Synchronous telehealth occurs when real-time technology allows the patient or client to interact with a practitioner using a telephone or video connection — or a combination of both. Providers and patients communicate directly, mimicking real-time interactions where the parties converse as they would in person. The goal of synchronous telehealth service is to mirror the interactions in person to reach the end goals of developing a diagnosis, a treatment plan, or a prescription if medication or another course of action is warranted. The process can involve traditional in-person interview techniques but is often augmented by asking the client or patient to engage in physical activity, such as standing up and walking, using their limbs to demonstrate the ability to maintain balance or engage in some other specified motion. Hygiene, for example, may be checked by asking the client or patient to hold their fingers to the camera as they discuss their hygiene, where they live, and whether they can enjoy routine meals daily. The following are considered synchronous communication technologies:
- Videoconferencing applications (where behavioral health has been a leader from the start)
- Interactive educational computer programs
- Chat rooms
- Affective computing uses video cameras to help identify emotions in people (can be synchronous or asynchronous)
- Virtual reality (simulated environments used for a host of behavioral health treatments for disorders ranging from PTSD to alcoholism or sexual abuse and molestation)
- Text messaging (can be synchronous or asynchronous)
- Virtual programmable humans are artificial intelligent characters (AICs) that can involve computer programs that facilitate complex activities such as role-playing for new skill development (learning, enhancement, and practice) with human-like behavior. They can be trained for content-specific conversations, such as delivering intake protocols in which the characters can listen, respond and engage in real-time dialogue.
Compared to synchronous telehealth, when the interaction between parties occurs in real-time, asynchronous telehealth occurs over time, with a delay between contributions from each party such that the interaction occurs independently of time. Asynchronous contact is also known as “store-and-forward,” such as when an intake worker interviews a new opioid addicted-patient in a rural clinic, and the interview’s recording is forwarded to a specialist for diagnosis and treatment planning later point in time.
Asynchronous telehealth can occur using any of these or combinations of these technologies when they are HIPAA compliant or if the patient is in a different country when following the local jurisdictional requirements:
- Sophisticated educational multimedia presentations on the web
- Text-messaging behavioral programs, whereby the recipient can alter smoking behavior, for example, by responding to identified problem behaviors with new cognitions or skills. (Texting can be synchronous or asynchronous but is most often considered asynchronous.)
- “Apps” for mobile devices (including smartphones and tablets) such as a fitness app wherein a user can change behavior based on information received from the smartwatch, smartphone, or tablet
- Machine learning via data analysis allows computers or other gadgets to track, evaluate, and predict behavior in ways that are helpful to the user, such as a sleep app that lets the user know if they have experienced adequate time in all four stages of sleep to operate the following day fully, or over time intervals, such as weeks, months or years
- Email exchanges
- Newsgroups, forums, and social media sites that allow messaging as well as real-time communication
- Artificial intelligence and the use of avatars and robotics to assist with self-help psych-educational
- Sensor technologies such as those available in the Apple watch, the Oura ring, or any of more than a dozen
Combinations of Synchronous Telehealth & Asynchronous Telehealth
Synchronous treatment can be combined with asynchronous treatment, as when an interview occurs in real time between a patient in an emergency department and a social worker at home. The recording is then sent to a specialist for diagnosis and treatment planning (asynchronous telehealth). Many asynchronous technologies can be combined with a synchronous modality to deliver better data than can often be collected in person at a practitioner’s office. Many of today’s technologies are evolving into “therapy extenders” or “replaces,” whereby clients and patients are empowered by collecting data to measure their fitness, sleep cycles, and much more. See TBHI’s previous article What is Asynchronous Telehealth? How It Can Help Your Patients, Clients & You? for more information.
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