Even during a global pandemic, pregnancy happens. In the age of social distancing, telemedicine can provide safe, secure, and practical access to perinatal care.
The full effects of the COVID-19 on pregnancy have yet to be understood. There is still much to be learned about the risks of contracting SARS-CoV-2 virus during pregnancy, as well as the emotional toll of being pregnant and delivering a child amidst a pandemic. But if there is one lesson that perinatal providers have learned thus far it is that we still have to deliver high-quality perinatal care —encompassing the prenatal, intrapartum and postpartum periods — despite mandated lockdowns or quarantine orders.
Back to the future
Telemedicine is not a new concept. It can be traced back to the 60’s and 70’s when satellite technology made it possible to transmit complicated data such as x-rays, electrocardiographs, and other medical images across long distances in relatively short amounts of time. This allowed physicians to communicate with remote facilities, whether it was Indian Health Services stationed on Native American reservations or NASA astronauts orbiting Earth.
Yet despite this technological revolution, telemedicine remained under-utilized within our medical system. While there are likely many contributing factors, much of the resistance to adopting telemedicine can be blamed on traditional views of how medical care should be delivered. Since the days of Hippocrates, the physical exam has been fundamental in how physicians and medical providers diagnose and treat their patients. It is the bedrock or foundation of the physician-patient relationship, a covenant so strong that its protection supersedes most standard privacy laws.
When viewed through this lens, it is easy to see why medical providers and patients would hesitate to ever forego such an indispensable part of medical care. But there are financial incentives as well. Medical billing and reimbursement rates rely heavily on the physical exam to calculate the value of a physician-patient interaction. This is a huge barrier to providers incorporating telemedicine into their practices. Other than providing care to remote populations or in highly specialized situations, there has been little incentive to adopt telemedicine on a broad scale. Until now.
Do no harm
Telemedicine affords us the chance to provide secure access to quality care while adhering to public health mandates aimed at minimizing patient and provider exposure to COVID-19. Add to this the increased risk pregnant patients face with respiratory illnesses, as well as the daily exposure risk for our frontline providers, staff, and employees face, reducing in-person clinic volume should be viewed as a matter of patient safety. There are safe, sensible, and innovative ways to incorporate telehealth into prenatal and postpartum care, not only during the current COVID-19 pandemic, but for the future as well.
Combining telemedicine with in-person perinatal care has been proven effective and has been embraced by institutions such as the Mayo Clinic, University of Utah, and George Washington University, even before COVID-19 brought social distancing to the forefront. By providing patients with the right tools to participate, including secure video applications for smartphones or tablets, equipment such as home blood pressure cuffs or glucometers as needed, and ensuring they have a scale to record weight, a good portion of the routine prenatal visit can be conducted safely and securely at home. In the age of smartphones and wearable fitness technology, not to mention a generational shift in accepting virtual face-to-face communication, the idea of incorporating telemedicine should no longer be such a radical concept.
Telemedicine versus telehealth
The term telemedicine has become synonymous with providing traditional clinic encounters remotely via video or telephone interactions. Telehealth, on the other hand, is the utilization of technology to deliver a broader array of healthcare services by a wider community of providers. Such services include lactation consultation and support, screening for and addressing perinatal mood and anxiety disorders, and providing psychosocial support, social services, peer support and case management,
While it can be argued that telehealth encompasses telemedicine, it is helpful to think of them more as a spectrum of services patients can choose from depending on their needs. Much like a person with heart disease benefits from a clinical visit that assesses vital signs and medication refills, they can augment their health with group activities aimed at controlling diet or therapy to cope with limited activity. In terms of perinatal care, telemedicine systems are often developed and scaled towards providing routine prenatal and postpartum visits.
COVID-19 and beyond
The modern pregnant patient can benefit from telemedicine and telehealth service far beyond COVID-19. By integrating care within schedules and lifestyles that are increasingly mobile and less amenable to the traditional clinic model, we can leverage telemedicine to improve access, outcomes, and experience for patients and providers, thus breaking down barriers.
While telemedicine will never completely replace in-person medical care, COVID-19 has shown the benefits of telemedicine and the awesome potential for expanding telehealth offerings in our increasingly connected communities. To be sure, there are still issues with telemedicine that we’ll need to address, including equitable access for all, updated reimbursement models, and specialized tools, software, and technology. But if COVID-19 has taught perinatal providers anything, it’s adaptability and perseverance. These are the traits we share with our pregnant and postpartum patients.
