Operational Modes of Telemedicine

Technologies for connecting patients and providers at distance

Telemedicine radiology
Mark Harmel/Stone/Getty Images.

There are three major operational modes of telemedicine: store-and-forward, remote monitoring, and interactive telemedicine. 


Store-and-forward telemedicine allows photos, images, and other medical data to be captured and transmitted to a physician for evaluation. It is asynchronous communication because it does not require that the sender and receiver be present at the same time.

Certain subspecialty consultations are well suited for store-and-forward:

  • A dermatologist receives and reviews photos of skin lesions and rashes. AccessDerm, sponsored by the American Academy of Dermatology, provides primary care providers caring for underserved patients with access to consultations with dermatologists. The primary care provider and dermatologist use mobile devices or the Internet to transmit images and other information required for the consultation.

  • A radiologist receives and reviews x-rays, CT scans, and other radiographic studies

  • A pathologist receives and reviews images of microscopic sections of tissue, such as biopsies

After reviewing the images, the consulting specialist sends diagnosis and treatment recommendations back to the referring provider. Store-and-forward telemedicine extends the availability of specialists into geographic areas where referring physicians and patients would otherwise not have access to speciality services.

Remote Monitoring

Remote monitoring (aka telemonitoring or self-monitoring) allows health care professionals to monitor a patient remotely using various technological devices. Patients at home use devices to capture health data to send to their providers.

Remote monitoring is typically used for patients with chronic diseases.

The following are examples of chronic diseases and the types of relevant health data that can be monitored remotely:

  • Hypertension: blood pressure

  • Diabetes: blood glucose

  • Congestive heart failure: blood pressure, cardiac rhythm, oxygen levels, weight

  • Chronic lung disease: peak expiratory flow

The advantage of telemonitoring is that it allows health care professionals to monitor patients more frequently and conveniently compared to traditional office visits.

Interactive Telemedicine

Interactive telemedicine (aka telepresence) provides real-time synchronous interaction between the patient and provider through audio and video technology. Interactive telemedicine can be a viable alternative when traditional face-to-face health care is not available or feasible. This method involves can be applied for consultation, diagnosis, treatment, and education. In some cases, an nurse or technician is “on site” with the patient to manipulate telehealth-enabled instruments (peripherals), such as a stethoscope or otoscope, at the consultant’s direction.

For example, the Antenatal & Neonatal Guidelines, Education & Learning System (ANGELS) of the University  of Arkansas for Medical Services provides interactive telemedicine for patients with high-risk obstetrical and gynecological care needs. The program uses a variety of telemedicine technologies, such as special devices to perform colposcopies to allow for remote cervical examination and biopsy.

A Note About Mobile Health

Advancements in mobile health are expanding the capacity of telemedicine. But mobile health tools (e.g. devices that patients wear or carry with them) are merely a specific kind of technology for capturing health data which can be transmitted to health care providers according to the three modes discussed above.


American Academy of Dermatology. AccessDerm Teledermatology Program. Accessed on June 27, 2014.

American Medical Association. Coverage of and Payment for Telemedicine. Accessed on June 14, 2014.

University of Arkansas for Medical Services ANGELS. 2012 Annual Report. Accessed on June 27, 2014.

University of Miami. What is telehealth? Accessed  on June 27, 2014.

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