Pilot Project Tests Remote “Teleconsultations” for Women in Outlying Communities
The University of Maryland Department of Obstetrics, Gynecology and Reproductive Sciences is now evaluating the use of telemedicine to link women with high-risk pregnancies in outlying communities with specialists at the University of Maryland Medical Center in Baltimore, saving these patients the stress and inconvenience of traveling. The telemedicine project, funded in part by the Department of Health and Mental Hygiene, is part of the Maryland Perinatal Outreach Program.
“Telemedicine provides us with an opportunity to use technology to extend the reach of our health care system,” says Hugh Mighty, M.D., associate professor and chairman of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine and chief of obstetrics, gynecology and reproductive sciences at the University of Maryland Medical Center. “This telemedicine capability is particularly important in a time of uneven distribution of health care resources and the dwindling number of obstetric care providers.”
Currently, pregnant women living in outlying communities in Maryland have to travel long distances to meet with specialists in maternal-fetal medicine, since the majority of these perinatologists are concentrated in the Baltimore and Washington, D.C., areas. The telemedicine visits, or “teleconsultations,” allow patients to go to a local site, such as their community hospital, and have a real-time consultation with a maternal-fetal medicine specialist in Baltimore.
“Patients with complicated pregnancies often have a lot of questions and concerns,” says Dr. Mighty. “Through the teleconsultation, we can provide answers immediately and develop a plan for managing their care. The patient can interact with the physician and ask questions as in a regular consultation; however, in this case, the patient sees the specialist on a video monitor. The technology also allows us to show the patients pictures, diagrams, models or videos.”
The Maryland Perinatal Outreach Program will examine whether this telemedicine collaboration allows the women to manage their pregnancies at their local hospital with the support from the perinatologist, avoiding the cost and inconvenience of traveling for a consultation in which a physical exam is not needed. In many cases, the physical exam and any necessary lab work can be done at the primary prenatal care physician’s office or at a local laboratory, either prior to or following the teleconsultation. What many of these women and their physicians need is a perinatologist’s expertise and assistance to create and maintain a plan of care. The maternal-fetal medicine specialists can use the telemedicine consultations for a wide range of pregnancy conditions, from genetic conditions to maternal gestational diabetes.
Dr. Mighty says, “Sometimes, we recommend testing that would require travel, but our goal is to have these women receive most of their prenatal care in their own communities and deliver their babies there whenever possible.”
Union Hospital in Cecil County and St. Mary’s Hospital in St. Mary’s County are the first hospitals to use the program. Organizers hope to expand the program to other facilities soon.
“The women who have participated in the telemedicine program have been very enthusiastic,” says Jenifer Fahey, C.N.M., M.S.N., M.P.H., instructor and perinatal outreach coordinator for the University of Maryland’s Department of Obstetrics, Gynecology and Reproductive Sciences. “For patients, the idea of minimizing or eliminating travel is very appealing. They can stay close to home and continue to see their local obstetrician, but they still have access to the perinatal specialists and their expertise.”
In addition to minimizing the travel for the patients, telemedicine allows the physician to maximize his or her reach. In one afternoon, a single specialist can see women in opposite ends of the state. With a couple of clicks on a remote control, the perinatalogist can “travel” hundreds of miles. Similarly, the technology allows local hospitals and community physicians to connect remotely to lectures and presentations from the University of Maryland as well as conduct case presentations and discussions.
“The telemedicine program really enhances the support we give to community hospitals,” says Dr. Mighty. “The face-to-face contact combined with the ability to share images and documents takes the collaboration to another level, which ultimately helps the patients.”
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