Q&A: Telemedicine program halves time to fertility treatment
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A telemedicine program at Penn Medicine in Philadelphia halved patients’ time from initial visit for fertility care to receipt of treatment, data published in NEJM Catalyst Innovations in Care Delivery showed.
The average time to fertility treatment decreased from 97 to 41 days, enabling Penn Medicine to provide fertility care to 24% more patients in the year the Fast Track to Fertility program began than they would have using standard procedures.
Healio spoke with Fast Track to Fertility co-founders Anuja Dokras, MD, PhD, a professor of OB/GYN and chair of gynecology for the Women’s Health Service Line at Penn Medicine, and Suneeta Senapati, MD, an assistant professor of OB/GYN at Penn Medicine, to learn more about the program.
Healio: Why was this system developed?
Senapati: Nationally, one in eight couples has trouble getting pregnant. Infertility can lead to substantial distress due to the emotional, physical, financial and logistical burden it places on patients. Most patients have been trying to get pregnant for at least 1 year, if not several years, before seeking fertility care. When they make an appointment with a doctor, the emotional stakes can be high, and patients are eager to get started.
When we started this work in 2019, the wait time for new patient appointments at Penn Fertility Care was about 4 to 6 weeks, and the time it took couples to complete their fertility diagnostic workup spanned between 2 and 3 months due to the complexity and timing of the tests.
We knew we could do better, so we set out to explore innovative ways to initiate treatment sooner.
Healio: Is this the first system of its kind?
Senapati: Fast Track to Fertility is a novel care delivery model that introduces a digital front door to improve access to fertility care. To our knowledge, it is the first system that has utilized both an advanced practice provider (APP) and a digital platform to improve access and reduce time to complete workup.
Healio: How does it work?
Dokras: When patients call for an appointment, they first meet with an APP for a telehealth visit. During these visits, APPs obtain information about the couple’s medical history, provide education, answer questions and explain the workup process. They are also offered enrollment into a texting program that leverages artificial intelligence to help patients navigate the complicated, time-sensitive and cycle-dependent workup process that both partners must complete.
Historically, patients had to wait until their first appointment with a doctor to begin intake or start testing. Leveraging APPs to complete this step enables us to get patients started on their journey sooner, and the texting program supports them in completing the workup process in the shortest time possible.
Healio: What sort of training would clinicians need to use this system?
Senapati: There is very little training required for this system. All it requires is the usual conversations care providers would have with new patients and simply informing the patients that they will receive frequent text-based reminders. If the patient agrees, the provider informs our coordinator to add the patient’s testing information onto the digital platform. This allows for selection of the appropriate algorithm for sending reminders.
Healio: Is this a system that would work with any patient seeking fertility treatment, or are there certain criteria that patients need to meet to be able to partake?
Dokras: Fast Track to Fertility is designed to work for all fertility patients. The system is largely standardized but allows for personalization depending on specific patient needs.
Healio: Where is this system currently implemented?
Senapati: In June 2021, Fast Track to Fertility became a standard care model across all Penn Fertility Care sites, which include Penn Fertility Care, Penn Fertility Care Washington Square and Penn Fertility Care Radnor.
Healio: Are there plans to expand this service to make it more accessible?
Dokras: When designing this program, we wanted to keep accessibility in mind, which is why we are using [text messaging], rather than an app-based solution. This allows people without smartphones to utilize the program.
As we move from piloting to standard of care, we will continue to track who engages most and how they engage and will make changes if there are specific groups that show limited utilization. We are already thinking about ways to ensure that the program is introduced to all patients in our busy practice, simplify the text language used, translate program materials into other languages, such as Spanish, and provide extra help for patients with additional barriers to care.
Healio: Is there anything else you would like to add?
Dokras: First, the Fast Track to Fertility team employed a rapid-cycle innovation process to create and optimize the service. They conducted contextual inquiry to learn more about the patient experience and build empathy for the end user. They also conducted fake back-end pilots to test and authenticate various iterations of the texting program before investing in the build of the platform that exists today.
Second, it worked! Our goal was to reduce the time from the patient’s first contact with our practice to initiating fertility treatment, and our redesigned model did just that, decreasing time to treatment by approximately 50%. Fast Track to Fertility also increased annualized new patient access by 24%, enabling us to serve more patients experiencing infertility each year.
Third, this project is part of a larger body of work I’m doing to explore and implement innovative solutions in the women’s health space.
References:
- Fast Track to Fertility program sharply cuts time to treatment, Penn study finds. www.pennmedicine.org/news/news-releases/2022/october/fast-track-to-fertility-program-sharply-cuts-time-to-treatment. Published Oct. 10, 2022. Accessed Oct. 17, 2022.
- Senapati S, et al. NEJM Catal Innov Care Deliv. 2022;doi:10.1056/CAT.22.0065.