Telehealth conversations tend to default to one image: a patient and a clinician on a live video call. That framing leaves out a form of telehealth that predates consumer video visits by years and still handles a meaningful share of specialty consultation volume today — store-and-forward telehealth, in which clinical information (images, video clips, structured data) is captured, transmitted, and reviewed asynchronously, with no real-time interaction required between patient and specialist at all.

Store-and-forward is not a lesser or legacy version of “real” telehealth. It solves a different problem than live video: specialty access in situations where synchronous scheduling of two clinicians (or a clinician and a patient) across time zones, shift schedules, or geographic distance is the actual bottleneck, not the lack of a video interface. Understanding how it works, where it’s used clinically, and why reimbursement and licensure treat it differently than live video is essential for any digital-health strategy that goes beyond the video-visit use case.

What does “store-and-forward” actually mean?

Store-and-forward telehealth (sometimes called asynchronous telehealth) involves capturing clinical information at one point in time and location, then transmitting it to a clinician who reviews it and renders an interpretation or recommendation at a later time, without the two parties interacting live. The captured information can be a high-resolution photograph, a video clip, a scanned document, physiologic waveform data, or a bundle of structured clinical data — whatever the specialty in question requires to render a clinical judgment without needing to examine the patient directly and synchronously.

This distinguishes store-and-forward from two other telehealth modalities: live (synchronous) video visits, where patient and provider interact in real time, and remote patient monitoring, where physiologic data streams continuously and is reviewed against trend thresholds rather than as a single discrete consultation. Store-and-forward is episodic and asynchronous — a single case is captured, sent, and reviewed, much like an image being read by a radiologist hours or days after it was acquired.

Which specialties actually rely on this model?

Store-and-forward has the deepest clinical track record in specialties where diagnosis depends heavily on visual or image-based assessment rather than a hands-on physical exam:

  • Teledermatology is the most established use case — a primary care provider or patient captures a photograph of a skin lesion or rash, transmits it with clinical history, and a dermatologist reviews and responds without a live visit. This model has demonstrated strong triage value, letting primary care determine which patients genuinely need an in-person dermatology visit versus which concerns can be resolved or reassured asynchronously.
  • Teleradiology operates almost entirely as store-and-forward at scale — images are acquired at one site and read by a radiologist elsewhere, often hours later and often overnight, without any live interaction between radiologist and patient at all. This is arguably the largest-volume store-and-forward use case in American medicine, though it’s rarely discussed under the “telehealth” label because it long predates the term’s popularization.
  • Teleophthalmology, particularly diabetic retinopathy screening, uses store-and-forward retinal imaging captured at a primary care or community site and reviewed by an ophthalmologist or specialized reading center, extending screening access to settings without an on-site eye specialist.
  • Teledentistry and telewound-care programs use similar image-capture-and-review models for triage and follow-up, particularly in long-term care and correctional settings where scheduling live specialist visits is logistically difficult.

Why does reimbursement treat store-and-forward differently than live video?

This is where store-and-forward’s adoption story diverges sharply from live video telehealth. Medicare’s telehealth reimbursement framework has historically been far more restrictive toward asynchronous store-and-forward services than toward live video, and that gap didn’t fully close even as live-video telehealth coverage expanded dramatically. Under long-standing Medicare rules, store-and-forward telehealth reimbursement was limited primarily to federal telemedicine demonstration programs in Alaska and Hawaii, reflecting a policy assumption that asynchronous review was a narrower, more specialized use case than live interaction.1

Commercial payers and state Medicaid programs vary considerably on this point — some states explicitly reimburse store-and-forward dermatology and ophthalmology consultations at parity with in-person visits, while others exclude asynchronous modalities from telehealth parity laws entirely or reimburse them at a lower rate. This inconsistency means a program’s financial viability can depend heavily on payer mix and the specific state’s telehealth parity statute, which is a materially different planning problem than live-video telehealth, where coverage has become far more standardized across payers.

How does licensure complicate store-and-forward consultations?

Physician licensure requirements generally apply based on where the patient is physically located at the time of the encounter, regardless of whether the interaction is live or asynchronous — a rule that predates telehealth entirely and applies just as fully to store-and-forward review as to a live video visit. A radiologist reading images captured in a different state, or a dermatologist reviewing a photograph submitted from a state where they aren’t licensed, faces the same underlying licensure requirement as a physician conducting a live video visit across state lines.

