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Tele-Maternal-Fetal Medicine (Tele-MFM): Putting the Patient and Her Community at the Center

As a nation, we have much more to do to care for pregnant women so they have a healthy pregnancy and a healthy delivery. Compared to other developed nations, the U.S. has significantly more pregnancy-related deaths. About 17 deaths per 100,000 live births occur annually.

The causes are complex, but many of these deaths are preventable, and access to maternal-fetal medicine subspecialists is a key factor. MFM subspecialists partner with primary maternity providers in the management of at-risk expectant moms.

Yet, while efforts to reduce maternal morbidity and mortality and recognition of MFM specialists’ vital role are increasing, access to MFM specialists remains inconsistent. Of the country’s 1,700 MFM specialists, 95 percent practice in major urban areas, leaving vast areas of the country without access to their expertise.

In addition, traditional telemedicine MFM programs have centered not on the needs of the pregnant woman and her community but on the “hub” – the urban, typically tertiary facility.

In the regional hub-and-spoke teleMFM model, a nurse (or MA in some settings) and a sonographer are assigned to a remote clinic to which they may travel on a weekly or biweekly basis, while the MFM subspecialist stays at the hub, renders services, and documents the encounter in the hub’s native EHR.

The gaps in this model are significant:

  • What happens on the days the staff is not there in case an emergent referral is made?
  • Is this the best way to help the “spoke” community?
  • What if the clinic is under-utilized one day (only 1 patient scheduled out of 8 available slots)?

The Access Physicians tele-MFM program is different, and it prioritizes the patient and her community.

  1. Our goal is not to drive volume to a regional tertiary facility. Our goal is to improve access to local care and allow community hospitals to keep more of their patients.
  2. We work with local staff, providing ongoing training and education to provide higher level obstetric imaging. This elevation in skill benefits the entire community.
  3. With local care resources, not just a one-day-a-week clinic, the community has immediate access for emergent referrals. No family has to spend more than 24 anxious hours to be counseled about the condition that places the pregnancy in a high-risk category. The staff is already on the ground and the technology is already available. It is just a matter of finding a suitable time that the MFM can get on the video-feed to counsel the family before a more comprehensive visit takes place at the regularly scheduled clinic hours.
  4. We increase the likelihood of treatment plan compliance. With more convenient and locally accessible care, a pregnant woman with poor diabetic control, for example, is more likely to keep her appointments. She has less worry about taking time off work or finding childcare or needing money for gas.

A recent evaluation of 14 months of data of 3400 outpatient visits on nearly 1100 new referrals from 51 community maternity providers showed that Access Physicians’ tele-MFM model, utilizing and strengthening local care resources and staff, allowed 94 percent of families with an at-risk pregnancy to remain close to home for prenatal care and delivery.

Doing more to change the trajectory of maternal health across the country means making MFM subspecialists more available and accessible. The Access Physicians tele-MFM program is doing just that.