Health Equity in Obstetrics: Digital Health for Diverse Populations

For some lucky people, the pandemic has been a period of minor inconveniences with silver linings: a time to learn how to work effectively from home, to spend more intimate time with family and friends, to replace a long commute with meditative mornings and evening cooking adventures.

For others, the pandemic has presented a drastically different experience. For vulnerable individuals and families, the nationwide lockdowns and a battered economy have only exacerbated the struggles they face on a daily basis — food and housing insecurities, anxiety and depression, substance abuse problems, intimate partner violence, loss of income, and other challenges. 

Technology facilitated the transition to a new normal for the first group — but is it a sufficient or even accessible solution for the second?

Some are concerned that technology only widens the economic and social gaps in our communities. 

The question has especially preoccupied the healthcare industry, as digital health has been adopted across the board during Covid times. Broadband, Wifi, and data access pose a challenge for low-income and rural populations using digital healthcare. Cost is another issue.

Fortunately, as digital health becomes a standard part of care delivery, innovators are finding ways to bridge the technology gap in health care by using technologies like Bluetooth® and creating solutions that require minimal data usage. And as the benefit — and necessity — of digital health has become more obvious during the pandemic, reimbursement codes have been expanded to cover more and sometimes all the cost. 

Far from increasing divisions, technology in healthcare is acting as an equalizer. 

There is very little that is the same across medical systems — in-person care varies dramatically based on hospital, location, and the demographic it serves — safety-net vs. private, rural vs. urban vs. suburban, Medicaid vs. privately insured.  

At MedStar Washington Hospital Center’s Women and Infant Services (WIS), we use Babyscripts to supplement care management of our pregnant population, some of the most vulnerable patients that we serve. One of the primary challenges that these women face is access to prenatal care, leading to poor outcomes such as preterm birth and C-sections.

Increase Access to Care

With the technology arm of Babyscripts, WIS is able to reach these women outside the clinic — even if they aren’t coming to prenatal appointments, they are still tracking vital biometric data like blood pressure and weight through the app and remote monitoring devices, and getting 24/7 access to educational info and provider resources. 

Using a mobile device to deploy education information and deliver risk assessments and care checklists, among other things, is one way of streamlining the care experience — regardless of the physical location where a patient receives care. 

We’ve found that technology can remove info dump problems by providing a digital education layer, to ensure that even if a patient misses an appointment or fails to process and remember important info in the moment, they still have 24/7 access to that information to reference at need. 

In a 10-15 minute appointment, patient education gets the least air-time, especially if a patient has anything medically complicated. A digital education layer is an important safety-net, and it also cuts back on unnecessary triage, by reducing the amount of phone calls from patients seeking basic information. With the Babyscripts app, for example, a mom can get answers about symptoms like nausea, without needing to make a phone call to the doctor or getting lost in conflicting and sometimes false information on the internet.

Reduce disparities in maternal health

Remote monitoring solutions provide a layer of care enhancement that further equalizes the care experience. As doctors are increasingly using telehealth appointments to keep hospital beds free and the worried well out of the clinic, remote monitoring tools, including a weight scale or blood pressure (BP) cuff, can help patients feel more comfortable with the quality of care that they are receiving. This is especially important for low-income and minority populations. On its own, a telehealth appointment can feel like inferior care, to a population that is already disposed to feel overlooked and underserved by the system. 

With access to a remote monitoring tool like a BP cuff, for example, patients can speak more accurately about their condition, assigning a data point to the symptoms they’re experiencing. They can communicate the emergency of their condition in clear terms to their provider and receive the appropriate response. Having a headache is an easily dismissible problem, for example — having a headache and high blood pressure could be an event that requires immediate attention. 

A remote monitoring solution can also capture data from patients who may be no-shows at appointments, a massive problem for patients on Medicaid. No-shows are often caused by barriers of access, white coat syndrome, inability to navigate the health system, and other social determinants of health. Remote patient monitoring opens access to care for these patients, and it also opens appointments for the provider team to be able to treat the most acute patients.

With Babyscripts, data from remote patient monitoring is directly communicated back to the provider. Abnormal readings are flagged and communicated to the provider through a trigger alert system, facilitating triage and real-time intervention. In the maternal health field, this is a crucial tool for catching dangerous conditions like preeclampsia, and especially important for moms who may be missing scheduled appointments, due to social determinants of health and other barriers. 

Technology is not a cure-all, of course, and it will take the combined effort of stakeholders across the industry to truly face down the problems of inequity in our healthcare system. However, as a way of extending precision quality care to some of our most vulnerable populations, digital health is already playing a crucial role in that endeavor.