Asynchronous and Synchronous Modes in Internet Healthcare: Innovations and Applications

Asynchronous mode, a term derived from computer science, is applied in the field of internet healthcare as asynchronous telemedicine. A representative case is Zipnosis in the United States, which has been previously reported by VCBeat.(Click here for details)), in fact, the asynchronous healthcare model is a branch of telehealth (Telehealth/Telemedicine). For related information on telehealth, please see:Interpretation of Hot English Terms in Internet Healthcare: Telehealth/Telemedicine。 What Is Asynchronous Mode?Asynchronous mode specifically refers to the asynchronous medical model, also known as Prerecorded telemedicine or Store-and-forward telemedicine.. In simple terms, patients send messages, and doctors do not need to provide feedback synchronously; they can process them later, hence the term "asynchronous."

It leverages asynchronous, real-time computer-based communication devices to establish long-distance communication between patients and healthcare providers, or between referral coordinators and specialist physicians, thereby facilitating patient diagnosis and treatment and delivering the required medical services.

With technological advancements, communication devices available for asynchronous healthcare have expanded from email to include web-based computers, handheld devices, smartphones, and other terminals. Furthermore, due to the continuous reduction in data storage costs, transmitted data has become increasingly diverse, encompassing images, audio, video, and text. Transmission methods also vary, including telephone, internet, and sensors. The scope of clinical samples has continually extended as well; surgical wound photographs, skin moles or spots, electrocardiograms (ECGs), spirometry results, X-rays, CT scans, and magnetic resonance imaging (MRI) scans can all be conveniently acquired and transmitted to remote experts.

Summary: Four Steps of Asynchronous Telemedicine: 1. Acquire diagnostic information at the remote site; 2. Store the information in any format; 3. Transmit the stored information to the specialist end via appropriate methods; 4. Receive the information by remote specialists.Generally, asynchronous remote diagnosis requires not only the data transmitted in real time but also an electronic version of the patient’s medical history report. Due to the inherent latency of this model, it is not suitable for emergency situations.Additionally, potential issues include patients' inability to accurately transmit sample information, or experts' failure to properly utilize electronic data.Examples of Asynchronous Healthcare Models:Diseases across various specialties—including dermatology, radiology, pathology, cardiology, orthopedics, pediatrics, ophthalmology, plastic surgery, neurology, and hearing disorders—are well-suited for management through asynchronous healthcare models. Studies indicate that the past decade has sufficiently demonstrated the efficacy of asynchronous care in diagnosing and treating dermatological conditions, enhancing access to medical services and reducing consultation time. Moreover, for most skin diseases, the therapeutic outcomes and diagnostic accuracy of asynchronous models are comparable to those of in-person consultations. For skin cancer, asynchronous models enable more rapid assessment.

Evidently, the asynchronous model is well-suited for treating dermatological conditions, as it lowers costs and medical errors while reducing the administrative burden on healthcare professionals. In the realm of ophthalmic health, this model also holds significant potential for managing diabetic retinopathy and preventing blindness. It has been proven to be highly effective and cost-efficient in the diagnosis, monitoring, and management of this condition.The Value of Asynchronous Healthcare ApplicationsCurrently, this model is widely used and plays a significant role in developing countries with inadequate medical facilities, particularly in remote areas suffering from shortages of healthcare resources. It incurs lower costs than direct medical care and helps improve the quality of healthcare services while the medical system is being strengthened.For countries and regions with limited existing communication infrastructure, such as those in Africa, asynchronous telemedicine enables the comprehensive utilization of off-the-shelf communication networks, computer equipment, SMS services, and medical expertise at a low cost.Synchronous Medical ModelTelemedicine can be broadly categorized into two types: asynchronous mode and synchronous mode.Synchronous Medical Mode (Synchronous Mode or Real-Time Telemedicine), requiring both parties involved in the communication (including patients and remote medical specialists, or between two healthcare professionals) to remain online simultaneously, enabling synchronous, real-time interactive dialogue within the same timeframe.

Because healthcare providers can “see” patients, enabling bidirectional communication (both visual and audio), while simultaneously sharing documents, computer-based data, and whiteboard annotations. Communication modalities include online chat, telephone calls, and interactive video; for multi-participant interactions, video conferencing is the most commonly used synchronous mode. External devices are also connected to computers or video conferencing equipment.Examples of Synchronized Healthcare ModelsSuitable medical specialties include psychology, psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics, gynecology and obstetrics, and neurology.

