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Telemedicine Trialed for Obstetric Consultations

Cynthia Johnson, for HealthLeaders Media, July 7, 2010

While some companies give birth to new ideas, like Apple releasing the iPad, The BlueCross BlueShield of Tennessee Health Foundation has an idea that helps women give birth. In January 2009, the nonprofit organization funded a $1.8 million, three-year pilot project to determine whether telemedicine technology could provide effective perinatal consulting services to women who have high-risk pregnancies and live in rural areas of Eastern Tennessee.

Maternal fetal medicine specialists and healthcare professionals at Regional Obstetric Consultants of Chattanooga and Knoxville offer care to women with high-risk pregnancies. However, women living in the valleys and mountains of Eastern Tennessee frequently would miss appointments due to travel time. These missed appointments could result in increased health-related problems in both mother and child.

To improve patient outcomes and access to care, ROC collaborated with Community Health Network to form Solutions to Obstetrics in Rural Counties (STORC). The goal of the BlueCross BlueShield–funded project is to use videoconferencing technology by New York City–based Tandberg to connect rural patients with ROC specialists.

“It’s about bringing an individual with highly specialized knowledge and being able to access them in a very timely fashion,” says Joe D’Lorio, manager of healthcare services for Tandberg.

Have specialist, don’t travel

An obstetrician may refer a patient to STORC because she has a high-risk condition, such as multiple gestation, diabetes, or a suspected anomaly with the fetus. Even though The BlueCross BlueShield of Tennessee Health Foundation funds the project, it is open to any patient referred by any doctor regardless of the patient”s insurance situation.

“We’re so grateful to the BlueCross BlueShield of Tennessee Health Foundation for providing funds for programs like this,” says Debbie Lance, director of the STORC project. “There are organizations out there that are looking to be able to help.”

ROC uses a computer-based system to schedule appointments with the added variable of location. It blocks time for the remote locations, and nurse practitioners can make adjustments depending on patient volume and need. On the day of the appointment, a nurse practitioner and a sonographer from ROC meet with the patient at his or her local hospital or physician’s office.

“We can be in a hospital setting where they give us an exam area to set up the equipment, or we can be in a physician’s office,” says Lance. The equipment at the remote location consists of videoconferencing technology, a display monitor, and a laptop.

During a typical visit, the nurse practitioner takes the patient’s history and the sonographer performs the ultrasound. Then they transmit the ultrasound images to one of the hub sites, where the consulting physician views the images on an oversized screen in an exam room.

The consulting physician can look at the patient, the nurse practitioner, and the sonographer on a videoconferencing screen and review the ultrasound images with them. The specialist can guide the sonographer to take additional views of the fetus with the ultrasound.

Bringing specialty services to the patient’s location has made a huge difference in reducing the number of appointments missed. “Patients are compliant with actually keeping that appointment,” Lance says. Since the launch of the project, STORC has logged a mere five missed appointments by mothers who had already delivered their babies at their hometown hospitals.

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