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The MoM Experience:
This changed my practice…. Interview with Midwife Leah Barlow in Creston
July 1, 2017 / Blog post by Mona Mattei, Project Manager
Leah provides midwifery services in a small town of 5,306 people where the hospital supports C-section deliveries with a family physician group. Midwives deliver in either Creston or Nelson depending on the needs of the clients. Creston is 1.5 hours drive from Nelson with the choice of driving over the highest highway mountain pass in BC or around a lake with ferry services.
Dr. Moola began offering the Mobile Maternity (MoM) telehealth service to the area in October 2016. Leah has an iPad that she can take to the patient’s home and connect for a specialist appointment with the client. An important part of the initiative is to include primary care providers in all consults for tripartite care planning.
What my practice was like before MoM:
I work in a rural, remote area so for the women who have any risk factors or need consultation, they would have to leave our community to see a specialist. And for me to find out what the doctor said at the appointment, I’d either get it back in a letter or phone my client. So that puts my clients on the road at all times of the year, through the winter especially.
Sometimes there were delays in receiving information when I needed it. A lot of times I would have to call the specialist when the women were in labour and ask, what about this and this, and try to clear up a question with the consultant. Or else I would call the office to get more clarity on things that I didn’t understand in the letter.
We always seemed to work it out, but things are so much clearer now that the option to connect directly is there.
What my practice looks like now:
Now I offer clients the option to use telehealth to have a consultation with the specialist about a possible risk or complication using the iPad in their home. Occasionally we have done the appointment from the Creston hospital in order to view an ultrasound image or assist in an exam.
When I meet with a client jointly with their obstetrician by telehealth, we can have our plan in place immediately and we all know what to expect or what we can plan around. I feel like it is much clearer for all of us.
I really appreciate being a part of the conversation with the specialist because all of us are on the same page. I know what the doctor said, I know what we need to do next, and what to do for delivery. Because choice of birth site becomes an issue, I don’t know if I need to be in Creston or in Nelson, and we can clarify that at the same time. It really allows for women to have better planning.
Even with technical difficulties at one of the consults, my client said, “It may have taken an hour but if we’d gone to Nelson it would have taken a whole afternoon.” So even with technical difficulties we spent less time than if they had driven. Clients are appreciating that they are not on the road, their partners can be there and he doesn’t have to lose a whole afternoon of work to go with his wife. Partners appreciate that they know what to expect for the birth and can be comfortable with it as well.
The project itself, the quality of the video conferencing is such that you can see and hear well and the clients have all been totally satisfied in feeling that they have had a quality appointment without having to travel. They did not feel that being in front of the specialist in his office would have changed anything at all.
We did an appointment at the hospital and Dr. Moola could watch my exam, see the ultrasound, and was able to confirm the baby was breach. We could make plans without her ever having to travel. I think it has a lot of potential, especially in an acute care setting. Prenatally and in planning for care, it has been incredibly helpful already!
Impact on my practice:
For women, it really improves access to care. I am caring for a woman right now who can’t leave town due to transportation issues, so when I mentioned this she was so excited because financially she couldn’t go, she doesn’t have a car, she’s getting rides just to come to Creston. So, MoM made it possible for her to have a consult. I’ve had difficulties before when women couldn’t leave town and therefore, women didn’t have their consult when they actually needed it. I really love knowing women can get their care no matter what their circumstances!
From the women, they find that not being on the roads in the winter was, of course safer, but less travel also meant less costs and less problems finding child care. For the women it has many positive effects.
From my side, I love being a part of the team, I like being able to ask the questions even though they seem insignificant and I feel like I walk away feeling that I totally know what to do. I feel it really improves patient care, but also the flow and the continuity of their care. When I can ask questions in the moment of the consult, everything flows smoother for the patient’s care – especially when they need acute care because everybody’s on the same page and has already had that conversation.
I find it really takes the edge off for clients when I talk about a consult now. There’s no hesitation from the client because it’s not going to be a burden on their life.
The ability for women to stay in town to deliver is also very important. When we have a consult conversation through telehealth, women feel like they can stay in their hometown and know that we have support. It is also supportive of our Creston maternity team. We have a great group of doctors who provide C-section coverage – and this project lends support to our services here by helping us keep women in town to deliver if it is possible. It helps us to utilize the strengths of our team here, but to also have backup support if we need it.
