Asynchronous Telehealth

The Covid pandemic changed health care delivery forever. Patients used to see their providers in a clinic. Virtual visits and asynchronous telehealth are now common — especially in mental health.

Patients are generally familiar with virtual or “Zoom” visits. This is synchronous telehealth because the provider and patient are interacting with each other in real time though the use of audiovisual technology.¹

Asynchronous telehealth, on the other hand, is intermittent interactions dispersed across time.² Examples include inbox communication in a patient portal and e-mail messages.

All of this messaging takes a toll. As one provider observed

Like most physicians, I was getting many more messages than I had before the pandemic and was spending multiple hours a day answering them. I told my husband that I could fill my entire day just responding to patient messages and never actually examine anyone.

Another quipped

It is Saturday night. Do you know what your doctor is doing? Is she sitting on the deck with her husband watching the moon rise over the horizon? Enjoying conversation around the fire with her children? Returning home from a cultural night out? Heading to bed for a good night’s rest? Maybe. But there is also a good chance she is doing none of these restorative or healing activities, but rather is sitting in the glow of her computer screen, working down the inbox in her electronic health record (EHR) […]

This was my personal experience, too. Portal messages and e-mails increasingly demanded more of my time — time that I could no longer give away for free.

Lawyers, plumbers and car mechanics charge an hourly rate — mine has been $300/hour for years.³ My fee for in-office and virtual visits has always been based on that rate.

For asynchronous telehealth, I run a digital timer and charge in 10-minute increments.⁴ The alternative is to require in-office or virtual visits, which can be disruptive, often unnecessary, and definitely more expensive.

Does this reduce my “pajama time” in the EHR? Yes. I now consider asynchronous telehealth part of my normal day job, not something that I try to fit in elsewhere.

But is this good for patients? Also yes. Patients appreciate direct, unfiltered access to their providers, and are more likely to recommend providers with higher inbox activity. Inbox activity also leads to better quality of care. ✸

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1. Greek: syn (together) khronos (time), i.e., occurring at the same time ↩︎
2. Not coinciding in time ↩︎
3. Except for Medicare beneficiaries, where I’m required to follow its Physician Fee Schedule ↩︎
4. I use the following CPT codes: 99421-3 and 99199 ↩︎