Broadening Access to Family Planning Services through Telehealth

Overview • Drivers of telemedicine for PPNNE • Telemedicine pilot – Technology, locations, results to date

• Family planning services • Triple AIM: Population Health, Patient Experience and Reducing Cost

Drivers Drivers

Drivers

• How to serve a rural community • How to manage expenses for low volume sites • 48% of our visits types could be seen via telemedicine

Technology • Vsee – Low bandwidth, scalable and secure – Video chat is HIPAA compliant • It protects data privacy in that all

audio/video communication is securely encrypted and transmitted from point-topoint such that even VSee does not have access to to any identifiable health information that may be communicated. • VSee offers the HIPAA-required Business Associate Agreement where VSee agrees to be responsible for keeping all patient information secure and to immediately report any breach of personal health information

Pilot • Dec 2012 – Launched telemedicine in Newport and St Johnsbury VT

• Feb 2014 –

Expanded to Hyde Park and St Albans

• Telemedicine visit types – STI, pregnancy test, emergency contraception, vaginitis, UTI, options counseling, results • Jan – Aug 2014 visits 133 – BCM related 41%, PT 27%, STI 20%, UTI 8%

Planned Parenthood Services • Total visits 65,000 – Abortion (3,500) – Well woman – Birth control – STI screening and treatment – Pregnancy tests and options counseling – Problem visits, gynecologic, often • UTI • vaginitis

Structure of the visit • HCA sees patient and inserts normal historical and VS data into the EHR • HCA obtains any necessary tests • If a test is rapid, it is run and the results entered into the system • Pt has a videoconference with the practitioner • Plan is implemented – Medication – Referral – Follow-up

STI Screening • Nucleic Acid Amplification Tests (NAAT) for Gonorrhea (GC) and Chlamydia (CT) – Traditionally done via cervical sampling – Now can be done in urine

• Rapid HIV – done via finger stick • Blood draw requires a regular visit – Syphilis and Hepatitis • If risk factors (MSM,) then schedule a regular visit

STI Screening • Assessment of risk factors – Sexual history

• Counseling – What diseases we test for, – How to reduce risk, – When to retest

Pregnancy Tests • Urine PT lends itself to telemedicine visit, as primary function of the visit is counseling based on the results • Negative – Reproductive Life Planning – Contraceptive Counseling

• Positive – Options counseling

Emergency Contraception • Sexual history • Counseling • Administration of pill – OTC pill (Plan B, Next Choice) – Ella – If desires IUD, give pill and schedule insert asap within 5 day window.

Options Counseling • Patient has pregnancy test turn positive at home or in HC • Counseling – Likely dating of pregnancy – Options • Parenting • Adoption plan • Abortion

Results Counseling • Pt has abnormal lab result (such as Herpes) • Practitioner discusses results with her • Counseling about next steps

Birth Control Counseling and Rx • History by HCA targets contraindications to hormonal contraception • BP is most important component of exam • Counseling is done by APC over video conference • Rx if no contraindications • Can be used to counsel and plan for a long-acting reversible method if this comes up

UTI • Sx: dysuria or urinary frequency • Diagnostics: UA dip • Video visit

Vaginitis/Vaginosis • Pt calls with itching or discharge or odor • Self swab of vagina – BD Affirm tests for BV, trichomonas, and yeast • Sent to lab, so diagnosis happens the next day (not ideal)

– Other rapid tests exist, one for BV, one for trich • Currently don’t use because doesn’t test

Triple Aim: Patient Experience Pros

Cons

• Close to home

• Limited services, if patient ends up with more needs (has symptoms, or needs syphilis testing)

• Scheduling at a time that is convenient • Affordable, if patient is uninsured • Early data showed good patient satisfaction

Triple Aim: Population Health Pros

Cons

• Gets important preventive services to a broader population

• Still limited to bricks and mortar

• STI screening (CT and HIV) have CQMs, evidence basis for doing

• Birth control has important population health impact

Triple Aim: Cost per patient Pros

Cons

• Decreased clinician costs (were formerly staffing both health centers, with lower volumes)

• Still pay for bricks and mortar

• Additional cost of vaginal swab

Challenges • Model • Patient education • Next evolution – centralized?