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Comments Off on Uncontrolled Diabetes and Pregnancy: Doubly Important

Uncontrolled Diabetes and Pregnancy: Doubly Important

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This Pregnancy’s Challenge:

An 18 year old patient presented in a rural area to the local OB physician when she was 16 weeks pregnant. Her OB history showed she had been diagnosed with Type I Diabetes at age 5. She had been seeing a local endocrinologist but was told he would not follow her and manage her insulin during pregnancy.

The close diabetic monitoring required throughout the pregnancy would need to be provided by a Maternal-Fetal Specialist. Because the closest one was approximately 1 ½ hours from the patient’s home, she was referred to Women’s Telehealth by her local OB physician for co-management. Women’s Telehealth provided MFM care through telemedicine visits.
Of additional concern was that the patient was noted to be non-compliant in her insulin regime and diabetic care.

The Team’s Actions:

  • Initially, the patient was taking both long-acting insulin daily and at bedtime, and rapid-acting insulin with meals. She had an implanted blood glucose monitor and was to follow an ADA diet.
  • During her initial MFM consult, Women’s Telehealth counseled the patient to monitor and bring her blood sugar logs and insulin regime to every visit. 
  • For four weekly visits, the patient did not follow instructions.  Women’s Telehealth continued to counsel her as to the potentially poor outcomes for the baby if her blood sugar was not controlled, as well as the importance of complying with the monitoring, diet and insulin regime. During this time, her baby slipped from the 55th percentile to the 29th percentile.  Not a positive trend. 
  • Women’s Telehealth provided on-going insulin management, ultrasound fetal monitoring and counseling regarding non-compliance. With positive reinforcement, SOMETHING CHANGED!
  • Her 18-20 week anatomy scan was normal.
  • From 23 through 33 weeks, the patient started bringing in her blood sugar logs and her insulin levels became controlled.  In fact, she reported they were, “the best they’ve ever been.” The baby grew from the 29th percentile to the 52nd percentile. Dopplers and antenatal testing showed GREAT improvement. 

The Results:

  • The story has not ended as the baby has not delivered. But, the baby is healthy and within a few weeks of a safe delivery.  The patient was moved to an “all as needed” status with her insulin regime and blood sugars under control.
  • Through telemedicine, the patient was able to stay local and receive the needed medical care, as she could not have traveled outside of her area.
  • The tele-MFM option greatly improved patient compliance and results.  
  • The patient realized travel savings of 1,980 miles and over 35 hours.                                                                                                                                                                      

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The prevalence of diabetes in pregnancy in the U.S. is increasing. Pre-existing, Type I diabetes confers an increased and more significant risk to both mom and baby than gestational diabetes. Tight blood sugar control is critically important at all stages of pregnancy. Uncontrolled diabetes in pregnancy can lead to such complications as fetal anomalies, pre-eclampsia, fetal demise, macrosomia, neonatal hypoglycemia and spontaneous abortion.

 To learn more, visit: https://www.cdc.gov/pregnancy/diabetes-types.html

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Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing high risk situations and  to help turn patient and OB provider concern into the best possible care plans and outcomes for mom’s and their babies. For more information, call our office at:  404.478.3017              

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Comments Off on Baby’s Gastroschisis: Early Diagnosis and Preparedness Made the Difference!

Baby’s Gastroschisis: Early Diagnosis and Preparedness Made the Difference!

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How to successfully manage the complexities of gastroschisis in pregnancy is the focus of this Women’s Telehealth patient story. [Pictured above: Gastroschisis Baby – Post Op]

This Pregnancy’s Challenge:

At the anatomy ultrasound scan at 17 weeks, the OB physician found that his 24 year old Caucasian patient had a suspected gastroschisis.

Gastroschisis is a birth defect in which the fetus’ intestines and/or stomach protrude outside the abdominal wall. A baby with this condition requires immediate surgery after birth to place the organs in the proper place in the abdominal cavity and close the hole in the abdominal wall. Hospitalization is also needed for an extended period of time to ensure that the baby’s feeding and digestive tract are functioning well. Most babies with appropriate care and surgery at birth will grow up to have normal lives. Successful outcomes often depend on early identification of this birth defect and preparing for surgery upon birth.

