The term Telehealth has come to stand for both the industry-at-large, as well as forms 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 became a risk for contagion for patient and clinician alike. The growth of this new subspecialty was explosive and remote encounters became essential care.

However, the industry 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), due to subspecialty underdevelopment, incomplete systems and inadequate electronic decision support software.

Telephone triage predated telehealth by about 50 years. Telephone triage — defined as the “remote assessment by phone to estimate symptom urgency and triage symptoms”, has been performed informally and formally in ambulatory care settings ranging from physician offices, clinics, student health centers, disease management and ambulatory surgery as well as Urgent Care, emergency department (ED) and Labor and Delivery settings.

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visits, biotelemetry, patient wearables) will subsume telephone triage – a technologically limited field based on outdated technology.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 non-urgent — a pre-scheduled, televisit – a substitute for a routine face-to-face medical appointment, and may be 20-30 minutes in length. Telephone triage is time-sensitive, typically unscheduled, brief (2-10 minutes), and possibly urgent encounter (by phone only) initiated by patients seeking help to decide how soon they need to be - in the ED, Urgent care or Office visit.

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

Generally speaking, currently, teletriage and telehealth are the true entry point on the continuum of care, and rightfully qualify as a form of “pre-hospital care“ with unique challenges.

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. Teletriage software — guardrails — to enhance safety and reduce recurrent error.