Delivery of Obstetric Telemedicine Services 1/24/20

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DELIVERY OF OBSTETRIC TELEMEDICINE SERVICES

Terry Harper, MDDivision ChiefMaternal Fetal MedicineUniversity of Colorado Acknowledgements: Dr Bettina Cuneo, Children's Hospital Colorado and Dr Curtis Lowery, University of Arkansas

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WHAT IS TELEMEDICINE??THE USE OF ELECTRONIC INFORMATION AND

TELECOMMUNICATIONS TECHNOLOGY TO SUPPORT THE DELIVERY OF HEALTH

Telemedicine is a remote clinical services, telehealth is delivery of remote non-clinical services (CME, provider training) etc

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COMMON USES OF TELEMEDICINEBRIDGING THE DISTANCE FOR RURAL AREAS FAR FROM CENTERS OF EXCELLENCE

• Mental health consults• Home monitoring of blood pressure, blood glucoses

• Retinopathy screening for diabetes• Teledermatology• Otoscope that connects to iphone

• Telepathology• Telestroke programs

• Teleradiology• MFM consult and High risk ultrasound services

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Delivery of Obstetric Telemedicine Services 1/24/20

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LESS COMMON USES!!!!

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GOALS OF PRACTICES START TELEMEDICINE• Increased access for patients• Increased markets for providers

• Reduced costs• Improved health outcomes• Improve patient satisfaction

• Improve provider satisfaction

Are you the hub or the spoke or both!?!?!

MFMOBGYN

FamMedMidwives

OBGYN

Patients

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HOW IS TELEMEDICINE DELIVERED?

MFM Consult with Ultrasound

MFM Remote Ob Ultrasound Reads

Ob Providers/MFM

Appointment reminders, behavioralreminders

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Delivery of Obstetric Telemedicine Services 1/24/20

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USES IN OBGYN

• mHealth excessive weight gain prevention• Preterm labor home monitoring

• Preeclampsia home monitoring• Diabetes blood glucose monitoring• Obstetrical ultrasound and MFM consultative services

• Postpartum Visits—Mood disorder screen, Breast feeding support

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IMAGING SERVICES FROM A DISTANCE

Live and Real-time

Any ultrasound machine, designated location with experienced sonographer

Anatomic survey with suspected abnormality

Physician reviews at time of visit

Direct interaction with sonographer and patient, scanning done under supervison of physician, diagnosis and consult at time of visit

Real time diagnosis and management

Giving bad news by specialist “in person”

Can bill for read and consult

Equipment cost decreasing but currently additional cost to site

Store and Forward

Any ultrasound machine, designated location with experienced sonographerAnatomic survey with suspected abnormality

Physician reviews at convenient time for MD

No direct interaction with sonographer or patient; if images are not of diagnostic quality, patient has to returnHours to days between study and diagnosis/managementGiving bad news remotely (or by referring provider)Can bill for ultrasound read but not consult

Equipment cost minimal

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DENVER TO GRAND JUNCTION: ONE EXAMPLE OF TELEMEDICINE

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Delivery of Obstetric Telemedicine Services 1/24/20

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COLORADO GEOGRAPHIC CHALLENGES

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Delivery of Obstetric Telemedicine Services 1/24/20

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VIDEO OF FETAL ECHO TELEMED APPOINTMENT

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CHALLENGES• Reimbursement (prior auths occasionally required-Aetna)• Technology infrastructure and support

• Providers must be licensed in the state where the patient is receiving care• Patient and provider acceptance • Malpractice coverage

• Medical records/documentation

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REIMBURSEMENT

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Delivery of Obstetric Telemedicine Services 1/24/20

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PATIENT SATISFACTION

• 2019 metaanalysis reviewed 36 studies from many specialties• System experience- high levels of satisfaction• Information sharing- Confidence in communication and confidentiality• Patient centered professional and emotional support was high • Overall satisfaction 81% by participants

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TRAVEL TO DENVER?

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Delivery of Obstetric Telemedicine Services 1/24/20

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CHILD CARE AND TIME OFF WORK

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Delivery of Obstetric Telemedicine Services 1/24/20

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HOW TO START A PROGRAM?

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NATIONAL CONSORTIUM OF TELEHEALTH RESOURCE CENTERS

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REFERENCES

• World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth: World Health Organization, 2010.

• CUMed Guidelines• Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a

mode of service delivery in managing patients’ health. Orlando etal PLOS ONE 2019• Herring etal Do mHealth interventions prevent excessive gestational weight gain? BJOG 2017• Morrison etal Telemedicine: cost-effective management of high-risk pregnancy. Manag Care 2001• Lanssens D etal Midwives’ , obstetricians’ and recently delivered mothers’ perceptions of remote

monitoring for prenatal care: Retrospective Survey 2019. • Ming etal Telemedicine Technologies for Diabetes in Pregnancy: A systematic Review and Meta-

analysis 2016. J Med Internet Res

• Cuneo etal Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiolgoy 2019 ObGyn

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