by Robert L. Smith, MD

Communication between healthcare professionals can be difficult to say the least. With mobile devices and new communication methods appearing almost daily, the choice of tools available to physicians is truly staggering.

The need to call a neurosurgeon for an urgent evaluation of possible cauda equina syndrome or simply send a cardiologist an updated EKG about a future consult does not always require the same traditional methods of communication. This article will discuss the various differences between synchronous and asynchronous communication.The role for synchronous and asynchronous communications in healthcare is important due to the necessity of choosing the correct method at the right time for a particular clinical concern.

As a busy family medicine physician in a Level 3 NCQA Patient Centered Medical Home, I encounter these issues on a daily basis. Fortunately, I have a toolbox full of communication methodologies that I can go to when picking the perfect tool for the clinical problem at hand.

Synchronous communication is any form of live communication that demands all parties involved in a conversation be present at the same time. This forces the conversation to occur when both parties are available and may inconvenience schedules of one or both of the participants. An example of this is a curbside consult in the hospital ICU, a telephone call between providers, or a live web conferencing session. It does not specify whether the mode of communication is in person or virtual, rather that it is live and “synchronous”.

Asynchronous communication is a method of segmental communication, where both parties involved can interact with each other at different times that are appropriate for them. Examples include email and secure messaging, instant messaging, and secure file exchange.

Deciding when and how to use each of these information pathways is vital towards efficient communication. Obviously, differing clinical situations will dictate the need for either of these forms of communication.

In the past, one’s options for synchronous communications were face-to-face interactions or getting someone on the other end of the telephone. Asynchronous options were snail mail, sticky notes, pagers, and faxes.

We now have synchronous options such as GoToMeeting with HD Faces and Vidyo for live, secure video conferencing. Asynchronous options include Updox and Sharefile as robust document management and file exchange platforms that replace faxes and enable a paperless office. Google Talk can be used as a replacement for your pager, allowing fellow colleagues and group members to instantly message you regardless of whatever device you are logged into at a particular time. In a perfect world, the paper fax and the game called “phone tag” will start to go by the wayside.

With the implementation of virtual care principles and new communication technologies, not only does communication become highly efficient, but it also increases the safety of patient care. Imagine the following case scenario: You are seeing a patient in your office with a complaint of a severe migraine headache. You would like to simply have a second opinion by a neurologist instead of reflexively, or defensively, sending that patient to the emergency room. In the past, you might have asked your receptionist to page the hospital operator, contact the neurology office, ask to speak to the doctor, and then make the specialist wait on the phone while a nurse tracks you down in the middle of your own patient encounter. Sound familiar?

With Google Talk, for example, I could simply see which neurologist was online, send a quick message asking if they could meet in between patients and either leave a cell phone number, a URL to a dedicated online video conferencing room, or simply a GoToMeeting ID number. By empowering asynchronous communications first, we have opened the door to using the appropriate synchronous communication within the next 10-15 minutes when both physicians are free. No wasted time and each office can maintain their normal flow of clinical duties.

The specialist decides that they would like to enter into a GoToMeeting conference with you as he/she has an iPad and is currently mobile on the hospital wards. While walking from the nursing station in the ICU to his office on the second floor, he/she is able to speak with you about a patient with the migraine and ultimately help guide therapy for to this patient as an outpatient rather than in the emergency room where an unnecessary CT scan may have been performed.

At the conclusion of the GoToMeeting with HD Faces session, he asks me to send him the patient’s med list and brief clinical history in preparation for a specialist visit the following week. Using Updox or Sharefile, I am able to digitally upload medical files to a secure folder synced with the specialist or simply securely message the other physician with the appropriate medical data.

The combination of asynchronous and synchronous communication during this entire encounter was seamless, occurred at an appropriate time for both parties involved, and resulted with secure file exchange of data without requiring either party to be on the same IT platform.