Asynchronous telehealth
Asynchronous telehealth (store-and-forward) is a care model in which the patient submits health information — an intake questionnaire, photos, lab results — that a licensed clinician reviews and acts on later, without a live video or phone encounter.
- Also called store-and-forward telehealth
- Permitted for many conditions in most US states; a minority require live video first
- Standard of care is identical to an in-person or video visit
- Controlled substances generally require synchronous encounters
How asynchronous visits work
In an async encounter, the patient completes a structured medical intake on their own time. A licensed clinician in the patient’s state reviews the submission, asks follow-up questions through messaging if needed, and then makes a clinical decision — prescribe, order labs, recommend a synchronous visit, or decline treatment. The clinical judgment is identical to a live visit; the modality is different.
Async is the backbone of most DTC telehealth economics: it lets clinicians review encounters efficiently, patients complete visits at midnight, and programs operate across time zones — which is why conversion and cost-per-visit differ so much between async-permitted and sync-required states.
Where asynchronous prescribing is allowed
State law controls whether a valid patient-clinician relationship can be established asynchronously and whether prescribing can follow. Most states now permit async establishment for many conditions; a minority still require a synchronous (live audio/video) encounter first, and requirements can differ by drug class — controlled substances almost always carry stricter modality rules.
This is the single most consequential compliance variable in program design: the same product may be async in one state, video-first in a second, and unavailable in a third. Infrastructure should route each encounter to the modality the patient’s state requires.
Why modality rules shape program economics
Async is not just a compliance category — it is the difference between a visit that costs a clinician four minutes and one that costs twenty plus scheduling overhead. Conversion moves too: patients finish an async intake at midnight at rates a booked-video flow never sees. That is why modality routing — async where allowed, video where required — is an economics feature, not just a legal one.
The design principle: build the intake once, capture everything a clinician needs for an async decision, and treat the synchronous visit as an escalation path — triggered by state rules or clinical judgment, whichever fires first.
Compliance handled, so you can build
Lithos runs the clinicians, pharmacies, and 50-state rules behind your care program — one API.
Frequently asked questions
Is asynchronous telehealth legal?
Yes, in most US states for many conditions — but which conditions, drug classes, and consent requirements apply varies by state and changes frequently.
Is async care lower quality than a video visit?
The standard of care is the same: a licensed clinician reviews complete intake data and can escalate to a live visit whenever clinically indicated.
Can controlled substances be prescribed async?
Generally no — controlled substances carry stricter modality requirements under state and DEA rules, typically requiring synchronous encounters where telehealth prescribing is permitted at all.