Synchronous Telehealth

Synchronous telehealth replicates much of the traditional clinical encounter through real-time technology. The patient and clinician interact via video conference or phone, allowing real-time conversation, observation of patient affect and movement, and back-and-forth clinical reasoning.

Synchronous telehealth is required by some state regulations for specific clinical scenarios — particularly initial evaluation for controlled substance prescribing in many jurisdictions, mental health evaluations, and any clinical scenario where physical observation matters.

The DEA Ryan Haight Act generally requires an in-person evaluation before controlled substance prescribing, with telemedicine carve-outs that have evolved during and after the COVID-19 public health emergency. The specific rules at any time should be verified through current DEA guidance.

Synchronous telehealth is more clinician-time intensive than async, which means costs are typically higher per encounter. Many telehealth platforms blend models: async intake screening with synchronous consultation for medications or scenarios that require it.

For clinical scenarios well-suited to async (hair loss, ED, structured weight management intakes), synchronous telehealth often does not provide additional clinical value. For scenarios involving controlled substances, mental health, complex chronic disease, or new symptoms requiring real-time clinical reasoning, synchronous telehealth is generally preferable.