As abortion clinics shutter across the country, providers in states where abortion is still legal are expecting an influx of patients — and they’re hoping technology can help them manage the deluge.
Clinicians at brick-and-mortar and virtual abortion sites tell STAT they’re using and exploring technology like virtual assistants, online scheduling, increased virtual visits, and asynchronous messaging to ensure more convenient access to abortion care. Ideally, these tools could minimize the need for patients traveling from other states to visit clinics and keep wait times low, they say.
“We’re working to try to figure out the best way to accommodate people,” said Melissa Grant, chief operating officer at Carafem, a chain of reproductive health care clinics in Georgia, Illinois, Tennessee and Washington, D.C. After the Supreme Court reversed Roe v. Wade last month, Carafem saw its call volume double, from about 250 to 500 requests from patients each day. “Part of it is trying to make the online system as flexible and user friendly as possible. Digital technology is really, really helpful because you can scale more quickly.”
Their goal isn’t to replace in-person care. Instead, it’s to help the country’s remaining clinics treat more patients with less, said Mai Fleming, an assistant clinical professor at the University of California, San Francisco’s Department of Family and Community Medicine and a medical director at HeyJane, an online abortion medication provider. That means making it easy for patients to book appointments and dial in from wherever they are, but also keeping the clinic open for anyone who needs in-person care.
“During a time where reproductive autonomy is being stripped left and right, it’s really important for us to prioritize efficient processes, and prioritize autonomy in the decisions that [patients] are able to make,” she said.
With Roe v. Wade now gone, 26 states have either banned or are likely to ban abortion care, according to the Guttmacher Institute, a reproductive health policy research group. Under current law, patients in states with severe restrictions can travel to states where abortion is still allowed, though many people — especially low income and already marginalized populations — cannot afford to make that journey. Since abortion medication can now legally and safely be prescribed virtually and delivered to homes, patients from more restrictive states don’t need to visit clinics to pick up the pills as long as they can have them delivered within the state where it was prescribed. Patients who need a surgical abortion or other types of in-person care must still visit clinics.
Carafem, which offers video consultations and in-person care, is hiring more telehealth providers who can treat patients wherever they’re licensed regardless of the clinicians’ actual location. Virtual care “decreases expense, improves availability, and sometimes increases privacy depending on if [patients] can’t travel,” Grant said, adding that some patients call from their cars, friends’ houses, and other locations outside their homes to protect their own privacy.
The clinic group also recently introduced online booking: patients pick a time slot, type their medical history into a secure portal, and get an invite to a virtual waiting room before consulting with a provider, Grant said.
Automation also helps providers keep tabs on patients at home; those who opt in can text a virtual assistant called “Cara” who sends shipment updates, reminders to take the medication, and follow-up questions for the days and weeks after. Cara can summon a staff member if patients report abnormal side effects through the program, Grant said. Fleming said HeyJane also has a secure messaging system in its electronic health record allowing patients to consult nursing staff via text as needed.
Maine Family Planning is building a new system that will let rural patients — especially those without broadband — consult with providers in a “store-and-forward” format that doesn’t require both parties to be online at the same time, said Mareisa Weil, who works in development at the chain of clinics.
“By scaling up dramatically and continuing to scale up those telehealth options, we’re hoping that we will be able to avoid any disruptions and access to care for people already living in Maine, who may have had barriers to access that might be impacted by this increase in patients from out of state,” she said, though she explained that it’s too early to tell how many patients will make the trek to Maine from elsewhere.
While the Roe decision might have nudged some clinics to embrace technology faster, recent attempts to effectively ban abortions by limiting the procedure after a number of weeks into pregnancy had already forced them to turn to tools like telehealth, Grant said.
“The change under Roe has just allowed them to take the final step…it’s not all that much different, it was already significantly impacted,” Grant said. “Now it’s happening on a greater scale.”