This document describes the development of a telehealth network in Virginia to improve access to high-risk obstetrics care for rural and underserved populations. It notes the need for expanded access given the limited availability of maternal-fetal medicine specialists. The network partners with community health centers and local providers to deliver virtual specialty consultations. Early data shows the program has increased early entry into prenatal care and reduced missed appointment rates compared to prior to the program. It has also saved substantial mileage for patients who previously had to travel long distances for in-person specialty visits.

1. Development of a High Risk
Obstetrics Telehealth Network
Christian A. Chisholm, M.D.
University of Virginia
School of Medicine

2. Background
 UVA Telemedicine network
 Arkansas ANGELS

3. UVA Telehealth Network

4. UVA Telehealth Network

5. Definition of Need
 Large, widely dispersed population in a
geographically diverse state
 Insufficient number of MFM specialists,
geographic concentrated in urban areas
 Poor prenatal care access
 Not meeting HP2010 goals (access to
prenatal care, preterm birth, perinatal
mortality)

6. Geographic distribution of
MFM services in Virginia
Note MFM services in Lynchburg only 2 days/month

7. Getting started
 Established Telehealth network helps
greatly
 Even with an established network, grant
support will facilitate early success
 Governor’s Productivity Investment Fund
 HRSA Office for Advancement of
Telehealth

8. Community Partners
 Commitment to patients with greatest
access limitations
 Health departments, community health
centers
 Skill level of local providers
 Communication, record-sharing, logistics
of delivery

9. Harrisonburg Community Health Center

10. Harrisonburg Community Health Center

11. Culpeper Health Department

12. Central Shenandoah Health District

13. Central Shenandoah Health District

14. Barriers to Success
 Lack of support from local obstetrical
community
 Misunderstanding of role; perceived
threat to local services
 Miscommunication about location of
delivery
 Difficult patient population
 Reimbursement for uninsured patients

15. Early Outcome Data
 Population: predominantly Hispanic,
most non-English speaking, most
uninsured
 Most common problem leading to MFM
referral: diabetes. Others include
hypertension, thyroid disease, multiple
gestation, prior poor obstetrical outcome

16. Early Outcome Data
 Cohort prior to establishment of
telehealth MFM program:
 Mean GA first PNV: 17.2 weeks
 25% entered care after 20 weeks
 10.7% rate of missed visits
 After MFM telehealth program:
 Mean GA first visit 14.7 weeks (deceptive)
 None entered care after 20 weeks
 4.4% rate of missed visits

17. Early Outcome Data
 Other outcomes: too early / too few to
assess for differences
 Preterm birth
 Background rate of 10.2% reflects all women
 Our subset has a higher risk for preterm birth
 Diabetes control
 Infant mortality
 Will need more time to show a difference
 Arkansas program showed 26% reduction in
infant mortality!

18. Early Outcome Data
 Continuity – post-natal care and pediatric
care
 Patient satisfaction - HIGH!
 Provider satisfaction – HIGHER!

19. Reduced Patient Travel
 HRSA sites: 20,000 miles of patient
travel saved per 6 month block
 HCHC site: over 60,000 miles saved
since initiation of program
 Opportunity to save substantial expense
to Medicaid in patient transportation
 Other specialties available

20. MFM Telehealth in Virginia!