MedCity FemFwd: The Importance of Virtual Maternal-Fetal Medicine

Welcome back to another episode of MedCity FemFwd, a podcast dedicated to discussing the breakthroughs and challenges in women’s health. In this episode, we’re joined by Dr. Blake Porter, chief of maternal-fetal medicine with Access TeleCare.

He discusses the need to expand access to virtual maternal-fetal medicine care and the ways Access TeleCare is helping make that possible.

Here is an AI-generated transcript of the episode.

Marissa Plescia: Welcome back to another episode of MedCity FemFwd. I’m Marissa Plescia, reporter for MedCity News. In this episode, we’re joined by Dr. Blake Porter, chief of Maternal Fetal Medicine with Access TeleCare. We discuss the need to expand access to virtual maternal fetal medicine care, particularly in rural areas.

Hi, Dr. Porter. Thanks so much for joining MedCity FemFwd. 

Dr. Blake Porter: Hey, thanks for having me. 

Marissa Plescia: Yeah, of course. So, maybe just to start, can you just, um, share with the audience a little more about yourself and your work? 

Dr. Blake Porter: So, um, thanks Marissa. I’m Blake Porter. I’m the Chief of Maternal fetal Medicine at Access Telecare.

Um, maternal fetal medicine or MFM for short is one of eight clinical subspecialties that Access Telecare offers and MFMs are specialists that are both double board certified and OB GYN and have done additional three years of training in high risk pregnancy care. So that enables us to, you know, provide advanced care both before, during, and after pregnancy.

Um, MFM specialists are rare, but increasingly important in the maternal health landscape annually. There are about 150, uh, new MFM physicians that enter the workforce, but the majority end up in urban and metro areas. In my role at Access Telecare, I equip our team of virtual MFMs to deliver consistent high quality care to patients across the country, um, that don’t really have good access to in-person MFM Care.

I work hand in hand with both operational and technology teams at the hospitals that Access Telecare is partnered with, and we guide the alignment of their clinical workflows and ensure that access Telecare really remains at the forefront of telemedicine. Um, I mean, for me personally, the promise of telehealth to close gaps in care for both patients and clinicians regardless of where they live or their care setting.

Combined with my passion for expanding that access to high quality pregnancy care is really what drew me to telemedicine in the first place. 

Marissa Plescia: Yeah, very well thought. Thank you for sharing that. Um, so going off of that, what does, um, or when it comes to maternal fetal medicine, what populations really stand to benefit the most from this, and what are some of the challenges?

That they’re, that can be improved by telemedicine. 

Dr. Blake Porter: Yeah, that’s a really crucial question. I mean, it kind of gets to the, the heart of our mission and what we do. I think, um. From the primary group groups, the benefit are really like twofold, both patients in underserved areas, and of course the local physician groups who are caring for them.

So from, for patients, especially those in rural underserved communities, the main challenge is simply a lack of MFM specialists. And that often means either driving hours for a consult or that, you know, that can add stress and risk to already complex pregnancy. But virtual MFM obviously removes that geographic barrier.

Um, so we can provide timely access to expert care, uh, often right from their immediate, like local clinic. Um. We’re in whatever community they’re in. And so that can significantly reduce the burden of travel and obviously improve the overall wellbeing for their pregnancy care. Um, we can be immediately at their bedside in their hospitals, um, and elevate the local care delivery there.

So patients, um, don’t need to travel so far. We’re able to effectively reduce out of hospital transfers and keep more care local and keep more deliveries local. On the flip side of that, of course there’s, you know, the local physician groups that face the challenge of managing ever more complex pregnancies, um, and at times uncomfortable cases without the immediate support of a subspecialist.

So we equip the local physicians with immediate access to our expertise, and we provide real time decision support, provide our, you know, second opinion. And we do collaborative care planning in terms of, uh, what a. What they’re up against, what has been presented in front of ’em and what diagnosis they need help with. 

Um, through this model, we ensure that really most pregnancies, uh, even high risk ones, can be safely managed, closer to home. That allows the patient to build a relationship with the local care team, um, have the birth experience in their own community. And of course, that has, you know, immense emotional and community value.

In essence, what we do, like our virtual MFM, we use technology to deliver our expert care precisely where and when it’s needed the most. And through that we can keep families together while empowering and elevating the local healthcare teams. 

Marissa Plescia: Yeah, that’s really great. Um, so can you go into a little bit more detail about what this, um, virtual maternal fetal medicine care really looks like from the patient perspective and what happens when they need in-person care?

Dr. Blake Porter: Yeah. So many facilities don’t have, um, you know, full-time in-person MFMs on staff, either because the hospital’s volume doesn’t warrant it or because full-time MFMs would just be too costly for a local healthcare system to undertake. And so that’s kind of where we come in. Um, we support the clinicians at the hospitals that access Telecare partners with Nationwide by offering both inpatient and outpatient care as well as ultrasound readings.

