Store and Forward

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

This information can include X-rays, MRIs, photos, patient data, and even video-exam clips. Store and 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. Because these consultations do not require the specialist, the primary care provider and the patient to be available simultaneously, the need for coordinating schedules is removed, and the efficiency of the health care services is increased.

These technologies provide important benefits to patients and providers.  Some of these benefits include:

  • Patients can get timely specialty care without needing to travel beyond the location of their primary care providers;
  • Wait times for specialty care are 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 overcome language and cultural barriers.

Store and forward technologies are most commonly used in radiology, pathology, dermatology, and ophthalmology:

  • 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 and determination of treatment if needed;
  • 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.

It is important to note that store and forward services are not always reimbursable by private insurers, and Medicaid policies on this issue vary from state to state.

To see firsthand how store and forward would work in a clinic setting please watch the above video.

Store and Forward Successes

Studies have shown that store and forward technologies are important tools to help expand access to health care, in particular, specialty care, and to increase the comprehensiveness and efficiency of a health care delivery system.

  • A  2015 study titled, “Cost and Utility Analysis of a Store-and-Forward Teledermatology Referral System: A Randomized Control Trial", researched the costs and utility of store-and-forward teledermatology consultations compared to traditional referrals in the context of a VA medical facility. The researchers randomized 391 participants to receive traditional referrals or store-and forward referrals, then collected time trade-off utility measures and costs for both groups. The results found no difference in utility between the two groups. However, the study did find statistically significant reductions in cost using store-and-forward technology from the perspective of society. 
  • This 2016 study titled, “Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting", investigated the impact of store-and-forward teledermatology on outpatient diagnosis, management, and access to dermatologic care in an underserved urban primary care setting. The researchers measured diagnostic agreement between primary care providers and dermatologists, time to complete the consult, anticipated level of dermatology input without telehealth, and the number of telehealth consults that were managed with teledermatology alone. The researchers found promising results suggesting that store and forward teledermatology is innovative and impactful in providing care to medically underserved urban settings.


For more information on store-and-forward research, see CCHP's research catalogue of teledermatology studies.