The term Telehealth has come to stand for both the industry-at-large, as well as telephone triage — an earlier form of remote, virtual care — as a substitute for an on-site visit. Even before the pandemic, telehealth already had many facets and subsets –including home telemonitoring and management of chronically ill patient groups.

When the COVID epidemic hit, overnight, face to face visits risked contagion for patient and clinician alike. The growth of this new subspecialty was explosive and remote encounters became essential care.

However, the telehealth industry still needs evidence based research on safe outcomes. Some experts believe that both telephone triage and telehealth may be at increased risk for system error (Wachter, 2017). The remote nature of the work, subspecialty underdevelopment, incomplete systems and inadequate, poorly designed computerized decision support software (CDSS).

Telephone triage is defined as the remote risk assessment of symptoms by phone by clinicians. Clinicians must gather adequate, relevant information in order to estimate symptom urgency and designate an acuity level to symptoms.

Telephone triage predates telehealth by 50+ years. Still an informal subspecialty, and clinicians perform this task Informally and formally, in ambulatory care settings ranging from physician offices, clinics, student health centers, disease management and ambulatory surgery, to Urgent Care, emergency department (ED) and Labor and Delivery settings, Telephone triage is ubiquitous.

Soon, the broad, high-tech field and industry of telehealth (video visits, biotelemetry, patient wearables) will subsume telephone triage – a technologically limited field based on outdated technology.

Both telehealth and telephone triage are remote encounters; however they differ in several ways. Telehealth is typically a pre-scheduled remote encounter about a non-urgent matter– a substitute for a face-to-face, routine medical appointment, and may be 20-30 minutes in length.

On the other hand, telephone triage calls are typically about acute, time-sensitive symptoms. Calls are brief (2-10 minutes), unscheduled, initiated by patients seeking clinicians’ help to decide how serious the symptoms sound. They need instructions on where, when and why they need to be seen - in the ED, Urgent care, Office or simply apply Home Treatment.

The next generation of telephone triage will require a wide range of high-tech features (video, biotelemetry, Predictive analytics, AI and patient wearables). Technology will enhance these remote, brief but urgent encounters — teletriage. Advanced technology will transform remote encounters into data driven virtual visits.

Currently, telephone triage rightfully qualifies as a form of “pre-hospital care“ with unique challenges. As an initial entry point into the continuum of care, telephone triage requires “guard rails” — a system. If treated as typical subspecialty —it must also include standard system components - clinical training, standards, qualified, experienced staff, Finally, many standards can be embedded into the EMR and CDSS.

Software developers can take steps to reduce "patterns of recurrent mistakes" (Gawande) by incorporating professional standards, ethical practices, the Duty of Due Care, and traditional medical practices -- all of which form the basis for legal decisions. A system — guardrails — to enhance safety and reduce recurrent error.