Um, so, uh, you know. We try to mimic in-person care as much as possible. Um, with the exception obviously of, you know, procedures, uh, we provide kind of the entire gamut of what a woman might need in a hospital setting. So we can, uh, prop up, um, outpatient clinics that could be as frequently as, uh, you know, multiple times a week, uh, but as infrequently as once every other week, um, which would be delivering, uh, consults in an outpatient clinic, um, counseling women about either their issues before pregnancy in a preconception fashion.

We’re helping manage their comorbidities during a pregnancy. Uh, and all the while, you know, reading and interpreting their ultrasound exams and letting them know if there are any challenges that their, uh, baby’s gonna face from either, um, a fetal anomalies or birth defect standpoint, um, or other issues that can arise during their pregnancy.

Um, that kind of speaks to a significant, uh, aspect of what we do is we have, um, an additional advanced practice sonography team. And so those are a team of highly experienced MFM sonographers who, uh, kind of aid the local teams and our m fm positions and identifying abnormalities on ultrasound. And so when we pair our MFM positions plus our advanced practice sonographers.

We identify or catch about an additional 8% of abnormalities beyond what local care teams identify initially when they bring exams to us. And so we really are kind of elevating the, the quality of the imaging and elevating what local care teams can do in terms of not only of course deliver, you know, just delivering the care in the first place, but actually providing a significantly elevated expert level of care.

Um, that would be the same type of care that they would expect in any major metro around the country. Um, on the inpatient side, it looks like us, um, kind of, you know, uh, being at the bedside and delivering consults at the bedside and directly helping their, uh, local ob doctors manage, uh, the patients. And whether that’s.

Uh, just counseling and talking them through a difficult situation and letting them know both prognosis and what the next steps are. Um, but also working with the physicians to help develop that plan of care and make sure that we, um, have, have the resources, uh, and also have the right, uh, plan of care in place no matter, you know, how significant their condition is.

Marissa Plescia: Yeah. That’s really interesting. And you’ve mentioned a few times about how you’re partnering with some of the local providers, their local physicians and hospitals. Um, can you share a bit more about what they’re facing and what they’re um, experiencing in terms of challenges and how you’re supporting those local providers?

Dr. Blake Porter: Yeah, so a lot of times, you know, not surprisingly, um, obstetrics is, um, a very complex field where we can take a normal pregnancy and have significant problems in a very short amount of time. And so when we have those situations, almost every patient enters their pregnancy thinking things are normal, and thinking things are go well.

Um, it’s very natural and normal, myself included, that when, uh, we’re going through the family building process, we think everything will be fine and everything will be great. And the unfortunate reality is we know that many problem, many problems arise in pregnancy that we weren’t expecting in pregnancies that were previously normal.

And so. Of course there are, you know, very, uh, major significant challenges, uh, to pregnancies that do need in-person, um, uh, MFM care that ends up in, you know, Metro Urban Centers. Um, but most of what we do and where we excel is, uh, by keeping patients local, um, helping elevate their, uh, OBGYNs and helping their OBGYNs really just.

Feel like we’re, like they’re doing the right things. Um, and being kind of a comfort blanket to them and a sounding board that, you know, this has gotten maybe a little bit challenging and maybe this isn’t a problem that they see every day, but really bring our expertise in behind and either say, suggesting, you know, actually you’re totally on the right track.

This is a great plan. Yes, this is, you know, scary. Um, yes, this is something that maybe your hospital doesn’t see all the time, but we see this a ton. Um, we have handled this in many pregnancies. And helping kind of advise on, uh, understanding their local care systems and understanding if they have the right resources to ultimately care for that patient locally.

Um, many times they do, many times after talking through whatever the pathology is, we can help the local care teams understand that uh, we have a good plan of care in place. Um, it is something that they are equipped to take care of locally and through that process of working with their OB care teams.

Help them understand, uh, that, you know, this baby can potentially deliver locally. Um, of course we encounter times when that’s not the case and neither from a resource or a complexity standpoint, uh, we need to transfer out, uh, to a major, uh, larger healthcare system, uh, that is better resourced to handle the problem.

But, um, if we are successful in partnering with the local care team, elevating what they do and keeping those deliveries local, of course that means, you know, more, uh, patients delivering in their communities. More babies that are born with dad at the bedside with grandma and grandpa at the bedside with their brothers and sisters at the bedside.

And really kind of increasing, uh, the numbers across the country of deliver deliveries that can happen in their local communities, in their local care systems, and really kind of change the way, uh, the way patients experience, uh, birth in this country globally. So, um, that’s a little bit about how, you know, we really work alongside the local care team.

