The ANGELS Program at the University of Arkansas for Medical Sciences (UAMS) has pioneered the use of telemedicine in high-risk obstetrics in recent years to conduct specialist consultations. Telemedicine allows patients in rural areas to have specialized care without having to travel to the tertiary care center. Traditionally in the ANGELS Program, telemedicine consults have been limited to Attending Staff Physician use only. More recently however, advanced practice nurses (APNs) working along-side resident physicians in a high risk obstetric clinic, have had the advantage of utilizing this same technology.

Arkansas is a rural state and is underserved by many specialists including maternal-fetal medicine specialists (MFM).  The three at UAMS simply cannot be in the resident/APN clinic every day because of other duties, yet the acuity of the patients there is very high.  Telemedicine is an essential link that allows for MFM input into the complex cases, while the MFM is elsewhere.  If a consultation is necessary, a tele-technology unit can be rolled into a patient room and in moments, the patient, APN or resident, and MFM can all converse in a real-time fashion about the plan of care. 

Another use of the telemedicine equipment in the clinic is to conduct routine patient visits instead of the patient having to come to the tertiary care center.  These visits can be conducted by the APN or resident and rarely need MFM involvement.  These visits include, but are not limited to: review of diabetic patient glucose logs, consultation regarding vaginal birth after cesarean section (VBAC), and co-managed patients with a variety of other diagnoses.  Travel to Little Rock is often very unnecessary if all that needs to occur is a discussion.  Telemedicine allows for conversation with opportunity for the patient to provide history and ask questions.  This university clinic is often triple-booked and the waiting time can be quite long.  Telemedicine on select patients helps decompress the patient volume, while still providing the patient with the needed information.

Research is ongoing to determine how patients feel about telemedicine visits.  Anecdotal reports include very positive feedback, highlighting the shortened driving distance compared to having to present to the tertiary care center in Little Rock.  APNs and resident physicians recognize the value of almost unlimited access to a MFM while seeing patients in the high risk clinic.  This use of telemedicine is yet another innovative approach to caring for high risk patients.