In addition to the suspected gastroschisis, other complicating factors included mom’s obesity, pregnancy-induced hypertension, low amniotic fluid, abnormal cervix and active kidney disease. The mom-to-be also needed an extra dose of oversight and compassion due to the loss of a baby during a previous pregnancy, caused by open neural tube defect.

The mom-to-be was referred by the OB physician to Women’s Telehealth maternal-fetal medicine (MFM) physicians for diagnosis and collaborative pregnancy management. Women’s Telehealth was asked to manage BOTH infant and maternal pregnancy complications.

The Team’s Actions:

  • The patient was seen multiple times by Women’s Telehealth to assess her baby’s and her own well-being. The severity of the baby’s birth defect was moderate.
  • Advanced, serial “live” ultrasound imaging for fetal growth and well-being was performed including: targeted ultrasound scan, fetal echo, BPP, Dopplers, cervical length and AFI measurements.
  • Mom was admitted to the hospital for low amniotic fluid once during her pregnancy.
  • Mom was counseled for what to do in the event of pre-term labor.
  • Women’s Telehealth arranged for a pre-delivery consult with a pediatric surgeon at CHOA in Atlanta, as the baby would be transferred to the pediatric hospital as soon as it was born.                          
  • Women’s Telehealth arranged for a local Atlanta OB GYN group to deliver the baby via C-Section due to the birth defect.           

The Results:       

  • Weekly monitoring by the Women’s Telehealth MFM doctor showed a worsening of the mom’s kidney disease.
  • The decision was made to deliver the baby via C-section at 35 weeks at a hospital close to the children’s hospital where the baby would have its surgery and remain for some time.
  • A baby girl weighing 6 lbs. 3 oz., with Apgar scores of 8/8, was delivered without incident.
  • The baby was promptly transferred to the children’s hospital where successful closure surgery was performed.

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The CDC estimates that Gastroschisis affects 1 in every 1,900 babies born in the U.S. each year. The cause of this birth defect is currently unknown but researchers have speculated that potential causes may be adaptations in genes and/or the lifestyle or environment of the mother.  Young, Caucasian women are the most common population to be at risk. For more information about this condition visit:  https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html

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WT partners with OB/GYN physicians and healthcare facilities to provide the highest level of Maternal-Fetal Medicine (MFM) available through telemedicine.  WT provides services in local hospitals, doctor’s offices and government clinics.

Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing high risk situations and to help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies. For more information, call our office at:  404.478.3017

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Comments Off on Advisory Board Publication, Telehealth Primer: Pregnancy Care, Features Women’s Telehealth

Advisory Board Publication, Telehealth Primer: Pregnancy Care, Features Women’s Telehealth

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Virtual pregnancy care spans from prenatal to postpartum care.  It incorporates a variety of telehealth modalities including audiovisual visits, remote patient monitoring and “live” and asynchronous store and forward imaging.

The Advisory Board is the best practice firm helping healthcare organizations worldwide improve their performance using a combination of research, technology and consulting. They have 12 offices on 3 continents and publish to over 9,000 healthcare organization outlets.

Recently, the Advisory Board published the piece, “Telehealth Primer: Pregnancy Care.” The publication features four innovative healthcare organizations using telehealth tools to deliver different aspects of pregnancy care and their business cases and results.

Women’s Telehealth is pleased to be featured in the primer for our work in providing maternal-fetal medicine services, delivered 100% via telemedicine, to help decrease preterm labor and improve access to maternal-fetal medicine providers.  

The Mayo Clinic’s OB Nest program and the University of Utah were also featured in the Primer for their work in delivering antepartum visits virtually vs. in-person visits, to improve patient satisfaction with the same clinical outcomes.

The Primer also featured the University of Pennsylvania for delivering postpartum visits via remote patient monitoring to ease post-delivery care and outcomes for new moms.

For a copy of this informative primer, visit: https://www.advisory.com/research/service-line-strategy-advisor/resources/2018/telehealth-primer-pregnancy-care

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Comments Off on Telehealth from a Soldier’s Perspective: Saluting Lt. Col. (Ret.) Daniel R. Brewer

Telehealth from a Soldier’s Perspective: Saluting Lt. Col. (Ret.) Daniel R. Brewer

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On a spring day at Lake Blackshear at the Global Partnership for Telehealth annual GA conference, I heard one of the most inspirational keynote speeches I’ve ever heard about my telehealth profession. Dressed in full uniform, LTC(R) Daniel R. Brewer delivered the moving address, “A Soldier’s Perspective on Healthcare.” Along with a series of impactful pictures, Brewer’s presentation about the intersection of telehealth and war unfolded. The audience was spellbound.

