Store and Forward

Store & forward technologies allow for the electronic transmission of medical information, such as digital images, documents, and pre-recorded videos.

This information can include X-rays, MRI's, photos, patient data, and video exam clips. Store & 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.

These technologies provide important benefits to patients and providers. For example:

• Patients can get specialty care without needing to travel beyond the offices of their primary care providers.
• Wait times for specialty care can be 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 eliminate language and cultural barriers.

Store & forward technologies are most commonly used in radiology, pathology, dermatology, and ophthalmology. For example:

• 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.
• 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.

Store & Forward Successes

Studies have shown that store & forward technologies can remove barriers to treatment and speed important medical care processes.

• A 1998 study evaluated a store & 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 & 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% of all cases, and treatment changes in 26% of all cases.
• A 2008 study compared process times for patients with suspected skin cancer who received tele-dermatology referrals with store & forward technologies versus patients who received conventional dermatology referrals. The tele-dermatology patients, on average, completed their initial consults in 4 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.