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October 5, 2021

The evolution of telehealth: How did asynchronous care come to be?

Imagine this: it’s 1925, and on the cover of your favorite magazine is a funny device, aptly named a “Teledactyl.” It’s revolutionary, with its founder Hugo Gernsback citing a fresh, new, and innovative concept—what’s known today as telemedicine.

In this blog, we dive into the history of telehealth and the evolution of asynchronous telemedicine. Discover the origins of the technology and its growing popularity given modern day concerns, centered around Covid-19, physician shortages, and increased market competition.

[Curious to read more about the basics and benefits of asynchronous care? Check out the first blog in our series here.]

How did asynchronous virtual care come to be?

Telemedicine, virtual telehealth, connected health, connected care, and virtual health are all terms derived from Gernsback’s “Teledactyl” device and are often used interchangeably. Since then, the U.S. Health Resources & Services Administration (HRSA) has defined the differences between telehealth and telemedicine.

“Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services.” — HRSA

The rise of asynchronous telemedicine

Between the late 1950s and early 1960s, one of the earliest and most famous use cases of hospital-based telemedicine occurred—a closed-circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital for psychiatric consultations.

Although several university programs began serious planning efforts toward the end of the 1980s, reports of telemedicine consultations were far and few between. It wasn’t until the 1990s that telemedicine began to see its “developmental years.” During this decade, large state and system projects were created, allowing telecommunication to become more accessible and affordable. The passage of state and federal legislation also propelled the field forward by recognizing telemedicine as a reimbursable mode of care.

In 2001, a landmark paper published as part of the Institute of Medicine’s Quality of Healthcare in America project titled Crossing the Quality Chasm: A New Health System for the 21st Century, said that “information technology must play a central role in the redesign of the health care system if a substantial improvement in quality is to be achieved.” This soon led to advances in telecommunication and information technology addressing disparities among rural communities and their access to care.

In 2003, authors of a study published in the International Journal of Healthcare Technology and Management surmised that asynchronous virtual care technologies were likely to cause “major changes” in the way patients and providers communicate. “Initially, these technologies will be applied to undemanding communication uses, such as requesting prescription refills. In the longer term, however, the technologies may provide strategic benefits to healthcare innovators,” they wrote.

A timeline of asynchronous telehealth:

First closed-circuit television link established

Telemedicine begins its “developmental years”

Landmark research published that speaks to the redesign of the healthcare system

Experts chronicle the future benefits of asynchronous tech in the Journal of Healthcare Technology and Management

Multiple states begin to enact health insurance coverage mandates for telemedicine

A global pandemic pushed asynchronous healthcare into the limelight

Individual states continue to push for payment parity of asynchronous care to be permanent

Where does asynchronous telehealth stand today?

Policy advancements continued to support the evolution of telehealth during this decade. By 2010, 11 states including California had enacted some form of health insurance coverage mandate for telemedicine. Other states soon followed suit, each with varying degrees of requirements with regard to mandated coverage for telemedicine.

As the pandemic swept across the globe in 2020, asynchronous telehealth became a revolution of sorts. A number of factors contributed to the rise of this approach to care, including a heightened need for improved efficiencies in care delivery given greater strains on the healthcare system than ever before, and a generation of incoming providers who grew up in a digital world. With more of an appetite for on-demand communication—mixed with a global pandemic that limited in-person care—patients and providers are becoming increasingly open to the benefits of asynchronous telehealth.

This shift in care delivery is also making its way through state legislatures—which is critical, as policy changes and reimbursement parity are lagging behind technology when it comes to asynchronous care. For instance, in May 2021, Arizona Gov. Doug Ducey signed HB 2454, which allows patients and providers to establish a patient-provider relationship via asynchronous interactions and requires payors to reimburse asynchronous telehealth at a rate equal to an in-person visit. Colorado governor Jared Polis soon followed suit, signing HB 21-1190, which expanded the state’s definition of telemedicine to include “information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers.” Maine, Maryland, New York, Idaho and more have made similar moves, as has the federal government.

What’s next for asynchronous care?

As asynchronous technology continues to power hybrid care delivery, many are realizing the benefits of implementing these solutions. Learnings from Covid-19 confirm the need for increased efficiency, as hospital systems continue to deal with physician shortages and burnout alongside heightened patient demand. At the same time, asynchronous platforms aid in bettering the patient experience, and enabling organizations to remain competitive as convenience care options continue to grow. As many in the industry look to implement asynchronous care, the remaining hurdles to enabling more rapid adoption are legislation and policy changes, as well as more widespread education for both providers and consumers.

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