Can Digital Health Tools Improve Grim Maternal Health Outcomes?

Even as the COVID-19 pandemic spotlighted the country's wide-ranging health inequities, the public health crisis also accelerated the growth in digital health tools that could reduce some of these care gaps.

As the country emerges from the pandemic, the landscape has shifted in clear and significant ways. Across the healthcare field, there's a heightened interest in the powerful role of digital tools in improving access and outcomes—and a growing appetite to embrace these new technologies. In a recent American Medical Association webinar, for example, health leaders described the tremendous potential of these tools in pregnancy and postpartum care.

“Health systems, payers, care delivery providers across the nation are going through a digital transformation largely fueled by COVID and the impact COVID has had on telehealth," explained Anish Sebastian, the co-founder and CEO of Babyscripts, a prenatal and postpartum virtual care platform.

Digital health tools fill need beyond pandemic

When Hurricane Ida made landfall in southern Louisiana in 2021, patients and physicians alike evacuated the region. The experience had the potential to majorly disrupt care for pregnant women, pointed out Dr. Veronica Gillispie-Bell, a board-certified OB-GYN and an associate professor for Ochsner Health in New Orleans.

Since telehealth systems were already in place, though, patients could easily transition to virtual visits. In addition, providers could still access vital health information for people who were using remote patient monitoring tools.

“When we think about disasters such as hurricanes, or we think about pandemics like COVID-19, having telehealth allows us to provide that continuity of care when our traditional systems can't be used," Gillispie-Bell said in the AMA Innovation Academy webinar.

Attention, resources turn to dismal maternal outcomes

These emerging tools come at a time when the US is facing increasingly dismal maternal health statistics. The country has experienced a yearly rise in the rate of maternal mortality from 754 deaths in 2019 to 861 in 2020 and 1205 in 2021, according to the National Center for Health Statistics, a 60% increase over 3 years.

This upward trajectory contrasts with worldwide statistics. Between 2000 and 2020, the maternal mortality ratio dropped by about 34% worldwide.

Within the US, these grim figures aren't distributed evenly among all populations. Black women are 3 times as likely to die from pregnancy-related complications, Native American women are more than twice as likely to die, and women in rural areas are 60% more likely to die, notes Vice President Kamala Harris in a Call to Action to reduce the country's maternal mortality.

Improving access can transform maternal health outcomes

Most maternal deaths are preventable, according to the World Health Organization. That's why access to high quality care in pregnancy and during and after childbirth is so vital. Timely management and treatment of complications can mean the difference between life and death for both mothers and the newborn.

In the US, addressing the vast outcome inequities in maternal health will require new models of healthcare delivery, notes an issues brief from the Commonwealth Foundation. That brief stressed the urgency for innovative approaches in light of the pandemic's evidence of Black, Hispanic, and Indigenous women being disproportionately affected by COVID-19 during pregnancy.

Pandemic ushered in new era of technology

The United States' effort to lower maternal mortality rates and inequities in maternal health outcomes coincides with an emerging growth, acceptance, and demand for digital health. As the pandemic limited in-person healthcare, more and more patients turned to digital health solutions such as telehealth. The public emergency also relaxed some restrictions on these platforms while increasing reimbursements.

The transition has shifted the culture of medicine and care, according to a recent Harvard Business Review article looking at the emerging era of telehealth.

“Any nation seeking to raise healthcare quality, increase access, and lower costs should be expanding, not contracting, the use of virtual care," the authors write.

Looking at digital tools to improve maternal health outcomes

Technological health tools, increasingly adopted by practitioners, have the potential to reduce inequities and improve outcomes. Experts in the recent AMA panel expressed optimism, pointing to specific examples of digital health's promise in addressing barriers to care.

Too often, transportation and childcare limit individuals' abilities to access care, Gillispie-Bell noted. Telehealth allows providers to overcome some of those barriers challenging patients. At the same time, telehealth offers an opportunity for busy providers to add in visits, thereby increasing access.

“When we think about convenience, telehealth allows us to bring care to the patient instead of the patient coming to care," she said. “That's really important when we think about our patients, and we think about a lot of the barriers to accessing care."