The first few weeks….
Nov 16, 2016 / Blog post by Mona Mattei, Project Manager
Once the baby has come it is always a time for adjustments in the family – learning to meet the needs of the new member of the group, how to communicate and testing out new ways of managing life.
Mobile Maternity project manager Mona Mattei, delivered the mobile technology to primary maternity providers in September with orientation on how the new tool can be used. The new member of the family, the iPad, was accepted into the various clinics across the region including: Grand Forks, Creston, New Denver, Kaslo and Nakusp. And the new service was born.
Dr. Shiraz Moola, obstetrician and project lead, has since seen five patients through his new telehealth service. Each of these patient visits presented a new opportunity to learn. Only one of the five used the mobile technology provided and included a midwife in the visit; it was a scheduled consultation. Three of the next consults were emergent visits where Dr. Moola reached out to the Interior Health Telehealth office to coordinate rooms at different sites for patients to attend and meet with him. These visits have led the team to consider the benefits of coordinating various options for patients to be able to meet with Dr. Moola in different settings.
Curious to hear from the physicians and midwives about their ideas for the new service, Dr. Moola set out on a tour of the region seeking to test out the new communications tool and encourage teams to adopt the new service.
As with most telehealth services, a shift in practice from both the referring practitioner and specialist engaged is critical to the consultation. Remembering to ask for telehealth in referrals, promoting and explaining the service to patients, and taking the time to actually do the visits are all new to providers. Telehealth takes a bit more time for the first while – adjusting schedules, making sure there is extra time in case of technology problems, and extra work on behalf of office assistants.
Yes, learning to incorporate telehealth into practice is a labour of love for doing our work in a different way. It takes champions – specialists, family physicians and midwives to succeed.
Connecting in person was pivotal for Dr. Moola and the providers at the rural sites. Meeting face to face, testing technology and discussing the potential barriers to success were important to building excitement and commitment for this new service.
After 1000 kilometers and nearly 20 hours of travel, Dr. Moola and the team are confident that during the next few months, many patients will be spared the need to do that same amount of travel! Stay tuned to see the baby take its first steps!
First Delivery: Kaslo, Nakusp, and New Denver
Sept 16, 2016 / Blog post by Mona Mattei, Project Manager
With blustery weather of fall upon us, I ventured out into the Kootenay Boundary region feeling a bit like Santa Claus to deliver technology packages for Mobile Maternity. Our first deliveries were to midwives and family physicians north of Nelson in Kaslo, Nakusp and New Denver.
Mobile Maternity, a telehealth research project to enable moms in rural communities to visit with an obstetrician for pre- and post-natal care, officially started on June 1st, 2016. Since inception, it has been the vision of Dr. Shiraz Moola to shift the way that patients access maternity care, by bringing it closer to home. Aiming to ensure that pregnant women are able to see him when they have perinatal risks, and to increase the number of times they are able to visit with him, this project will span over two years tracking the use of the new telehealth service, and how it impacts patients and their babies.
So our first round of deliveries (no not babies… although they feel like newborns) were to the teams around the north Kootenay Lake and Arrow Lake. Small communities between 500 – 1500 people border the lakes and are home to resource workers, tourism staff, and people who like to live a bit off the grid. Many of these women prefer midwifery supports, and there is a group of women in the area who largely refuse medical care, choosing to do unassisted home births instead. Travel to see the OB/GYN can sometimes be a four-hour return trip in challenging weather.
Apple iPad Pros were provided to the GPs and midwives around these areas – a total of 5 in the three locations. These iPads are pre-loaded with a video conferencing system called Real Presence, the designated software that Interior Health Authority (IH) uses. iPads are optimized to pick up IH WiFi signals in any of their locations. All iPads have cellular capability (i.e. data) so in areas where the providers are away from their office, they can still use the iPads.
At the meetings, Dr. Moola linked up with the GPs and midwives using Real Presence while I trained them in how to log into the system and to maneuver their way around the iPads. For some providers, it was the first time seeing Dr. Moola face to face (at least virtually!)
So these iPads are set and ready for patient consults – and potentially emergent care! Next up…. Creston and the surrounding valley, and the Boundary area!