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. Definition of Need
 Dispersed population
 Insufficient number of MFM’s,
geographic concentration
 Poor prenatal care access
 Not meeting HP2010 goals (preterm
birth, perinatal mortality)

5. Geographic distribution of
MFM services in Virginia
Note MFM services in Lynchburg only 1 day/week

6. 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

7. 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

8. Harrisonburg Community Health Center

9. Harrisonburg Community Health Center

10. Barriers to Success
 Lack of support from local obstetrical
community
 Miscommunication about location of
delivery
 Difficult patient population
 Insurance reimbursement for telehealth

11. 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

12. Early Outcome Data
 Cohort prior to establishment of
telehealth MFM program:
 Mean GA first PNV: 17 weeks
 25% entered care after 20 weeks
 Frequent missed visits
 First year of MFM telehealth program:
 Mean GA first visit 13 weeks
 None entered care after 20 weeks
 Only 3 missed visits among entire cohort

13. Early Outcome Data
 Other outcomes: too early /too few to
assess for differences
 Preterm birth
 Diabetes control
 Continuity – post-natal care and pediatric
care
 Patient satisfaction - HIGH!

14. MFM Telehealth in Virginia!