Telehealth for the Ob/Gyn

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Reading for this podcast:
Committee Opinion 798: Implementing Telehealth in Practice 

What is Telehealth? 

  • Definition

    • Collection of means or methods for enhancing the health care, public health, and health education delivery and support using telecommunications technologies

    • Term of “telehealth” is often used to refer to traditional clinical diagnosis and monitoring that are delivered by technology (ie. doing a visit on Zoom) 

    • Connected health and digital health are also terms that broadly describe similar technology applications in health care 

    • But remember that telehealth can refer to a broad list of healthcare topics, such as diagnosis and management, education (ie. podcasts!), and other related fields of health care 

      • Can include remote monitoring, mobile health care (ie. text messages, apps) 

      • These services can be real time (synchronous) or “store-and-forward” (ie. asynchronous) 

The Data Behind TH 

  • A lot of this data is recent due to the COVID-19 pandemic 

    • This has especially been true in OB care given the need for multiple prenatal visits in a short period of time 

  • One great study that came out in February 2020 (right before COVID!) in the green: 

    • Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes, by Dr. Denicola et al 

    • The looked at 47 total studies, which included 31,967 patients 

    • Telehealth improved obstetric outcomes via: 

      • Increased smoking cessation and increased breastfeeding 

      • Also decreased need for high-risk obstetric monitoring office visits, but did not lead to worse maternal and fetal outcomes 

      • Also effective for continuation of oral and injectable contraception 

      • TH provision of medication abortion services had similar outcomes compared with in-person care and improved access to early abortions 

Providing Equitable Telehealth Care 

  • Just like in any time of health care, there will always be barriers to equity 

  • Healthcare practitioner factors 

    • Includes attitudes and perceptions, inherent biases and assumptions 

    • Studies have shown that when looking at patient portal use, Latino, Black and individuals with low income were less likely to be offered patient portal access and had significantly lower uptake 

  • Health system factors 

    • Safety net health systems and community health centers often lag behind in offering telemedicine 

    • Possibly due to lack of supportive infrastructure 

  • Patient factors 

    • Absence of technology or reliable internet coverage

    • Low health and digital literacy 

    • Non-English speakers can also have a barrier to telemed use 

    • Disproportionately affect those in rural areas, those identify as BIPOC, and those living on low incomes 

  • Payor and Policy Factors 

    • State Medicaid programs continue to restrict coverage of telemedicine and other remote management services 

    • Before COVID-19, only 19 state Medicaid programs explicitly recognized patient’s home as an eligible originating site for telemedicine 

    • States also require practitioners to be licensed within the state where the patient was receiving their care, so this limits patients from accessing telehealth services from out of state practitioners 

    • Also there is limited coverage for audio-only services 

  • Recommendations to mitigate these barriers 

    • Individual practitioners to acknowledge and mitigate implicit biases 

    • Systems should ensure that telehealth platforms are secure and widely usable 

    • Provide technological and clinical infrastructure including patient-centered education tools 

    • Allow for telephone visits when video visits are not feasible or desired

    • Conduct rigorous quality assurance efforts  

    • Payers should make telemedicine a standard coverage benefit and cover at-home monitoring equipment 

    • Payers can also provide mobile devices with data plan or Wi-Fi 

    • Require reimbursement of audio-only visit 

    • Ensure payment parity across sites and types of visits 

    • Expand ability to practice telemedicine across state lines and remove existing barriers to multi-state licensure