To give them, uh, our expertise and equip them to keep, keep local deliveries happening, uh, keep, you know, families delivering in their own communities. And then also over time, uh, the long-term goal there is that we, uh, really elevate these community health programs so that not only, of course, the hospital administrators, the physicians that work there take pride in what they do, but really the community themselves see this as a hospital that.

Invests in experts, invests in, uh, bringing the right technology and expertise to their bedside and really is equipped to handle, um, you know, the highest complexities that they’re able to from a resource standpoint. Um, but that can deliver a very quality care product, uh, locally in their community. 

Marissa Plescia: Yeah, that’s really important.

Thank you for sharing that. Um, you mentioned earlier, uh, sonography. Can you talk a bit more about what additional tools and technology that you’re using to really support this care? 

Dr. Blake Porter: Yeah. Um, so, uh, we’re, uh, a, a tech enabled, uh, health, health company, healthcare delivery company, if you will. Um, and so, uh, while our doctors are certainly experts, uh, from coast to coast in their own right, um, a significant portion of what we do is bring, um, different tools and technology that do elevate our ability to deliver care beyond kind of the, the average, uh, telehealth company.

So we use. Our technology platform is called Telemed iq or TIQ for short. It’s kind of the backbone of our tech stack and what we do, this is our, uh, patient facing tech, um, uh, that enables our clinicians to talk back and forth, uh, quickly and effectively. And then additionally, we have our proprietary telemedicine cart.

So our. Portable telemedicine carts are kind of wheeled into patient rooms, um, that enables that one-on-one provider patient interaction. They have, uh, they’re, they’re very fancy fancier than my tech. They’ve got, you know, HD camera that zooms and tilts. They’ve got a large Apple Mac screen, um, and Apple iPad attached that they run over and they’re intentionally designed to make patients feel like, you know, our life-size providers are actually in the room with them.

And so, uh, those, those are carts are great. Um, um, they really do kind of, um, bring us into the patient’s room and allow us as, uh, physicians to kind of break through the screen and get, you know, that, uh, experience that we’re after where we really do feel like, um, there’s no tech actually limiting anything we’re doing.

It’s just enhancing our ability to deliver care. Of course, on the sonography side of things, we also have, uh, multiple different, um, sonography reporting platforms that we run over. So we try to be relatively tech agnostic when there’s specific things that clients need us to do, um, in terms of if they have.

Different types of ultrasound programs that they’re utilizing. Um, we oftentimes can go into those, uh, go into those ultrasound programs. Um, we can get into their EMR directly. We don’t ask them to change a whole lot of what they’re doing. Uh, we try to, uh, when there’s, uh, tech and software already on board, we integrate into that as seamlessly as possible and really try to become a member of their hospital staff, both in a.

Actual, you know, uh, credentialing, licensing, privileging standpoint. Um, but also in terms of the work we do in producing, you know, the notes directly in their EMR, so they’re not hunting through, uh, a different portal to get at our recommendations. Um, producing their ultrasound reports directly in their native ultrasound reporting software.

So there’s not a different portal where they have to go download stuff. Um, that’s really critical to what we do. Um, in terms of both keeping our client hospital partners happy, but also in terms of getting the communication directly to the providers at the source and the way that they’re used to receiving it.

Um, that allows us to really shorten that time to care, shorten that time to, uh, medical decision making. And that’s one of the critical things that we do in terms of, um, how our, our tech drive, our operations and our operations ultimately drive better patient care. 

Marissa Plescia: Absolutely. Well said. Um, we also know that mental health can really affect, uh, pregnancy complications.

How can telehealth support this area? 

Dr. Blake Porter: Yeah, so, you know, mental health is, uh, you know, I, I trained obviously to be an OB GYN and then Irish pregnancy specialist, but it, there’s not a field of medicine that’s not touched by the increasing need for mental health services, regardless of which subspecialty you’re in.

And so. Our, uh, our care is not unique in that, um, we know that, uh, our, uh, mental health, uh, conditions are on the rise. And whether it’s talking about perinatal depression or, um, also, uh, more significant, uh, mental health conditions, um, they affect, uh, pregnancies. And really, uh, we know that there’s a significant burden of mental health conditions on both pregnancy complications and pregnancy related deaths in the us.

So. Our MFM physicians work, um, with many patients that experience either deteriorating mental health conditions or just managing their chronic, um, mental health, um, both during pregnancy and uh, potentially postpartum. Um, we partner with their local OB GYN teams, uh, whether it’s, you know, managing multiple medications, uh, both to optimize their maternal medical condition, um, or to reduce fetal exposure to the medicines that are needed to manage their mental health.

