Synchronous telehealth
Synchronous telehealth is a live, real-time encounter between a patient and a clinician — video or phone — as opposed to asynchronous care, where information is submitted and reviewed later.
- Live video or phone, in real time
- Required by some states for the first visit or certain drug classes
- Controlled-substance prescribing generally requires it
- Costs more clinician time per encounter than async review
When synchronous care is required
Three triggers. State law: a minority of states require a live encounter to establish the patient relationship or to prescribe certain drug classes. Drug class: controlled-substance prescribing generally demands synchronous encounters where telehealth prescribing is allowed at all. And clinical judgment: any async reviewer can and should escalate to live when the picture is unclear — the escalation path is part of the standard of care.
Sync vs async in program design
Synchronous visits cost more clinician time per encounter and add scheduling friction that shows up directly in conversion. The design pattern that works: async as the default wherever the state and condition allow, synchronous as the routed exception — with the routing decided automatically from the patient’s state and the program’s drug list, never left to guesswork.
Making live visits convert
Where video is unavoidable, the levers are wait time and friction: on-demand queues beat scheduled slots, short visits designed around a completed intake beat open-ended appointments, and phone fallback (where states permit audio-only) rescues patients whose connection or comfort fails on video. Programs that treat the video visit as a product surface, not a calendar event, keep most of the async conversion advantage.
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 a phone call synchronous telehealth?
Yes — audio-only is synchronous. Some states restrict which services audio-only can support, so video remains the safer default where rules are strict.
Why do some programs require video visits?
Usually because state law or drug class demands it — TRT and other controlled-substance programs are the common case.
Can one program mix sync and async?
Yes, and the best ones do: async by default where permitted, with automatic routing to live visits where state rules or clinical judgment require.