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Telehealth has a wide array of applications for patients of all ages, with or without chronic health conditions, to improve access to needed healthcare. A recent review of patient satisfaction with telehealth identified 44 papers published since 2010 that describe wide‐ranging interventions for special populations using varied technology which highlights the diverse potential applications for telehealth [16]. In the National Quality Forum’s report entitled, “Creating a Framework to Support Measure Development for Telehealth,” a robust section delineates telehealth programs in both the United States (US) and abroad and describes the diversity of interventions and the potential opportunities for influencing health outcomes in ways that traditional in‐clinic medicine cannot [17].

Table 4.1 Telehealth modalities that can apply to Long Term Follow Up (LTFU) HCT survivors

Modality	Example
Synchronous (real‐time)	A Skyped “clinic visit” between an LTFU patient in a rural community provider’s office and the HCT center specialist
Asynchronous (store‐and‐forward)	An LTFU patient sends photos of a skin rash which is later reviewed by an HCT center specialist to help with the diagnosis of cGVHD
Remote patient monitoring	Results of an LTFU patient’s home spirometry using a handheld smart device are transmitted automatically and securely for monitoring of lung GVHD by the HCT Pulmonologist
Mobile health	A Fitbit device that tracks fitness goals for an LTFU survivor increasing exercise tolerance that allows the patient to report objective health measures to providers

HCT, hematopoietic cell transplantation; GVHD, graft‐versus‐host disease.

In the earlier days, telehealth was thought to be most effective for specialties that relied more on verbal interactions than physical contact, such as psychology or neurology [18], but improved technologies have led telehealth to benefit a broader range of sub‐specialties, including oncology [5]. A French review of “Cancer outside the Hospital Walls,” identified recent clinical trials that have demonstrated every level of care in oncology (education, prevention, diagnosis, treatment and monitoring) delivered via telehealth to have good results [19].

Twenty percent of the US population lives in a rural area, but only 3% of medical oncologists practice in rural areas and over 70% of US counties lack a practicing medical oncologist [20]. Additionally, the number of LTFU HCT survivors is growing annually with a predicted 500,000 HCT survivors living in the US by 2030 [21]. HCT recipients are usually discharged back to their primary communities within several months of transplant and oftentimes, they do not live in proximity to their transplant center. Usually, HCT survivors want to retain a connection to their transplant center and may prefer to have their LTFU in person. However, they are often unable to return to their transplant center and, therefore, a telehealth option is an attractive option for delivering care to HCT survivors [22]. Telehealth can help HCT survivors and their caregivers save time and money by offering access to specialty care remotely. Cox et. al. reported that the reassurance cancer survivors feel by having telehealth available to them, “I can always get in touch,” is a helpful connection that provides a sense of safety [23]. An identified key advantage to telehealth is the ability to deliver complex care remotely, which is particularly valuable to academic centers that consult on patients with rare conditions, such as chronic graft‐versus‐host disease (cGVHD) [24].