Um, additionally, access Telecare broadly, uh, has a significant behavioral health specialty unit, and so many of our hospitals and health systems that we partner with, um, they also, uh, hold, uh, a behavioral health service line that can provide either consultations in their emergency department or, um, you know, consults on complex medical conditions that also need behavioral health management.

Um. During their inpatient stay. And so, uh, through access to those, uh, partners and, um, Dr. Genevieve’s group, uh, I love working with them. ’cause oftentimes we’re bouncing things back and forth off each other, uh, to make sure that, um, both of us are operating on, you know, the most current and evidence backed recommendations we can have for managing mental health and pregnancy.

So whether it’s, um, you know. A healthcare system that has access to our behavioral health team, our MFM team, or both, um, we can kind of collaborate, um, across specialty lines to really make sure that, uh, both the behavioral healthcare and mental health care as well as the pregnancy care that Access Telecare broadly is delivering, is really, you know, leading, uh, leading the charge in terms of providing the, um, not only meeting the standard of care, but exceeding that standard of care and providing that kind of best in class service that we look for in our, in our experts.

Marissa Plescia: Absolutely. So important. Um, well, Dr. Porter, uh, Porter, I really only have one last question for you. Um, what do you hope to see from the healthcare industry to really expand access to virtual maternal fetal medicine? 

Dr. Blake Porter: Um, yeah, that’s a great question. I mean, I guess broadly, I hope they just expanded, you know, expanded it to the hilt.

Um, I think we’re seeing that, you know, uh, our virtual MFM care, uh, has the greatest impact in rural areas. We know that, uh, nearly uh, nearly half of like rural US counties are maternity care deserts. Um, we know that a lack of providers and limited access to. High level of care translates to significantly worse pregnancy outcomes.

Um, and the trickle down effect of that, of course is increasing numbers of, uh, you know, in its worst form, increasing numbers of maternal death. Um, the investments that we’re making are great. I think, you know, a lot of buzz has been a. Talked about the Rural Health Transformation Fund and the Rural Health Transformation Program.

Um, definitely a step in the right direction, but I still think absolutely we need more to be done to improve access to care for our rural patients. Um, of course, you know, we know that women, uh, you know. Across cultural trends are that women are delaying childbearing and women over 40 experience, you know, worse pregnancy and delivery complications at a higher rate.

And of course, the need for our subspecialty to get into those areas is only growing. Uh, but there are very few practicing MFMs compared to other specialties, and most of them work in the large metropolitan areas. So, um, we’ll need to continue to, uh, adopt strategies that, uh, get MFMs into rural. Rural communities, smaller hospitals, smaller and medium sized hospitals.

Um, telehealth just happens to be a great lever to pull on, uh, to get subspecialty care where it needs to go regardless of zip code. Um, we also know that, uh. A key kind of critical function of, um, ensuring that we keep our labor and deliveries open at rural centers is, uh, supporting the OBGYNs and access to subspecialty backup is a significant part of kind of attracting and retaining OB GYN physicians to keep their rural labor and deliveries functional, to keep deliveries, uh, happening locally.

And then of course, obviously we, uh, not only support the obs. So that hospitals can attract and retain them, but also keeping the transfers as low as reasonably possible, uh, so that those, uh, rural healthcare systems are vibrant and financially stable. Um, so really there’s, there’s several different ways, um, that we, uh, see ourselves kind of supporting the, the need and the growing need for, um, our rural healthcare systems to be.

Um, kind of vibrant and stable. Uh, and it’s exciting that we have things like the Rural Health Transformation Fund that are going to continue these investments. Um, we of course, just look forward to partnering with states and, uh, local healthcare systems, uh, as more of this comes online and more of this becomes available about how this will work.

Um, making sure that they have access to, you know, a great group of physicians. A great, uh, a great service. Um, and so that, uh, we can continue those investments in rural healthcare. 

Marissa Plescia: Yeah. Very well said. That’s great call to action there. Um, well, Dr. Porter, this has been such an interesting conversation.

Thank you so much for joining MedCity FemFwd. 

Dr. Blake Porter: Absolutely. Um, thanks for having me. Um, I’m super grateful for the work that you guys do. Um, the, uh, from knowing the different podcasts and the different people you have on, um, there’s so many different ways that, uh, all different walks of healthcare, not just, you know, physicians and direct care providers, but ways that we can focus on.

Um, really how women’s healthcare needs to be put. Um, uh, put in more into the spotlight and more resources devoted towards uh, um, obviously what I do in terms of the pregnancy world, but really all across the age spectrum. Uh, having a focus towards how we can put attention and resources into women’s healthcare and really bring, uh, bring that standard up to, uh, the rest of our healthcare systems.

Marissa Plescia: Alright, absolutely. Thank you so much. Really appreciate it. 

Dr. Blake Porter: Absolutely. Thanks Marissa.