As we know, the American Society for Reproductive Medicine has issued interim guidelines regarding management of patients during the current COVID19 crisis.
One of their key recommendations was to minimize in-person interactions and increase utilisation of telehealth.
Telehealth is defined as the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring and remote admissions. It is often used interchangeably with the word telemedicine, although strictly speaking telemedicine is limited to remote diagnostic/clinical services.
In addition to remote diagnostic and clinical services, telehealth, according to the United States Department of Health and Human Services, includes:
- non-clinical services
- provider training
- administrative meetings
- continuing medical education.
Provision of telehealth
Delivery of telehealth services can come within four distinct domains:
- live video (synchronous)
- store-and-forward (asynchronous)
- remote patient monitoring
- mobile health.
Generally, this takes the form of livestreaming and examples might include:
personal video consultations between a healthcare professional and a patient and/or web conferences between healthcare providers at different locations to discuss the patient.
In the sense of telehealth this refers to items like videos, for instance: self-help videos for patients that can be stored remotely and accessed at will.
Remote patient monitoring (RPM)
This is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area. It can be particularly useful when patients are managing complex self-care processes such as home haemodialysis. Real time remote monitoring and trend analysis of physiological parameters enables the healthcare provider to keep an eye on things and spot issues early on without the need to be physically present.
Most RPM technologies follow a general architecture that consists of four components:
- Sensors on a device that is enabled by wireless communications to measure physiological parameters. More and more devices are now compatible with smartphones ,like the FitBit and Apple watches
- Local data storage at patients’ site that interfaces between sensors and other centralized data repository and/or healthcare providers. e.g. this might be as simple as a standard smartphone
- Centralised repository to store data sent from sensors, local data storage, diagnostic applications, and/or healthcare providers. e.g. dedicated server space at the clinic
- Diagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data. However, this is not an essential component so long as a healthcare professional monitors and interprets the data.
This is the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablets and laptop computers.
A recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF1.
The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.
It goes without saying that telehealth requires a strong, reliable broadband connection and in that sense, we are lucky that COVID19 didn’t come along twenty years ago! Although we came close with SARS. In light of the current crisis the US Congress has recognised the utility of the idea and has agreed to unlock $500m in funding to roll out the provision of telehealth.
Telemedicine can help to reduce the spread of COVID19
By keeping patients at home and out of crowded waiting rooms. It expands remote care programs from the clinic, but this is only the first step. The next frontier is raising awareness among patients about why they need to be taking advantage of the technology. It certainly looks like the threat of COVID19 will be an incentive to drive take-up of the technology.
Take the example of Bergen New Bridge Medical Center in New Jersey, who created a dedicated telemedicine service for COVID19 in a very short period of time. Now, the hospital is focused on getting the word out, making sure people know that they have access to it. Largely by pushing information about the new service on Bergen New Bridge’s website and social media.
CDC guidelines to screen patients for COVID19 by video interview
Nurses at Bergen use the CDC guidelines to screen patients for COVID19 by video interview, which includes asking about a patient’s travel history and exposure to the virus as well as their symptoms. If the nurse suspects a patient may have coronavirus, a staff member contacts the New Jersey Department of Health to coordinate an assessment with the agency’s epidemiologist, as well as the CDC to authorize testing.
Meanwhile, down the road, the Paramus Hospital launched its telemedicine service in October, but in the wake of the virus decided to expand it. Patients concerned about coronavirus can dial a hotline for a screening with a nurse, who will refer them to a video consultation with an infectious disease specialist if they need further evaluation.
Limitations to telemedicine screenings for COVID19
Of course, there are limitations to telemedicine screenings for COVID19. Clinicians are not able to listen to a patient’s lungs without specialized equipment and ultimate diagnosis requires a laboratory test.
When determining which patients should be pushed toward remote care, it is important to consider their specific conditions and needs. However, in terms of fertility consultations, video can be a viable option for patients who are medically stable and not in immediate need of a physical exam or procedure.
Linda Branagan, Director of Telehealth Programs, University of California, San Francisco (UCSF) said, “Doctors will need and deserve time to confer with colleagues. They need consult literature and access other resources as they learn how to best integrate telehealth into their clinical toolbox, even in the midst of an outbreak.”
With that in mind, staff members at UCSF are proactively reaching out to patients with various conditions ahead of their scheduled in-person appointments, to see if they can be converted to a video visit.
While most IVF clinics are probably not at the stage of offering full telehealth services, switching to a video consultation model should be feasible. For some consultations that would normally have taken place face-to-face before the COVID19 pandemic struck.
Neil Madden, Editor
The Fertility Hub
- Chausiaux O, Hayes J, Long C, Morris S, Williams G, Husheer S. 2020. Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation/Intracytoplasmic Sperm Injection. European Obstetrics & Gynaecology. 2020. 6 (2): 92–4.