Telehealth: a brave new world for ob-gyns

The practice of health care was upended by the COVID-19 pandemic, and one of its most dramatic changes was the swift and aggressive move to telehealth. This was the theme of a presentation by Nathaniel DeNicola, MD, MSPH, Johns Hopkins Medicine in Washington, DC, titled “The ABOG Educational Foundation Lectureship on Patient Safety and Quality telemedicine, virtual visits, and artificial intelligence in obstetrics and gynecology.”

DeNicola took a comprehensive look at telehealth, including guidance on benefits and pitfalls for its applications, and a tutorial on how to implement (carefully!) artificial intelligence in obstetrics and gynecology. Statistics bear out how important this information is for practicing ob gyns: female patients aged 18 to 44 years were more likely to choose telemedicine than male patients, or patients of other ages.

First, a quick definition of telehealth was offered, which includes remote patient monitoring (health data collection from someone in one location via electronic technologies); mobile health (health care and public health practice/education, supported by cell phones, tablets, computers, etc.); and store-and-forward (the transmission of recorded health history through an electronic system to a practitioner). Government organizations were quick to support the new and urgent need for remote care, implementing waivers in the early months of the pandemic. These included Health and Human Services allowing the use or FaceTime and Skype for patient visits and the Drug Enforcement Administration allowing remote prescribing of controlled substances.

As patients began to dip a toe into telehealth services, response was encouraging: in a survey of patients using telehealth post-COVID-19, 75% were very or completely satisfied and 50% were willing to switch to telehealth on a regular basis. There was more good news: randomized control trials showed improved smoking cessation with text message intervention, and telehealth interventions with text and web-based interventions showed dramatic improvement in breastfeeding rates.

“We can [also] space out prenatal care appointments safely, with high patient satisfaction, utilizing remote monitoring,” said DeNicola.

Next, DeNicola showed how technology programs for expectant mothers could be implemented with platforms like Babyscripts, a market-leader pregnancy app. DeNicola also discussed telemedicine interventions for high-risk obstetrics (gestational hypertension and diabetes, asthma, preterm birth), and how they can effectively maintain maternal and fetal outcomes (one study showed some evidence of telehealth interventions effectively decreasing the number of outpatient clinic appointments for these high-risk conditions).

DeNicola moved on to look at how a patient interested in using long-acting reversible contraception (LARC) could have a positive outcome through remote interventions: before telemedicine, a patient would typically make 4 physical visits to a practitioner for a LARC, for counseling, screening, placement, and follow-up. In the telehealth era, only 1 physical visit would be needed, as counseling could happen via telehealth; after that, a physical visit for screening and placement; and then, a remote follow-up.

Apps for fertility awareness are also filling the market, but DeNicola stressed that clinicians do their due diligence before using or suggesting a particular app: one recent study of mobile phone apps designed to avoid pregnancy showed that only 6 out of 30 apps could accurately predict a fertile window.

Finally, a look at artificial intelligence (AI) demonstrated how AI could be used by practitioners and patients in a variety of ways, including as a “fertility coach,” JUBEL (an app that guides and educates patients who are exploring a pregnancy journeys such as trying to conceive, freezing eggs, undergoing fertility treatment, and others; and SERA (a test that can predict a patient’s risk of spontaneous preterm delivery).

In wrapping up, DeNicola showed how the femtech market was booming, now filled with dozens of devices, software, and services. With proper usage and compliance, these new tools can enrich one’s practice and provide new choices to help educate and empower patients.

Reference

DeNicola N. The ABOG Educational Foundation lectureship on patient safety and quality improvement: telemedicine, virtual visits, and artificial intelligence in obstetrics and gynecology. 2022 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting. May 8, 2022. San Diego, California