By Sina Haeri, MD
I like to start my presentations to health care groups by pointing out that telemedicine in the care of pregnant women is nothing new. We’ve been doing virtual prenatal visits for years. And, we’ve had at-home monitoring of weight, blood pressure, and fetal heart rate. There’s also online communication with providers, mental health support, virtual postpartum visits, and outpatient subspecialty support.
Still, as telemedicine goes more mainstream and expands into more use cases, it’s important to level-set about the why. Here are six reasons why telemedicine in the subspecialty of maternal-fetal medicine (MFM) supports reduced maternal mortality and morbidity, better fetal outcomes, and stronger community presence and impact for local hospitals.
# 1 Clinical shortage of maternal-fetal specialists
With less than 2,000 MFM specialists nationwide, there are simply not enough maternal-fetal medicine specialists to provide timely access for pregnant women across the country. Compounding the problem is the fact that over 95% of MFM specialists are concentrated in major metropolitan areas, which in turn has created large maternity deserts. This means limited access to expert high-risk pregnancy specialists who are essential for healthy pregnancies and healthy deliveries.
Smaller hospitals typically can’t afford to recruit and retain a full-time MFM specialist. Most small hospitals lack the patient volume to justify the expense of having a full-time MFM specialist. From my experience, you need about 1,000 to 1,500 deliveries at your facility to support one MFM as an FTE.
Telemedicine gives facilities access to MFM specialists on-demand, when and where they are needed.
# 2 Poor distribution of MFM specialists
Of the country’s nearly 2,000 MFM specialists, 95+ percent practice in major urban areas, leaving vast areas of the country without access to their expertise.
From my own experience, if you look at the Texas Medical Center, for example, they are doing wonderful things when it comes to advancing maternal-fetal care including complex fetal interventions. But, that three-street block in downtown Houston at times has more MFMs than the rest of Texas combined.
MFM Telemedicine rebalances this poor geographic distribution by putting specialists in facilities when they are needed even if the specialist is physically 1,000 miles away.
#3 Reaching the underserved
Many clinicians will assume that discussions about the underserved mean rural communities. But that’s not necessarily correct.
Think of a mom in a big city who needs to have an MFM consult, but she doesn’t have the bus money, the gas money, or $10 or more it costs to park her car. She, and other individuals like her, become an underserved population when financial barriers impede access, and unfairly get labeled as “non-compliant.”
Telemedicine can help in this scenario, although you have to be cautious. For example, say I’m sitting in North Austin, and I have a patient in South Austin who can’t physically come to see me. Ideally, I’d want to jump on a telemedicine visit and see her, however I need to make sure state law doesn’t prevent it. In some states, you are restricted from providing telemedicine visits (and be reimbursed for them) if you are in the same community as the patient.
#4 Windshield time for pregnant moms
Windshield time is why I personally got into telemedicine. Windshield time is the 90 minutes a pregnant mom has to spend driving to see an MFM specialist. And, conversely, it’s the amount of time an MFM specialist has to spend in the car to get to underserved communities to see patients. Minimizing the inconvenience of drive time by using telemedicine instead increases the likelihood the patient keeps her appointment. And, it means the physician can see more patients.
# 5 Reducing language barriers
Telemedicine can help overcome language barriers and improve outcomes and the patient experience. This is especially helpful if you are discussing something complex, such as a hypoplastic left heart syndrome.
For example, if a patient is a native Spanish speaker, and one of the providers doesn’t speak Spanish, telemedicine can be used bring together multiple providers, allowing one who speaks Spanish to participate in the consultation to aid in the discussion.
#6 Reducing delays in treatment
Avoiding delays in treatment is key to better outcomes for moms and babies. With telemedicine, patients with a serious condition such as complications with certain twin pregnancies that require time-sensitive intervention can be seen quickly by a telemedicine MFM specialist. Through the power of telemedicine, an MFM specialist can see them, review diagnostic ultrasounds and other tests, and discuss what next steps can be taken to ensure they get whatever care is needed.