KEY ACTIVITY #21:
Telehealth in Perinatal Care
Overview
The modern schedule of prenatal and postpartum visits was developed almost a century ago; in this paradigm, visits occur in-person in a cadence that varies little from patient to patient. The COVID-19 pandemic presented an opportunity to reimagine perinatal care, beginning with the necessary introduction of telehealth visits to promote patient safety. This has led to efforts to better tailor schedules of prenatal and postpartum visits to meet the individualized clinical and social needs of each patient.[1] In California, many of the telehealth flexibilities implemented to respond to the public health emergency remain available[2] to patients and providers in the current state. Thoughtfully integrating telehealth into your provision of perinatal care services could be beneficial in supporting care quality, patient experience, and health equity.
Telehealth can serve as a useful tool to leverage in meeting many of the quality measures of interest in the perinatal population. For example, timely (first trimester) entry into prenatal care can be supported using telehealth for intake visits with intention (e.g., to guide physical examination and tailored laboratory and imaging studies prior to follow up). Depression screening can be performed via telehealth both prenatally and postpartum. Two postpartum visits are recommended for Medi-Cal beneficiaries; one of these two visits (either earlier or later) could be provided via telehealth, if aligned with the patient’s postpartum clinical needs. Beyond these specific quality-related benefits, the use of telehealth may have other advantages in providing services specific to the perinatal population[3] such as consultation with specialists, lactation support, and mental health services.
High-quality telehealth in perinatal care calls for greater patient engagement through self-monitoring. Weight, blood pressure and even fetal heart rate are key clinical data elements that patients can gather on their own. This level of engagement in care may improve patient confidence and self-efficacy in managing their own health.
Integrating telehealth into your perinatal workflows must be done with equity at the center.[4] Failing to consider health equity in telehealth implementation can in fact worsen disparities in care access and quality. The COVID-19 pandemic demonstrated that telehealth services had to be paired with equitable patient access to hardware and broadband networks. Language and health literacy considerations must be addressed in the provision of telehealth as they would be in all clinical care.
Once the obstacles to access described above are addressed, telehealth has great potential to improve equitable health outcomes in the perinatal population.
Subgroups of your pregnant and postpartum population with social needs may have the most to gain from the equitable integration of telehealth into your practice. Telehealth has shown to greatly benefit patients with transportation barriers (e.g., rural populations, those without vehicle access). It may also improve adherence to care among patients with competing needs, including inflexible jobs and childcare needs.
Action steps and roles
1. Identify quality gaps where telehealth could help.
Suggested staff responsibilities: Clinical lead, operations lead, data or evaluation lead.
Quality measures where telehealth might be leveraged should be identified. Data should be stratified by key sociodemographic factors to identify any patient subpopulations where the introduction of telehealth could mitigate care inequities.
2. Infrastructure: Telehealth operations and billing.
Suggested staff responsibilities: Operations lead, IT lead.
If telehealth services are new to your practice, appropriate technology and data security infrastructure must be put into place[5] prior to launch. Accurate coding and billing workflows for telehealth should also be developed.
3. Create telehealth workflows.
Suggested staff responsibilities: Clinical lead, operations lead, frontline staff, patients.
Introducing telehealth visits into your perinatal care model will impact existing standard clinical workflows. Engaging all clinical staff into redesigning these workflows will be key. Patient perspectives must be considered in launching telehealth with enough support to ensure its uptake.
Resources
Endnotes
- Redesigning Prenatal Care Initiative [Internet]. www.acog.org. Available from: https://www.acog.org/programs/redesigning-prenatal-care-initiative
- Telehealth [Internet]. www.dhcs.ca.gov. Available from: https://www.dhcs.ca.gov/provgovpart/Pages/Telehealth.aspx
- Weigel G, Frederiksen B. Telemedicine and Pregnancy Care [Internet]. The Henry J. Kaiser Family Foundation. 2020. Available from: https://www.kff.org/womens-health-policy/issue-brief/telemedicine-and-pregnancy-care/
- Health equity in telehealth | Telehealth.HHS.gov [Internet]. telehealth.hhs.gov. [cited 2024 Jan 16]. Available from: https://telehealth.hhs.gov/providers/health-equity-in-telehealth?gclid=Cj0KCQiAkeSsBhDUARIsAK3tiec6KfLZ9Ua5_IC9WkI_E-SZfbdjBX5gtrnP4bQCmDF1GQ39P1WSjcMaAqIMEALw_wcB"
- Implementing Telehealth in Practice [Internet]. www.acog.org. 2020. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/implementing-telehealth-in-practice