Store and forward is a type of telehealth where medical information, such as photos, test results, or clinical notes, is collected at one point in time and sent to a specialist for review later. Unlike a live video call with a doctor, there’s no real-time conversation. The patient’s data is “stored” digitally, then “forwarded” to a provider who reviews it on their own schedule. You might also see it called asynchronous telemedicine.
How Store and Forward Works
The process is straightforward. A patient or their primary care provider captures clinical information, typically digital images, a written description of symptoms, and relevant medical history. That package of information gets sent electronically to a specialist, who reviews everything and sends back a diagnosis, recommendation, or treatment plan. The two sides don’t need to be online at the same time, which is the key distinction from a live video visit.
A common example: your primary care doctor photographs a suspicious mole during a routine visit, attaches notes about when it appeared and how it’s changed, and sends the file to a dermatologist. The dermatologist reviews the images that afternoon or the next day and replies with their assessment. You never had to book a separate appointment, drive to a specialist’s office, or wait in another waiting room.
Specialties That Use It Most
Dermatology is the most prominent use case. Teledermatology programs in safety-net health systems routinely have primary care providers take photographs during office visits and forward them to dermatologists for consultation. In one English pilot study for skin cancer referrals, clinician-taken photos were used to triage patients: 35.1% of patients avoided an in-person visit entirely, 43.8% were given a clinic appointment, and 20.2% were booked directly for surgery. That kind of sorting saves weeks of waiting.
Research shows teledermatologists and in-person dermatologists agree on whether a patient needs same-day evaluation or biopsy more than 90% of the time. Diagnostic agreement is somewhat lower, ranging from about 56% to 67% depending on the study, which reflects the inherent limitation of working from photographs rather than examining skin in person. For straightforward conditions, though, the approach works well. One study found that dermatologists could adjust acne medication based on patient-submitted photos with no significant difference in outcomes compared to in-person visits.
Radiology is another natural fit, since imaging has been transmitted digitally for decades. Pathology, ophthalmology, and wound care also rely heavily on store-and-forward workflows, where visual information is central to diagnosis.
Benefits Over Live Video Visits
The biggest advantage is convenience on both sides. Patients don’t need to coordinate schedules with a specialist or sit through a video call. Specialists can review cases in batches when it fits their day, which tends to be more efficient than scheduling individual appointments. In telehealth networks studied during 2020, a single specialist handled anywhere from about 3 to 10 cases in a given period, and the most efficient network had coordinators managing 285 cases each, roughly four times more than less optimized setups.
For patients, the practical benefits are real: no travel, no waiting rooms, and no need to take time off work for a specialist visit that might last five minutes. People who live far from specialist centers or in rural areas gain access to expertise that would otherwise require a long trip. The specialist’s written response also tends to be detailed and fact-based, giving patients something concrete to reference later.
Limitations Compared to Real-Time Care
The tradeoff is the loss of live interaction. Patients in studies consistently describe asynchronous consultations as feeling “cold” or impersonal. There’s no back-and-forth conversation, no ability to point to a spot on your body and say “it hurts right here,” and no opportunity for the doctor to ask a quick follow-up question in the moment. If your written description misses something important, that gap might not get caught until the specialist sends a reply asking for more information, adding days to the process.
Physical examination is impossible. A dermatologist can look at a photo of a rash but can’t feel its texture or press on it to see if it blanches. Psychological cues, body language, and other health-related factors that a doctor might pick up in person can go unnoticed. For complex or ambiguous cases, store and forward often serves as a triage step rather than a final diagnosis, determining whether a patient needs an in-person visit rather than replacing one.
Insurance Coverage and Reimbursement
Coverage varies significantly by state. As of fall 2024, 37 state Medicaid programs reimburse for store-and-forward services. Colorado, Delaware, New Hampshire, and Pennsylvania recently added reimbursement, though each in a limited capacity. Some states only cover store-and-forward through specific billing codes tied to communication-based services rather than through general telehealth reimbursement.
A complicating factor is how individual states define telehealth. Some states require “live” or “interactive” contact in their telehealth definition, which technically excludes asynchronous services from standard telehealth coverage. By default, Medicaid programs are supposed to reimburse telehealth at the same rate as in-person services unless they’ve obtained an exception from CMS. Private insurance coverage is even more variable, so checking with your plan before assuming a store-and-forward consultation will be covered is worth the effort.
Privacy and Data Security
Because store-and-forward involves transmitting medical images and health records electronically, it falls under the same federal privacy rules as other forms of digital health care. Platforms used for these consultations are required to use technical safeguards like end-to-end encryption, password-based access controls, and audit trails that log who accessed the data and when. Only authorized individuals should be able to decrypt and view the information.
The practical risk comes from third-party apps. When patients submit their own photos through an app outside a hospital’s main system, that introduces an extra layer of potential privacy exposure. Federal regulators encourage providers to let patients know when third-party applications are involved and to enable every available encryption and privacy setting.
How It Fits Into Health Records
Ideally, data from store-and-forward consultations flows directly into your electronic health record so every provider on your care team can see it. In practice, this integration is still a work in progress. When patient-submitted data from external apps doesn’t connect smoothly with a hospital’s records system, clinicians may end up with duplicate entries, incomplete information, or extra manual work copying data from one system to another.
Health systems are increasingly using standardized data formats to bridge this gap, allowing apps to write patient-reported information directly into clinical workflows. The goal is for a specialist reviewing your forwarded images to see them alongside your full medical history in one place, and for their response to appear in your record automatically. Some institutions have achieved this, but many are still working through the technical details of making different software systems talk to each other reliably.