By Matt Fisher, General Counsel, Carium
Twitter: @matt_r_fisher
Twitter: @cariumcares
Host of Healthcare de Jure – #HCdeJure
Terms that emerge together in healthcare can often be thrown around interchangeably without fully appreciating the differences and nuances between each of the terms. Equating concepts in this way (consider electronic medical record and electronic health record, they are different) leads to confusion inside and outside of the industry. Telehealth, and its many subcategories, is the latest to join the confusion pantheon.
The need to better understand the different forms of telehealth is highlighted by the rapid growth and expansion of use. Survey results from the Rock Health 2020 Digital Health Consumer Adoption Report found that in 2020:
- live video telemedicine increased by 43%
- wearable ownership increased by 43%
- digital health tracking increased by 54%
Those results and other findings become difficult to interpret without understanding the variety of telehealth solutions.
Appreciating what exactly is meant by telehealth and a number of subcategories under it promotes a deeper appreciation of the broad scope encompassed by telehealth as well as the benefits of each service.
Telehealth
Telehealth (despite being used as both a high-level term and a specific) is really the parent term for remote means of delivering care. The Health Resources and Services Administration within the federal Department of Health and Human Services defines telehealth as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration.”
KLAS, a respected reviewer of technology solutions, also follows a definition of telehealth that is meant to be an umbrella term. KLAS views telehealth as “the broad means by which healthcare organizations provide healthcare remotely through telecommunication technologies.” KLAS then explicitly identifies virtual care and remote patient monitoring as sub-categories of telehealth.
As shown by the definitions, telehealth is intended to be an all-encompassing term that captures many other forms of remote interaction.
Virtual Care
Virtual case is a term gaining more prominence and consistency within the environment of technology-enabled remote care of patients. Oftentimes the definition of virtual care seems to be the same as telehealth. However, virtual care may potentially be a category even above telehealth. To clarify, virtual care covers all remotes methods to communicate and interact with patients that likely occur between in-person visits or even audio or video visits. From that perspective, virtual care appears to co-equal to telehealth, but a step or two more expansive.
In light of the near complete overlap between virtual care and telehealth, it should be expected that the terms will be used interchangeably as the fine distinctions may not call for separation of the terms. Ultimately, the aim is to understand that virtual care or telehealth are looking at a platform perspective of connecting multiple streams and modalities of interacting with patients to promote overall health, wellbeing, and engagement.
Telemedicine
Telemedicine is another term relatively large in scope, but still one that falls under the bigger telehealth heading. Telemedicine is focused on the delivery of clinical care by a physician and is really the equivalent of an in-person visit in a medical office. It may be possible for telemedicine to be delivered by some of the other modalities to be addressed.
On the whole, telemedicine is distinguished by the physician and patient not being present in the same room. As a result, the care interaction occurs in one of a few ways, which can include audio-only, live interactive videoconferencing, or store and forward (a fancy way of saying that information is recorded or documented by a patient, then sent to the physician for review without being live).
A nice way of summarizing telemedicine is that all telemedicine is telehealth, but not all telehealth is telemedicine.
Remote Patient Monitoring
Remote patient monitoring (RPM) is a subcategory of telehealth that focuses on patients recording information about their own health that can subsequently be reviewed and acted upon by the patient’s care team. Turning again to KLAS, RPM is defined as “solutions that acquire, store, transmit, and display electronic health information from patients outside of conventional clinical settings.” Implicit in that definition is that the transmission and display typically go to the care team. It cannot just go into a black hole or no benefit would be created.
From this perspective, RPM is primarily a store and forward service as interactions are not necessarily assessed in real-time. However, that does not mean RPM does not include a live interactive component as the opportunity can certainly arise for a call (audio or video) to supplement and enhance the service, as well as asynchronous messaging.
Asynchronous Telehealth
Asynchronous telehealth does not necessarily refer to a specific means of delivering telehealth. Instead, the asynchronous component is the key feature, which is just a fancy way of saying that information is recorded by a patient, then sent to the clinician for interpretation or analysis at a later time. The interpretation is sent back to the patient so they can review when it’s convenient for them, which then gives a suggestion on what action, if any, to take.
mHealth (or Mobile Health)
mHealth refers to the delivery of healthcare services using a mobile device. Like so many definitions in telehealth, mHealth is also quite broad and includes examples that could fall under a number of different categories. The use of a mobile device is the distinguishing factor though and the reason that not every form of telehealth is also defined as mHealth.
By tracking health information with a mobile-enabled platform, mHealth may reflect a more continuous form of monitoring and provide more than just a point in time picture of an individual’s health. From that perspective, mHealth can often function as an asynchronous solution.
In addition to the collection of data, mHealth can often function as a means of delivering information to individuals. Since the mHealth solutions are applications on a mobile device, content can be delivered right to an individual in a place where the individual is likely engaged a good amount of time.
Navigating the Jumble
A good grounding in the distinctions between terms and categories may help drive more targeted discussion and keep everyone on the same page. Helping to get to a place where all are talking the same language should create a more even field and hopefully minimize misunderstandings or differing expectations. It’s always positive when a conversation starts at the same point and not with blank stares because each person is coming from a different starting point.
This article was originally published on The Pulse blog and is republished here with permission.