The American College of Obstetricians and Gynecologists Releases Primer on Implementing Telehealth for Obstetrician–Gynecologists

Washington, D.C.—Today the American College of Obstetricians and Gynecologists (ACOG) released its first-ever guidance for practitioners on how to implement telehealth in practice.

The new Committee Opinion on telehealth is the result of a presidential initiative led by former ACOG President Haywood Brown, MD, and focuses specifically on how to navigate licensure, credentialing, billing, and technology requirements. It will be published in the journal Obstetrics & Gynecology in February in tandem with a systematic review by the ACOG Telehealth Expert Work Group.

Telehealth can include everything from virtual patient consultations and remote observation of ultrasound recordings to bladder diary tracking with smartphone apps. Other telehealth interventions, such as remote blood pressure and glucose monitoring, offer innovative ways to potentially remodel prenatal and postpartum care.

“Telehealth is increasingly used in nearly every aspect of obstetrics and gynecology today,” said Brown. “Therefore, it is important for physicians to become adept at using this technology in practice. In our guidance we highlight that telehealth can be very useful in increasing access to care and services, reducing the need for unscheduled in-person visits, and assisting with adherence to medical recommendations and guidelines.”

However, there are a few things that obstetrician–gynecologists need to be mindful of before implementation. In addition to security and privacy precautions and ensuring that their facility is equipped with the necessary hardware, software, and a reliable and secure internet connection, practitioners must be licensed in the state where the patient is located. They may also need to be credentialed (or obtain privileges) at the facility where the patient is located.

“Licensure is only the first step,” said Nathaniel DeNicola, MD, MSHP, a lead author of the Committee Opinion and the systematic review. “Obstetrician–gynecologists must make sure that their care is going to be covered by insurance and be aware of how they will be reimbursed for the services they’re providing. This is especially important for remote care across state lines. Some states have parity laws that require the equivalent health insurance reimbursement for similar in-person and telehealth services but not all.”

As of 2018, 49 states and Washington, D.C., provided reimbursement for some form of live video in Medicaid fee-for-service, and 35 states had enacted telemedicine parity laws.

Additionally, not all liability insurers cover telemedicine malpractice, so practitioners will want to confirm this aspect of their liability coverage and ensure that the liability coverage extends to other states in which they are practicing.

“There are certainly a lot of bases to cover, but overall telehealth has proven to enhance patient satisfaction and improve engagement,” said Brown. “It may also be a means for addressing issues with rural access to care. In some instances, there is no substitute for actual face-to-face interaction, but telehealth has been found to provide comparable health outcomes when compared with traditional methods of health care delivery and can only enhance the care we as physicians provide.”

Committee Opinion 798: Implementing Telehealth in Practice will be published in the February edition of Obstetrics & Gynecology.

Other recommendations issued in the February edition of Obstetrics & Gynecology

Committee Opinion 797: Prevention of Group B Streptococcal Early-Onset Disease in Newborns

Group B streptococcus (GBS) is the leading cause of newborn infection (1). The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1 – 2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal–rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal–rectal cultures at 36 0/7 and 37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including Table 1, Box 2, and Figures 1–3, updates and replaces the obstetric components of the CDC 2010 guidelines, “Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010.”

The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of 60,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org