Obstetrician-gynecologists and other physicians should consider becoming familiar with and adept in telehealth technology. In most states, physicians, nurses, and other healthcare providers must be licensed in the state where the patient is located and may also need to be credentialed at the facility where the patient is located.

It is important that the patient–physician relationship is upheld and valued in the treatment plan, and physicians who provide telehealth should examine their state laws and medical board definitions closely to ensure that their practices are compliant.

Obstetrician–gynecologists and other physicians who provide telehealth should make certain that they have the necessary hardware, software, and a reliable, secure internet connection to ensure quality care and patient safety.

Physicians who provide telehealth must comply with the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules and also should be aware of the unique security risks posed by virtual healthcare technology, which can be vulnerable to outside threats

In response to the COVID-19 pandemic, many elements of a well-woman examination might be conducted with virtual counseling sessions, with the in-person physical examination deferred to a later date or performed on an as-needed basis.⁷⁵

The WPSI encourages healthcare professionals to continue to offer preventive services for their patients through telehealth platforms whenever possible. Healthcare professionals should consider telehealth modalities as an alternative to in-person preventive visits and services.

Many preventive services on the Well Woman Chart (https://www​.womenspreventivehealth​.org/wellwomanchart/) that involve screening, assessment, and counseling can be done via telehealth. It is important to note that in some situations, a physical examination may be indicated to address the particular preventive service being addressed. However, some aspects of the preventive visit, such as obtaining relevant medical history, family history, review of systems, counseling, education, and potential prescription could occur via telehealth, with the physical examination conducted at a later time during a subsequent in-person visit.

The following preventive services may be done via telehealth:

• Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants.
• Interpersonal and domestic violence screening and discussion of available resources
• Sexually Transmitted Infection prevention counseling
• Postpartum contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit
• Counseling regarding folic acid supplementation

Telehealth services can facilitate public health mitigation strategies during this pandemic by increasing social distancing. These services can be a safer option for healthcare providers and patients by reducing potential infectious exposures. They can reduce the strain on healthcare systems by minimizing the surge of patient demand on facilities and reduce the use of PPE by healthcare providers.

Maintaining continuity of care to the extent possible can avoid additional negative consequences from delayed preventive, chronic, or routine care. Remote access to healthcare services may increase participation for those who are medically or socially vulnerable or who do not have ready access to providers. Remote access can also help preserve the patient-provider relationship at times when an in-person visit is not practical or feasible.

During COVID-19, it is critical that access to family planning services remains available while keeping healthcare providers and their patients safe.

The AAFP supports expanded use of telehealth and telemedicine as an appropriate and efficient means of improving health, when conducted within the context of appropriate standards of care. The appropriateness of a telemedicine service should be dictated by the standard of care and not by arbitrary policies. Available technology capabilities as well as an existing physician-patient relationship impact whether the standard of care can be achieved for a specific patient encounter type.

The AAFP recommends streamlined licensure processes for obtaining several medical licenses that would facilitate the ability of physicians to provide telemedicine services in multiple states. The AAFP encourages states to engage in reciprocity compacts for physician licensing, especially to permit the use of telemedicine. Within a state licensure framework, the AAFP strongly believes that patients with an established relationship, who are traveling, should be allowed to be treated by their primary care physician, so long as the physician is licensed in the state in which the patient receives their usual care.

As telemedicine services are expanded and utilized to achieve the desired aims, it is imperative that outcomes are closely monitored to ensure disparities in care are not widened among vulnerable populations, attributed to increased use of telemedicine. Policies should acknowledge the geographical and socioeconomic disparities that exist and could be exacerbated by the improper adoption of telehealth if not explicitly addressed.

Access to broadband is a social determinant of health. All patients and practices should have broadband access to support delivery of telehealth services in accordance with AAFP’s policy on Health Care for All.