, patients typically use this system for either simple follow-up questions regarding their previous visit or queries before their next visit. Since this type of messaging is open-ended and often does not provide a structured flow, patients may be more likely to overuse this type of system compared with a telemedicine platform that utilizes specific questionnaires.