Telehealth has the potential to improve the efficiency of healthcare while reducing the burden on patients and caregivers. Encounters can be synchronous or asynchronous. When used for care of those with amyotrophic lateral sclerosis (ALS) by individual health care providers or by a multidisciplinary team, synchronous telehealth is feasible, acceptable, may produce outcomes comparable to those of in-person care, and is cost effective. Individuals with ALS who use telehealth tend to have lower physical and respiratory function and to live farther from an ALS clinic than those who exclusively attend in-person clinic visits. Asynchronous telehealth can be used as a substitute full multidisciplinary visits, or for remote monitoring of pulmonary function, gait/falls, and speech. Barriers to implementing telehealth on a wider scale include disparities in access to technology and challenges surrounding medical licensure and billing, but these are being addressed. K E Y W O R D S ALS, mHealth, mobile health, telehealth, telemedicine 1 | INTRODUCTION TO TELEMEDICINE AND TELEHEALTH Today's healthcare landscape contains many references to, and examples of, telemedicine and telehealth. Sometimes, these terms are used interchangeably. Generally, telemedicine is defined as a remote interaction between a clinician and a patient. This is the traditional way most people think of telemedicine. Telehealth is the provision of a broader range of services remotely. 1 For patients with neuromuscular diseases, this can include collection of data on clinical measures such as respiratory function, gait, falls, muscle strength, and the rate and quality of speech.Telehealth encounters can be synchronous or asynchronous. In synchronous encounters, information is transmitted in both directions during the same period of time. These can be binary transmissions between patients or caregivers and healthcare providers, or multiperson encounters with other healthcare providers or family members interacting simultaneously. A live videoconference between a patient, his or her caregiver, and a healthcare provider is an example of synchronous telehealth. Asynchronous encounters, also sometimes called the "store and forward" method, occur when information is collected at one time and then forwarded for review at another time. Examples of this include taking photographs, filming videos, or recording medical data (respiratory, cardiac, gait, etc.) at a location remote from the Abbreviations: AAN, American Academy of Neurology; ALS, amyotrophic lateral sclerosis;
