Potential Pitfalls of Prenatal Telemedicine—And How to Prevent Them
We love telemedicine and can see so much potential for it to improve health outcomes among pregnant patients in the U.S. and around the globe. Statistics for prenatal telemedicine are largely positive and encouraging, and we want to see that trend continue.
In pursuit of that goal, we have to consider potential pitfalls and work to prevent them. In this article, we’ll leave technical issues to the IT specialists and examine patient-centric problems the healthcare industry can work to avoid.
The five pitfalls we’ve identified are low technical literacy and access, impersonal connection, relational fragmentation, ineffective communication, and lack of assurance. Let’s take them one by one, examine the potential issues, and suggest some solutions.
1. Low Technical Literacy and Access
Familiarity with technology and access to devices or an Internet connection are not equal across the patient population. Those with limited access or limited technical literacy may struggle to attend and navigate telemedicine appointments.
The good news for pregnant patients is that a gender gap doesn’t exist for the issue of digital literacy and access, and age only tends to become a factor for the 55+ crowd. However, other factors can impact their use of telemedicine:
Rurality: About 40% of rural Americans lack access to broadband service. They’re also 4 times less likely to use the Internet than their urban counterparts.
Race: When looking at the whole adult population, almost half (46%) of digitally illiterate adults are White. However, when you break statistics down by race, 35% of Hispanic adults and 22% of Black adults struggle with digital literacy, compared to 11% of White adults.
Education: Stark contrasts in digital literacy exist among varying education levels. Only 5% of adults with a college degree are considered digitally illiterate, compared with 17% of those with high school diplomas and 41% of those without a high school diploma. Those who didn’t graduate high school are also more likely to lack Internet access.
Income: Low-income households are more likely to lack access to a family computer (33% compared to only 6% of high-income households). Additionally, more than a quarter of low-income homes (27%) have smartphones, but no broadband access.
To provide great telemedicine care for everyone, providers can consider the following suggestions:
Make patient intake forms more inclusive by asking about patients’ access to technology, their preferences regarding appointment format, and the opportunity to indicate their need for assistive devices.
Before a telemedicine visit, call patients to confirm they have access to the necessary technology and are comfortable using it.
Schedule extra time for a virtual visit if the patient indicates they require technical support.
2. Impersonal Connection
Patients want to develop a trusting relationship with their providers, and sometimes telemedicine can feel like a barrier to that relationship. Pregnant patients especially, despite being satisfied with virtual prenatal care during the pandemic, overwhelmingly (89.95%) indicated a preference for in-person care.
Compared to telehealth visits, patients indicated that in-person appointments were more personal, established greater rapport, and built greater trust. These benefits, in turn, create more highly satisfied patients.
We’ve seen similar results in patient surveys regarding TeleScan®, our telesonography® solution. The care is rated highly, with 92% of patients indicating high satisfaction with the care team, and 69% of patients indicating high satisfaction with the telesonography exam experience. Those who didn’t indicate high satisfaction with their experience commented that telesonography felt distant compared to onsite sonography because it did not provide a more personalized, connective experience—like narration of the scan and more visualization of the baby.
So how can we use these telemedicine exams to build trust and provide a more personal experience?
Begin the appointment with small talk. It’s easy to jump right into business, but small talk can emphasize that providers care for patients holistically. Bonus points for making a note and following up during the next visit.
Practice good listening skills. Always look at the patient, indicate attentiveness through nonverbals like head nods and smiles, and use friendly body language and facial expressions.
Repeat what the patient says to confirm it’s correct. This can help them feel heard and minimize misunderstandings.
Bonus: We provide our telesonography patients with pictures of the baby after their exam, which provides a highly personalized touchpoint.
3. Relational Fragmentation
Whether patients are being seen in person or through telemedicine, care from different providers has the potential for relational fragmentation and discontinuity of care. Studies suggest fragmented care can lead to a loss of information and inconsistent advice, which can create unsafe situations. Conversely, one study suggests continuity of care may lead to a lessened need for pain relief and feeling safer during the birthing experience. Additionally, patients were less satisfied when they had to repeat their medical history to a new provider.
But offering both in-person and telemedicine care methods (even from multiple providers) doesn’t have to end in relational fragmentation. Here are some ways providers can create relational continuity:
Especially for the first telemedicine visit, try to schedule the appointment with a provider the patient is familiar with.
Integrate telemedicine and in-person data. That way, when a patient’s known provider is unavailable, another provider can step in, equipped with the information to make the patient feel known.
For patients who want a single point of contact, consider encouraging midwifery-led care, which gives the patient a constant care professional and offers providers more scheduling flexibility.
4. Ineffective Communication
Patients have indicated that in-person discussions put them more at ease and allow for a better flow of conversation. Pregnant patients worry that telemedicine appointments make it more difficult to bring things up with their doctor and believe the provider might miss something if they aren’t there in person. One patient reported, “I do wonder if you'll be able to catch everything that you would have [at] an in-person appointment. [. . .] In person, with facial expressions and such, you can pick up on some subtleties. So, I do wonder if something might get lost.” Patients were also concerned about their ability to understand and retain information that was provided during a telemedicine appointment.
A patient’s environment could also lead to ineffective communication. While telemedicine has been praised for its ability to give providers greater insight into a patient’s home life, it can also be disruptive if patients can’t find a quiet and private location to conduct their visit. One patient indicated that the waiting room also provided time to think about the visit and potential questions for the provider, as opposed to a telemedicine visit, where they were “running around the house” and “probably not thinking about the visit as much.”
Providers can consider the following ideas to encourage more effective communication during telemedicine calls:
Tell patients their provider will complete telemedicine visits from a quiet and secure location and encourage them to choose a similar type of space.
During the visit, pause for questions and ask about their comprehension often, not just at the end of the appointment.
Provide written appointment notes, treatment instructions, and follow-up directions, and show patients where they can access them for future reference.
5. Lack of Assurance
A recent survey showed patients’ peace of mind was lower in telemedicine appointments than during in-person prenatal check-ups. Pregnant patients particularly felt they had more need for in-person reassurance, and even those with remote monitoring tools were still worried that something would be missed or overlooked.
Additionally, some women linked high-risk pregnancies with an increased risk of losing their pregnancy and trusted in-person visits more than virtual appointments.
Fostering patient assurance, especially if a patient is experiencing a high-risk pregnancy, can be difficult. In-person examination and explanation is a highly effective tool, but there are ways to build patient confidence in virtual methods:
Ask about patient preferences. Most patients, both low- and high-risk, prefer a mix of in-person and virtual care during their pregnancy.
During a visit in early pregnancy, explain how remote monitoring technology operates, answer questions, and provide reassurance of the efficacy of telemedicine.
Don’t force a particular type of appointment on a patient. Rather, present methods they can benefit from, and then welcome their feelings, pushback, and engagement in their healthcare decisions.
Despite these potential pitfalls, we believe telemedicine offers significant advantages for both minority and rural patients as well as their providers and sonographers. We’ve even gone so far as to say that telesonography is the future of ultrasound! We love to see the development of telemedicine solutions and know that if we’re careful to prevent these pitfalls, we can get much closer to equitable care and positive maternal outcomes.