Rethinking the Delivery of Ob/Gyn Care

By Amy Merlino, MD

The COVID-19 pandemic radically changed healthcare delivery over a short period of time, and Cleveland Clinic’s Ob/Gyn & Women’s Health Institute (WHI) was well prepared for the challenges brought about by the ensuing rapid scaling of digital health.

As an institute, we saw incredible growth in the percentage of virtual vs. traditional, in-person consults. Compared to the same time period in 2019, WHI’s virtual visits were up 960% through August 2020. Even before the pandemic, Cleveland Clinic leadership activated a transition plan toward predominately remote care. In WHI, we had successful pilot models to follow.

The increasing role of technology in healthcare

Prior to the pandemic, we were aware of the increasing role of technology in healthcare. Despite early adoption of digital care by Cleveland Clinic, telehealth represented less than 2% of the total care – an experience not unlike that of other large healthcare organizations. Throughout the Cleveland Clinic enterprise, we were looking for more ways to fold virtual care into our practice.

Among WHI’s first virtual offerings were prenatal visits. Led by Julian Peskin, MD, MBA, a group of providers began conducting virtual prenatal visits for low-risk obstetric patients a few years ago. Qualifying patients receive a Doppler ultrasound device and blood pressure cuff during their second trimester. These patients are instructed to measure their weight and blood pressure, and listen to the fetal heart beat before each appointment.

The patients love the convenience of these visits – indicating that virtual visits reduced unnecessary stress related to any commute to the clinic, time away from work, childcare needs and exposure to viruses. It didn’t take Dr. Peskin long to realize that some high-risk patients might benefit from the reduced stress and exposure of home monitoring as well.

Toward the end of 2019, we were really challenging ourselves to think about how we could incorporate virtual visits into other aspects of our practice. And then came COVID-19.

Rapid adoption and scaling

As the pandemic evolved, it became apparent that Ob/Gyn providers would need to apply similar models of virtual care for patients, including infertility consults, preconception counseling, birth control discussions, preoperative counseling and surgical follow-up.

As an enterprise, our providers were quickly credentialed and trained to provide virtual care. We developed a Digital Health Playbook with tips and tricks for the entire care team — from schedulers to physicians — to ensure that our patients would continue to have access to appropriate and high-quality healthcare amid the pandemic. To further increase access for all patients during this unprecedented time, we made this playbook available to the public.

Continuous improvement

Since April, we rolled out a secure video service that is integrated into the digital health record. We were able to move virtual visits from the additional digital tools permitted for use during the health emergency and onto HIPAA compliant platforms for individual virtual visits and shared medical appointments.

Additionally, we have also optimized the check-in process for virtual visits to allow for more functionality. We leveraged this eCheck-in when we brought patients back to the clinic for face-to-face appointments to reduce interactions and ensure that physical distancing can be maintained.

We continue to track quality and patient experience metrics to ensure the provision of high quality, appropriate care for our patients with virtual visits.

What to expect going forward

At our peak of virtual visits in April and May, 60-70% of WHI’s patient visits were virtual. Virtual volumes have dropped off from that point as we reactivated; however, virtual visits are here to stay. Cleveland Clinic continues to explore new, innovative ways to meet our patient’s needs through virtual capabilities, and we believe these solutions will continue to deliver value to our patients in a post-COVID-19 environment.

About the author: Amy Merlino MD, is Enterprise Chief Medical Information Officer and a maternal-fetal medicine specialist in Cleveland Clinic’s Department of Subspecialty Care for Women’s Health.