As medical director of the Maryland Perinatal Outreach Program, Dr. Hugh Mighty would spend hours in his car traveling from Baltimore to the far reaches of the state and back just to visit one patient with a high-risk pregnancy.
Now, thanks to a pilot telemedicine program, Mighty can talk to several women around the state in one afternoon without ever leaving his office building.
With a $200,000 grant from the state Department of Health and Mental Hygiene, Mighty, chief of obstetrics, gynecology and reproductive sciences at the University of Maryland Medical Center, has established relationships with St. Mary's Hospital in Leonardtown and Union Hospital in Elkton to offer consultations for high-risk pregnant patients via video teleconference. He's conducted more than 30 of these medical visits since the program started in March.
One woman taking advantage of the program is 33-year-old Cathy Fernandez of Lusby, in Calvert County.
When Fernandez was pregnant with her daughter Morgan in 1995, she had a series of problems. About halfway through the pregnancy, she developed toxemia (bacteria in the blood) and pre-eclampsia, a dangerous condition that causes swelling and high blood pressure.
Then she was hospitalized for a kidney infection. At one point, her blood pressure got so high that she was placed on bed rest because she was at risk for fainting. Finally, 37 weeks into the pregnancy, she had an emergency Caesarean-section delivery when doctors discovered the umbilical cord was wrapped around Morgan's neck. Though Morgan was otherwise healthy, she was small for her age, weighing just under 5 pounds.
In 1998, Fernandez had a troubled second pregnancy. She went into labor on her due date and headed to the hospital. There, doctors found that the placenta had separated from her uterus. The baby girl was stillborn, and at full term, weighed a little more than 5 pounds.
Now more than halfway into her third pregnancy, Fernandez has already had one consultation with Mighty, who ordered tests and advised her to take a daily dose of baby aspirin to help ensure proper blood flow to her fetus.
Fernandez said she found the teleconference helpful.
"The first time I spoke to [Mighty], so many things [made] sense to me that never did before," she said. "It was just like being there face-to-face, or in this case, face-to-TV screen."
In starting the program, Mighty wanted to extend high-risk obstetrics services into communities that don't have them. His goal is to identify medical issues upfront and share information with the local obstetricians so women can deliver close to home.
In his 23 years of practice, Mighty, 49, has delivered more than 2,000 babies and seen his share of complications, including gestational diabetes, preterm labor and drug exposure. While he enjoyed conducting the home visits, his work administering an ob/gyn department, teaching, seeing patients and delivering babies precluded him from doing so more than once a month. Using teleconferencing, he sees high-risk patients every Thursday afternoon.
Telemedicine program coordinator Jenifer Fahey works with obstetricians in the two community hospitals to set up appointments and collect ultrasound photos and medical records for Mighty's review. During the consultations, Mighty answers patients' questions, offers advice and orders any necessary medical or laboratory tests.
In some cases, tests can be performed locally, sparing women the need to make trips to Baltimore. The teleconferences are recorded, and digital copies of Mighty's reports are sent to the hometown obstetricians the next day.
So far, the women he's consulted with have been able to deliver their babies in their local hospitals. Mighty hopes to expand the program to additional Maryland hospitals in the future.
Telemedicine itself isn't new. The technique has been used since the early 1990s for remote monitoring of cardiac patients, reviewing radiology reports and directing surgery in distant locations. However, there are only a handful of programs around the country that use the technology for high-risk pregnancies.
One of the largest programs is run by the University of Arkansas for Medical Sciences in Little Rock and funded by Medicaid. In its 3 1/2 years of operation, physicians there have consulted with nearly 2,000 patients in 40 sites around the state.
The program's director, Dr. Curtis Lowery, estimates that by working with local physicians to establish guidelines for managing high-risk pregnancies and establishing a transport network for women who need to deliver at hospitals with specialized equipment and intensive-care units, he and his colleagues have saved $17 million in Medicaid billing.
"We're changing the paradigm of health care so health care is delivered in ways other than face-to-face delivery," Lowery says.
In Maryland, obstetricians at the participating community hospitals praised the program.