In recent years, telemedicine has been on an upward trend, with successful programs seen across a diverse variety of medical specialties. Reproductive healthcare is now the latest area making use of telemedicine's efficacy, and, according to a recent study published in the American Journal of Public Health, it's been an all-around success.

The subject of the study, a four-year-old Heartland, Iowa-based telemedicine program aimed at improving a woman's access to medical abortions, has both reduced the number of surgical abortions throughout the state and expanded care to women living in more rural areas. 

Conducted by researchers at the Oakland, Calif.-based Ibis Reproductive Health, the University of California at San Francisco, Planned Parenthood and the University of Texas in Austin, the study found that medical services to women living in more remote areas improved, with medical abortions increasing by 8 percent.

Study findings show that although overall early abortion encounters increased by 1.7 percent as a result of expanding the services to more rural parts of the state (particularly for women living more than 50 miles from a surgical abortion clinic), surgical abortions after 13 weeks decreased by a significant 7 percent.

Dan Grossman, co-author of the study, said, "It doesn't make more women get abortions, which makes sense. I don't think women have abortions because they're easy to access, but it does improve access so it helps women get in earlier." 

Iowa is one of a handful of states that doesn't allow mid-level providers to prescribe the abortion pill but require only a physician to do so. With physicians already in short supply, particularly in rural locations, many women in Iowa had only limited access to the services, one of the driving factors to create this telemedicine program in the first place.

"We saw this as a way where we can provide the abortion pill in a safe and legal manner both while not having to spend the money to drive a physician all over the state to essentially hand out the pill," said Todd Buchacker, co-author of the study and former regional director of health services at Planned Parenthood of the Heartland. 

If Iowa did allow mid-level providers to prescribe the abortion pill, Buchacker said the group most likely would not have pursued the telemedicine program.  

One finding of the study that surprised Grossman was data showing that the distance women traveled to get care decreased only slightly.

"We thought we would see more of a decrease," he said. However, he cited several factors that could explain the numbers, such as women trying to get an appointment sooner, or, if they live in a small town, maybe they don't want to have that procedure done in that town. 

In 2008, the year of its inception, the telemedicine clinic provided some 74 percent of all abortions in Iowa. Citing a recently published cohort study, researchers say the telemedicine program was "equally effective compared to a model involving an in-person visit with a physician," and also came with a low rate of adverse events.

How it works, Buchacker said, is that a physician sitting in a central office connects with a patient with a staff member at any rural clinic site via a HIPAA-secure videoconference. After the woman's lab work, patient education and ultrasounds have been completed and have subsequently been checked and confirmed by the physician, the doctor will then have access to open essentially a "cash drawer," where the medication is held.

"Essentially it's like choosing a printer from a list of printers," Buchacker said. "The physician will say, 'Okay, I'm going to open this drawer in front of you,' and so the drawer pops open just like a cash register does." Inside the drawer are two labeled pills for the patient to take in front of the physician. 

Although many officials hail the many benefits of Iowa telemedicine when it comes to cost savings and improved access to care, other groups disagree. Other groups have different sentiments. 

The Wichita, Kan.-based pro-life group Operation Rescue, for example, lodged a complaint with the Iowa Board of Medicine back in 2010 about a year after the program was established. In a press release issued by the group, President Troy Newman said that Planned Parenthood exemplified "dangerous misuse of technology that kills innocent babies and endangers the lives of women." 

The board found that technology had not been misused. 

Buchacker said in last year's Iowa legislative session, there was a bill that went through the House and made it to the Senate to ban the use of telemedicine when it came to abortion services. "That did not pass or make it to the governor's desk," he said. But other state attempts banning the use of telemedicine for abortion services have been successful. He cited Nebraska as one example. 

Overall however, he said, the program has been a success for women's health across the state and has provided invaluable services to women in need.