Store-and-forward is the classic asynchronous pattern, and the words describe the mechanism exactly: capture a clinical artifact (a photograph, a scan, a recording, a structured form), store it securely, and forward it to a clinician for later review. No one is online at the same time. Teledermatology is the textbook case — a patient or referring provider photographs a skin lesion, and a dermatologist evaluates it hours or days later — but the same shape covers tele-ophthalmology retinal images, wound photos, and specialist e-consults.
The reimbursement picture is jurisdictional, which directly affects what you build and for whom. Medicare has historically reimbursed store-and-forward only narrowly (notably through the Alaska and Hawaii telehealth demonstrations), whereas many state Medicaid programs cover it more broadly. So the same feature can be billable in one state and unpaid in another, and your product needs to encode that variability rather than assume a single national rule.
Engineering-wise, store-and-forward is a queue-and-review product, not a latency product. The things that matter are upload integrity (the image the clinician sees is exactly what was captured, unaltered), image-quality validation at the point of capture, provenance metadata, and a complete audit trail — all of which is Protected Health Information and must be encrypted and access-controlled. A frequent pitfall is letting image compression or a mobile camera pipeline silently degrade diagnostic quality; validate quality at upload and reject or re-prompt rather than handing the clinician an unusable artifact.