Taking hearing disorders as an example, video technology can be utilized to treat patients with hearing impairments. For instance, an otoscope enables physicians to remotely examine a patient’s ears. Synchronous video allows clinicians to verify whether the patient’s diagnostic devices—including sensors, probes, and electrodes—are properly positioned. The video-capture equipment may range from built-in laptop webcams to more sophisticated, network-connected dedicated cameras.

Audiologists can employ two types of synchronous telehealth approaches. The first, applicable to other medical conditions, requires high-quality video capabilities to monitor and control the patient’s testing environment, with a technician present alongside the patient. Once the technician obtains sample data, the diagnosing physician must promptly provide clinical opinions or recommend treatment plans. This model requires the technician to possess certain operational skills but does not necessitate the ability to analyze test results. The second model involves the use of remote computer software or web-based solutions, requiring only the synchronous online presence of a professional audiologist. In this approach, the expert remotely operates the software, thereby eliminating the intermediate step of technician-conducted testing. However, the technician must still perform basic on-site tasks, such as patient instruction, sensor placement, otoscope positioning, and computer operation.

In addition, stethoscopes enable physicians to remotely auscultate patients' heartbeats. They also play a significant role in the diagnosis and treatment of stroke, with synchronous healthcare providing timely intervention for stroke patients. Robotic surgery is also part of synchronous healthcare.

Although synchronous video requires sufficient bandwidth, its advantages are evident as it enables “face-to-face” communication between patients and physicians. In the past, high costs limited the adoption of synchronous video. Today, with a significant reduction in costs, video technology has become widespread and is extensively applied.TelemedicineBoth asynchronous care and synchronous care fall under telemedicine, which can be further categorized into three types: store-and-forward, remote monitoring, and interactive services.Asynchronous healthcare, the concept mentioned above, is characterized by transmitting patient data to physicians, who then provide diagnoses at their convenience offline. It does not require both patients and providers to be online simultaneously. A significant difference between traditional in-person consultations and telemedicine is that telemedicine often overlooks physical examinations, whereas the asynchronous model relies on reviewing patients’ prior medical history.

Remote monitoring, also known as self-monitoring or self-diagnosis, leverages various technological means to enable healthcare professionals to remotely track and manage patients’ conditions. It is primarily used in the management of chronic diseases or specific conditions, such as heart disease, diabetes, and asthma. Compared with traditional approaches, remote monitoring allows for more effective control of these conditions.

Interactive healthcare facilitates real-time communication and interaction between patients and physicians through telephone consultations, online chats, or home visits. Certain medical activities, such as taking medical histories, conducting physical examinations, performing psychiatric evaluations, and carrying out ophthalmologic assessments, require this form of interactive care. Additionally, interactive telemedicine may be more cost-effective than in-person visits.

The European Commission defines telemedicine as the use of information and communication technologies (ICT) to enable healthcare providers or experts who are not in the same location to exchange securely transmitted medical information for the purposes of prevention, diagnosis, treatment, and monitoring of patients.

 The Future of Telemedicine Development and Its Obstacles

The reasons for the broad future development prospects are summarized as follows:

1. Future Improvements in Internet Speed

2. User-friendly software with smoother video playback

3. The Attribute of Free Connectivity of Mobile Devices

4. The establishment of electronic health records facilitates digital management

5. Asynchronous care enables patients to consult doctors from home

6. Better time management for physicians

7. For common diseases, a physician can diagnose multiple patients simultaneously

8. Physicians have more capacity to focus on complex cases

9. The growing number of people seeking medical consultations at community retail pharmacies indicates that home-based healthcare is an inevitable trend for the future.

10. Attracting Young People

11. From the physician’s perspective, it reduces costs and increases the revenue generated per unit of physicians’ time.

12. Hospitals Can Retain Patient Resources Through Electronic Health Records

Potential Factors Hindering Future Development:

1. Laws and Regulations

2. Financial Support

3. Technological Level

4. Cultural Identity

VCBeatTrending English Terms in Internet HealthcareChief Advisory Consultant: Zhao Xinyuan, current CEO of Beijing InTechLong Technology Co., Ltd., and member of the HL7 China Technical Steering Committee.

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