LTC Brewer served several tours in Afghanistan and Iraq and had the opportunity to work with Generals David H. Petraeus and James N. Mattis. Brewer solved environmental problems we often see or associate with war, when we are viewing from afar. However, burn pits, hazardous waste, medical waste, oil spills and improper water disposals were issues that needed his solutions. But then he was injured.

LTC Brewer clearly outlined for us from his first-hand perspective, how once a soldier is injured, the task at hand quickly focuses on staying alive. Access to immediate healthcare is essential and that’s what telehealth provides. Healthcare access = ALIVE. LTC Brewer pointed out that he and many other soldiers may not be here today if not for the remote care provided by the Department of Veterans Affairs.

Telehealth is one of the rare success stories of war. The U.S. military has been a leader in telemedicine for decades, employing technologies ranging from pictures from the battlefield, to direct emergency treatment, to mental telehealth visits for PTSD once vets are home. Telehealth at any point, delivered to an injured soldier, improves healthcare accessibility.

The military is also using new technologies, including EEG devices, to measure concussion effects and the extent of brain injuries. They lead in telemedicine in so many ways and the U.S. VA system is one of the world leaders in the use, scope and scalability of telehealth during deployment, active duty and once our soldiers are home.

At the end of his speech, LTC Brewer challenged the audience to be strong telehealth “enablers,” in the positive sense of helping make things happen! He was the biggest enabler of all of us that day and we were proud of acknowledge him with a standing ovation.

In our business, we save high risk moms’ and babies’ lives often via telehealth. But from the audience that day, I had the opportunity to see how telehealth also prevents death and injury from a different perspective. It made me proud to be in the business of telehealth and so proud of our U.S. military taking care of their own, when the system is often criticized.

As we celebrate our freedom this week, Women’s Telehealth once again salutes LTC Brewer for sharing his amazing story!
~Tanya Mack, President

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Comments Off on Twin to Twin Transfusion Syndrome: A Life-Saving Story

Twin to Twin Transfusion Syndrome: A Life-Saving Story

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A twin pregnancy comes with risks for mother and babies and this Women’s Telehealth patient story presents one such serious complication.

This Pregnancy’s Challenge: The ultrasound conducted by the patient’s local OB physician revealed that one twin was growing and the other was not. Preliminary tests indicated a suspected “Twin to Twin Transfusion Syndrome,” caused by a blood vessel defect. Left untreated, the survival rate for both twins would be less than 15%.  The mom-to-be needed immediate high-risk OB care and intervention. Because the closest MFM Specialist was two hours away and the patient would require consistent monitoring, she was referred to the OB/GYN’s MFM telemedicine partner in Atlanta, GA, Women’s Telehealth.

The Team’s Actions:

  • The initial MFM telemed consult and specialized ultrasound confirmed the “Twin to Twin Transfusion Syndrome” and identified the problematic blood vessels causing it. 
  • The MFM physician forwarded all images and notes immediately to the closest  fetal surgeon to see if he would take the case as there was a critical time window.
  • The surgery was performed in FL and the patient stayed in the hospital for a few days to monitor mom and babies before they were released to home.
  • WT continued to remotely monitor growth of both twins regularly until the OB and MFM doctors decided to deliver a little early via C-Section, to prevent loss and trauma.

The Results:

  • Two healthy baby girls were delivered slightly early by C-Section with no residual health problems.          
  • Cost savings were estimated to be > $12,000 in expenses.                                                                  
  • Travel savings of 2700 miles and 40 commuting hours were realized.                                               

Early identification and treatment of this often-fatal condition in a rural area, where there was no MFM specialist, led to the successful birth of these babies. Women’s Telehealth is pleased to have played a key role in arranging life-saving surgery through their network of high risk OB specialists and the use of continued monitoring via telemedicine!

