Store and forward technologies allow for the electronic transmission of medical information, such as digital images, documents, and pre-recorded videos through secure email transmission.
This information can include X-rays, MRIs, photos, patient data, and even video-exam clips. Store and forward communications primarily take place among medical professionals to aid in diagnoses and medical consultations when live video or face-to-face contact is not necessary. Because these consultations do not require the specialist, the primary care provider and the patient to be available simultaneously, the need for coordinating schedules is removed,and the efficiency of the health care services is increased.
To see firsthand how store and forward would work in a clinic setting please watch the above video.
These technologies provide important benefits to patients and providers. For example:
- Patients can get timely specialty care without needing to travel beyond the location of their primary care providers;
- Wait times for specialty care are lessened, especially in areas with shortages of medical specialists;
- Primary care providers and medical specialists can review patient cases, regardless of their respective locations;
- Medical specialists can review patient cases when it is convenient for them;
- The Store and Forward process can overcome language and cultural barriers.
Store and forward technologies are most commonly used in radiology, pathology, dermatology, and ophthalmology:
- In radiology, physicians at small rural hospitals can forward X-rays or MRI's to specialists at major medical centers for review;
- In dermatology, primary care providers can take digital photos of their patients' skin conditions and forward the images to dermatologists for review and determination of treatment if needed;
- In ophthalmology, eye screenings for diabetic retinopathy, a disease that is a major cause of blindness among individuals with diabetes, can be captured digitally by retinal cameras and transmitted to a specialist for review. These screenings are particularly effective in preventing vision loss or blindness.
However, it is important to note that store and forward services are not always reimbursable by private insurers, and Medicaid policies on this issue vary from state to state.
Store and Forward Successes
Studies have shown that store and forward technologies are important tools to help expand access to health care, in particular, specialty care, and to increase the comprehensiveness and efficiency of a health care delivery system.
According to a 2009 study commissioned by the California HealthCare Foundation and conducted by Blue Sky Consulting Group, store and forward teleophthalmology screening methods have the potential to simultaneously reduce costs and improve access and quality of health care services. In this study, for each patient examined for retinopathy with store and forward telemedicine, it estimated that state cost savings will total nearly $2,500 over the patient's lifetime.
A 2008 study compared process times for patients with suspected skin cancer who received tele-dermatology referrals with store and forward technologies versus patients who received conventional dermatology referrals. The tele-dermatology patients, on average, completed their initial consults in four days, compared to 48 days for conventionally referred patients; for biopsies, the wait was 38 days, versus 57 days; and for cancer removal surgery, 104 days versus 125 days. Tele-dermatology patients also had fewer dermatology clinic visits before surgery, which provided evidence of cost effectiveness as well as quicker access to crucial medical services.
A 1998 study evaluated a store and forward radiology demonstration project, which connected a rural hospital’s emergency department with an academic medical center. The study found no discrepancies between reviews of digital images and reviews of hard copy X-rays, documented an average turnaround time for store and forward reviews of 1.3 hours, and reported high levels of satisfaction among emergency department physicians. It also found that reviews by academic medical center specialty radiologists led to changes in the emergency department physicians' initial diagnosis in 30 percent of all cases, and treatment changes in 26 percent of all cases.