This creates a structural friction for scaling asynchronous specialty consultation networks nationally: a teleradiology or teledermatology service that wants to serve patients across many states needs its reviewing physicians licensed (or otherwise authorized) in every state where captured cases originate, which is a significant administrative and credentialing burden that has shaped how these services are typically structured — often through networks of physicians holding licenses across a defined set of states, or through state-specific interstate compact participation, rather than a single physician serving a nationwide patient population.

What is the actual clinical and access value of the model?

Store-and-forward’s core value proposition is decoupling specialist expertise from real-time availability. A single dermatologist reviewing a batch of asynchronous cases can review meaningfully more cases per hour than the same specialist could see in live consultations, because review doesn’t require scheduling coordination between two calendars, waiting rooms, or live technical connectivity — it only requires the specialist’s dedicated review time, whenever that time is available.

This makes store-and-forward particularly valuable for extending specialist access into settings that structurally can’t support live specialist scheduling: rural primary care practices without a local dermatologist or ophthalmologist, correctional facilities, and overnight radiology coverage where a live radiologist isn’t staffed at every acquiring site around the clock. It is not a general substitute for live video visits — conditions requiring real-time interaction, physical examination beyond what an image can convey, or immediate two-way clarification are still better served synchronously — but for the right clinical questions, asynchronous review extends specialty expertise further, and with less scheduling friction, than live telehealth alone.

What does a store-and-forward program need technically to run well?

Standing up a credible store-and-forward service requires more than an image-capture app and an emailed photo. Programs that hold up under clinical and legal scrutiny typically need:

  • Standardized image or data capture protocols specific to the specialty — a teledermatology program, for instance, generally needs defined lighting, framing, and resolution standards so a reviewing dermatologist isn’t asked to render judgment on an inconsistent, poorly lit photo, which is both a quality and a liability concern.
  • Structured clinical context accompanying the capture — a photo or image alone is rarely sufficient; the referring clinician’s history, differential, and specific question for the specialist materially affects how useful the asynchronous review can be.
  • A defined turnaround-time commitment, since asynchronous review still needs a service-level expectation the referring site and patient can rely on — “sometime in the next few days” is a materially different clinical product than a guaranteed 24-hour turnaround, and programs should be explicit about which they’re offering.
  • EHR integration for the response, so the specialist’s interpretation and recommendation flow back into the patient’s chart in a structured, discoverable way rather than existing only inside a separate point solution the referring clinician has to remember to check.

Programs that skip these operational details tend to underperform their clinical potential — not because the underlying store-and-forward model is flawed, but because the supporting workflow around capture, context, and turnaround wasn’t built with the same rigor applied to live-visit telehealth programs.

Frequently Asked Questions

What is the difference between store-and-forward telehealth and a live video visit?

Store-and-forward captures clinical information (images, video, data) at one point and transmits it for asynchronous review by a clinician later, with no real-time interaction. A live video visit involves synchronous, real-time interaction between patient and provider, similar to an in-person appointment conducted remotely.

Which medical specialties use store-and-forward telehealth most?

Teledermatology, teleradiology, teleophthalmology (especially diabetic retinopathy screening), and teledentistry rely most heavily on store-and-forward models, since diagnosis in these specialties depends heavily on image or visual review rather than a live, hands-on exam.

Does Medicare reimburse store-and-forward telehealth the same as live video?

Historically, no. Medicare’s telehealth framework has treated store-and-forward far more restrictively than live video, limiting broad reimbursement primarily to federal demonstration programs in Alaska and Hawaii, while commercial payers and state Medicaid programs vary considerably in their own coverage rules.

Does a physician need a license in the patient’s state to review a store-and-forward case?

Generally, yes. Licensure requirements are typically based on the patient’s physical location at the time of care, applying the same way to asynchronous review as to a live visit — which is a major structural challenge for scaling multi-state store-and-forward specialty networks.

Is store-and-forward telehealth a replacement for live video visits?

No. It solves a different problem — extending specialist review capacity without live scheduling coordination — and works best for image- or data-based clinical questions. Conditions requiring real-time interaction or physical examination are still better suited to a live visit or in-person care.

This article is intended for general informational purposes for health IT professionals and does not constitute medical advice. Reimbursement and licensure rules for store-and-forward telehealth vary by payer and state and should be confirmed directly with the relevant payer or licensing board.

  1. Centers for Medicare & Medicaid Services, “Telehealth Services,” Medicare Learning Network, CMS.gov, https://www.cms.gov/medicare/coverage/telehealth ↩︎