Telepractice is the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client/patient or clinician to clinician for assessment, intervention, and/or consultation.
Supervision, mentoring, and pre-service and continuing education are other activities that may be conducted through the use of technology. However, these activities are not included in ASHA's definition of telepractice and are best referred to as telesupervision/distance supervision and distance education. (See Clinical Supervision in Speech-Language Pathology: Technical Report [ASHA, 2008] for information related to the use of technology in clinical supervision in speech language pathology.)
ASHA adopted the term telepractice rather than the frequently used terms telemedicine or telehealth to avoid the misperception that these services are used only in health care settings. Other terms such as teleaudiology telespeech, and speech teletherapy may be used in addition to telepractice. Services delivered by audiologists and speech-language pathologists are also included in the broader generic term telerehabilitation (American Telemedicine Association, 2010). The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice in Audiology and Scope of Practice in Speech-Language Pathology, state and federal laws (e.g., licensure, HIPAA), and ASHA policy.
Telepractice venues include schools, medical centers, rehabilitation hospitals, community health centers, outpatient clinics, universities, clients'/patients' homes, residential health care facilities, childcare centers, and corporate settings. There are no inherent limits to where telepractice can be implemented, as long as the services comply with national, state, institutional, and professional regulations and policies.
The two most common terms describing types of telepractice are synchronous (client/patient interactive) and asynchronous (store and forward).
Synchronous services are conducted with interactive audio and video connection in real time to create an in-person experience similar to that achieved in a traditional encounter. Synchronous services may connect a client/patient or group of clients/patients with a clinician, or they may include consultation between a clinician and a specialist (Department of Health and Human Services, n.d., 2012).
In asynchronous services, images or data are captured and transmitted (i.e., stored and forwarded) for viewing or interpretation by a professional. Examples include transmission of voice clips, audiologic testing results, or outcomes of independent client/patient practice.
Hybrid applications of telepractice include combinations of synchronous, asynchronous, and/or inperson services. Clinicians and programs should verify state licensure and payer definitions to ensure that a particular type of service delivery is consistent with regulation and payment policies.