"Telemedicine provides us with an opportunity to use technology to extend the reach of our health care system", stated Hugh Mighty, M.D., associate professor and chairman of obstetrics, gynaecology and reproductive sciences at the University of Maryland School of Medicine and chief of obstetrics, gynaecology 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-foetal 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-foetal medicine specialist in Baltimore.
"Patients with complicated pregnancies often have a lot of questions and concerns", stated 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 Programme 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-foetal medicine specialists can use the telemedicine consultations for a wide range of pregnancy conditions, from genetic conditions to maternal gestational diabetes.
Dr. Mighty stated: "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 programme. Organizers hope to expand the programme to other facilities soon. "The women who have participated in the telemedicine programme have been very enthusiastic", stated Jenifer Fahey, C.N.M., M.S.N., M.P.H., instructor and perinatal outreach co-ordinator for the University of Maryland's Department of Obstetrics, Gynaecology 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 programme really enhances the support we give to community hospitals", stated 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."