Perinatal telemedicine at lower-level birthing hospitals in Maryland: lessons learned from a landscape analysis

The aim of this study was to assess the current perinatal telemedicine (PTM) landscape and inform the design and implementation of a PTM network linking level I/II birthing hospitals with the two-level IV hospitals in Maryland, to improve access to maternal-fetal medicine (MFM) specialist care.

Qualitative in-depth interviews were conducted with 24 clinicians and telemedicine experts during July-September 2020. We obtained data on 12 level I/II and both level IV hospitals.

Less than half of level I/II hospitals currently offer obstetric services through telemedicine, and both level IV hospitals have interest and technical capacity to support implementation of a PTM network in Maryland. The COVID-19 related shift to telehealth and telemedicine was identified as a facilitator for such PTM programs. Perceived barriers to provider adoption of PTM services and network in Maryland included hospital leadership buy-in, information technology (IT) literacy, and patient triage complexities. Perceived barriers to patient adoption of PTM were access to technology, IT literacy, and language. Key benefits of PTM services included overall improved patient access, convenience, cost-savings, and safety during the COVID-19 pandemic. Influential factors for implementing a PTM network in Maryland included buy-in and approval from hospital and health system administration, a streamlined telehealth platform allowing for electronic medical record integration and interoperability, program funding, and sustainability.

Gaps in availability of MFM care at level I/II birth hospitals call for expanded telemedicine programming to improve high-risk patients' access to specialty obstetric care and support the development of a PTM network in Maryland.