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Multiple births are much more common today than in the past. According to the U.S. Dept. of Health and Human Services, the twin birth rate has increased by over 75% since 1980, and triplet, quadruplet and high-order multiple births have increased at an even higher rate.  To learn more, visit:

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/multiple-pregnancy-and-birth-twins-triplets-and-high-order-multiples-booklet/

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Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing and intervening in high risk pregnancies. We help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies.
For more information, call our office at: 404.478.3017

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Comments Off on Eager to Share My Passions – Telehealth, Entrepreneurship, Leadership

Eager to Share My Passions – Telehealth, Entrepreneurship, Leadership

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Call me a healthcare adventurer! I’m always pursuing my vision to help others! Above all, my goal is to lead industry change with the tools available in modern healthcare.

I welcome your invitation to serve as a guest speaker or advisor! It would be an honor to share some of the varied expertise I’ve gained through seasoned experience. See bio for details.
~Tanya Mack, President

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Comments Off on TOP 10 “TAKEAWAYS” FROM ATA CONFERENCE 2019

TOP 10 “TAKEAWAYS” FROM ATA CONFERENCE 2019

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Educate. Inspire. Provoke.  The 2019 American Telehealth Association industry conference, held in New Orleans, LA this week, accomplished all of these. Telehealth is evolving as one component of “Digital Health” and has proven its value as a health care accelerator.  Here are some of my top of mind observations from the meeting:

  • A Huge Gap Exists Between Telehealth Capability and Use: Consumers are actually leading telehealth adoption.  Experts at the conference cited 22% of providers are using telehealth but 69% want to.  Hospital use disparity is similar. More opportunity exists than is realized.
  • Strategic Partnerships are Critical to Advance Telehealth: Telehealth delivery is too complex for organizations to work in isolation and do everything themselves.  Interesting partnerships are emerging to expand capability, share risk, access developed distribution channels and engage patients.
  • Access to Care Remains a Key Motivator: Behavioral Health.  Opioid Crisis.  Access to Specialty Care are top needs.
  • Retail Entering the Telehealth Space is Forcing Change Fast:  Think Best Buy Healthcare in stores and offering “Tech Pharmacy”- like device and service bundles.  Think Alexa answering medical questions, scheduling referrals and sending you medication reminders.  Think Geek Squad keeping your wearables and home blue tooth medical devices functioning.   It’s here people.
  • Meet the Patient Where They Are – Millennials First!: HopeLab shared, “46% of young people would rather have a broken bone than a broken phone.”  90% of young people go online for healthcare.  45% of millennials have no primary health provider.  Smartphones and online are the preferred access points. Patient engagement and satisfaction are vital signs of telehealth success.
  • Platform and Product Integration is Crucial: Hospitals are moving to enterprise telehealth solutions. Payers are looking for company diagnostic tech partners. Providers will not tolerate multiple in/out of platforms.  Patient devices vary. Who makes it all work together with the fastest, least amount of clicks wins.
  • The Hospital is Coming Home: Remote home monitoring, wearables, blue tooth devices, medical apps, sensor technology  and little healthcare affordability relief.  We are moving away from a hospital dominant healthcare system. Patients are finding healthcare environments comfortable and affordable for them.
  • AI and Data are Real. Now. : Analytic rigor. Disciplined innovation cycles. Population health management.  Hospitals showed how they are using AI in an intra-facility manner in the surgical post op area to alert staff more quickly via set triggers to avoid more complex complications using AI and feeds from medical monitors in-house.  In addition, one company outlined their use for AI in the healthcare operation space vs. clinical as a priority to speed up mundane processes.  Image reading by AI faster than we can blink, let alone think.   It’s here, evolving fast and touching telehealth.
  • We Remain Collectively Concerned about Security: Read the news. Daily breaches.  Our health privacy is top of mind for valid reasons. Keep vigilant.
  • The Government is Our Slowest Path to Change-But You Can Help: Senator Bill Cassidy of LA, who is also a physician, gave the audience a reality check about Congress members’ experience of healthcare. Not the same as ours – and he cautioned that any change is a long process that will require education.  Fastest way to advance telehealth – invite them to come and see what we do so they have the direct experience of it. While they are there, provide them with the answers they can use when they are questioned about telehealth – in writing.           

As I left the meeting, having attended for several years, it is satisfying to see telehealth not only mature but start skyrocketing to benefit many. We are all still learning quickly and together.  I was encouraged to see new faces… but, was left questioning whether the meeting was too heavy  on “industry” and too light on patients and providers tracks.  My biggest question, as echoed by others there:  “Now that we’ve proven it, how will we work together to get the value out of telehealth?”         

Tanya Mack, President
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