Digital health tools can add options in care deserts

While telehealth also serves a key role during disruptions, such as the hurricane season in Louisiana, these digital applications are also vital in regular times, too. That's because such a large portion of the state is considered a maternity care desert, in which people must travel long distances to access care.

“When we think about our treatment landscape and we think about those barriers, we have to do more to make sure our patients are able to access care once they've left the hospital," Gillispie-Bell said.

Despite advances, barriers persist

Programs that offer digital monitoring for patient blood pressure and other readings as well as virtual visits are making considerable strides in reducing healthcare barriers, adding convenience, and improving outcomes. At the same time, digital health doesn't operate in a vacuum, she stressed. Barriers that are pervasive throughout healthcare can also impact people's ability to access and use these digital tools. She pointed to:

• Access: Broadband internet can pose a barrier to the adoption of healthtech solutions. This digital divide can exacerbate existing inequities among historically marginalized groups, such as Black women and rural residents.
• Affordability: Widescale adoption of digital tools such as remote patient monitoring is dependent upon adequate funding such as insurance reimbursement.
• Digital health literacy: Not everyone is comfortable using digital health tools. Language and literacy barriers will be important to consider in product development.

Broadening the research landscape

Another maternal health technological advance comes in the form of digital data collection that could help educate and inform future treatments and approaches. For example, POWERMOM is a smartphone app-based research study that allows pregnant people to share data about their pregnancies with scientists. Through wearable technology, the program gathers data on factors such as sleep duration, activity, and resting heart rate.

“We know that a smartphone right now, even though it's limited, is a powerful tool not only to provide care but to collect info and partner with our participants to truly make a difference," said Dr. Tolúwalàṣé (Laṣé) Ajayi, the Director of Clinical Research at Scripps Research Translational Institute in the AMA webinar. “Right now, we can broaden the research landscape with this tool."

More data allows researchers to dig deeper

Collecting more health data will enable researchers to delve deeper into topics such as postpartum depression, nutrition, and blood pressure—and the relationship to pregnancy outcomes. The group will also be exploring the role of structural racism in the pregnancy journey and how a chatbot can impact postpartum depression.

Ultimately, the effort might lead to community partnerships and a better understanding of the barriers to care. The hope is that more data will help empower women to make the right decisions for themselves and their pregnancies, speakers said.

Sharing lessons from the private sector

As interest in digital health platforms for maternity care grows, Babyscripts CEO Anish Sebastian offered key lessons from the private sector in the AMA webinar. That company helps deploy virtual care solutions, from apps to engage moms during pregnancy to risk monitoring throughout the journey.

He shared these key insights from implementing and scaling mobile digital tools:

• Stakeholder buy-in matters: It's important to identify core clinical and nonclinical champions of the tools from people who believe in the value and are willing to put in the effort to effectively deploy it.
• Align expectations: It's helpful to specify the program's goals, such as improving outcomes, improving access to care, reducing clinical resource hours, improving patient experience, and reducing readmissions.
• Workflow: With more data collection, there's a risk of information overload, which could burden already overworked providers. That's why it's important to consider how the program will elevate items that require immediate attention, such as identifying triggers for additional attention and who needs to receive them.

Be mindful of how bias can creep into digital apps

As with other digital applications, it will be important to be mindful of the role of bias and steps needed to prevent and address it. One example is that historically marginalized populations have often been excluded from or disproportionally represented in clinical trials that lead to health data collection. Some studies have shown how AI can reinforce racial and gender bias, potentially widening already existent inequities.

The pandemic highlighted both healthcare inequities and the growing importance of digital healthcare, notes an article describing a framework for digital health equity in npj Digital Medicine. Increasingly, too, there has been a growing recognition of access to digital tools as a “digital determinant of health," the authors note.

RTI Health Advance offers guidance on digital health tools

As providers and health systems navigate the changing digital landscape, RTI Health Advance can help you identify tools that can transform and enhance healthcare delivery. Our team of digital health and health equity specialists can help you harness the power of these emerging technologies to reduce barriers to care and improve patient outcomes.