##Abstract

Objective. Research is increasing on the use of asynchronous technologies like e-mail, text, e-consultation, and asynchronous video by primary care and specialist providers. Providers need measurable skills, knowledge, and attitudes for these technologies to ensure quality care outcomes. Methods. This chapter compares care via asynchronous technologies with in-person care, synchronous video including telemental and telebehavioral health and asynchronous video. It outlines differences in approaches and skills in behavioral health and primary care, whose providers interface with these technologies. Results. Publications describing video, asynchronous video, and other asynchronous technologies focus on the technology used, how to do it, workflow processes, and medicolegal issues, but there is less written about clinical issues like the therapeutic frame, communication, boundaries, and trust. No studies specifically discuss behaviors or competencies for asynchronous care, though telepsychiatric, telebehavioral health, social media, and mobile health competencies have relevant elements. Users of asynchronous technologies (i.e., patients, primary care provider teams, and psychiatrists) need to adjust clinical skills, work as team members, and integrate technological and administrative factors into workflow. Implications for providers, trainees, faculty, administrators, and institutions are discussed. Conclusions. Adjustments in clinical and administrative workflow are needed when using asynchronous technologies in health care in comparison to in-person and video options. Research in measurable competency sets, implementation, and outcomes is needed.