Healing from a Distance

February 2016

Helping moms deal with the frightening experience of carrying a baby with a heart abnormality is all in a day’s work for the team at the Colorado Fetal Care Center​. The number of patients who need this level of care is growing—and we’re able to reach more moms because this program transcends what’s geographically possible. 

Bettina Cuneo​, MD, director of Perinatal Cardiology and Fetal Echo Telemedicine, and her team have saved moms living on the Western Slope hundreds of hours of driving time—and hundreds more hours of worry—simply by being able to connect with Children’s Colorado experts via a virtual clinic. (Dr. Cuneo pictured on right, above)

Through a partnership with St. Mary’s Maternal Fetal Medicine in Grand Junction, Dr. Cuneo and team provide real-time consults in cases of known and suspected fetal cardiac abnormalities. 

Learning your baby might have a heart condition is a stressful time for parents. “That’s why I think of telemedicine as healing from a distance,” Dr. Cuneo said. Whether she’s treating the mom and baby or she’s reassuring the parents that there isn’t an issue, Dr. Cuneo helps them heal.

The virtual clinic is possible thanks to a secure connection, the telehealth program managers at St. Mary’s and Children’s Colorado and the dedicated obstetrical sonographers at St. Mary’s. 

The Virtual Clinic

When a pregnant woman is identified to be at risk for having a fetus with a heart problem, or a heart problem is suspected on an obstetrical ultrasound, a fetal echocardiogram is scheduled. Dr. Cuneo “arrives” at her clinic, 400 miles from the patient. She takes the patient’s history and explains the reason for the fetal echo. The camera then switches from the patient to the ultrasound machine, and the rest is up to the sonographer. The sonographer obtains the diagnostic images of the fetal heart, and Dr. Cuneo watches as the imaging takes place, providing guidance when necessary. Once the exam is completed Dr. Cuneo discusses the diagnosis with the family and formulates the management plan with the help of Dr. Buddy Schaefer or Dr. Amy Gagnon, maternal fetal medicine specialists at St. Mary’s. The entire appointment takes 45 minutes to an hour. 

“Patients know the plan of care immediately. It’s comforting for them to witness the interaction between the perinatal cardiologist and the maternal fetal medicine specialist and know that everyone involved has created the plan together,” Dr. Cuneo said. 

Another strength of the program, and an asset unique to Grand Junction, is the support of pediatric cardiologist Jim Schroeder​, MD. He provides postnatal care for fetuses with cardiac conditions. Dr. Cuneo’s patients find comfort in knowing their baby will receive excellent care post-delivery. 

The team sees 20–30 remote patients per month, and they hope to expand to other regional hospitals willing to invest in bringing virtual perinatal cardiology services to their patients.

Ensuring Success

Dr. Cuneo explains that there are two things required to ensure a successful program. The first is the sonographer: not only the “boots on the ground” sonographer at the outreach site, but the sonographers at Children’s Hospital Colorado who have taught and trained the outreach sonographers.  The perinatal cardiology team has created a specialized fetal echo course to train sonographers for the responsibility of obtaining diagnostic views of the fetal heart. 

The second requirement is the commitment of hospitals to the right technology. “There were some technical issues in the beginning, simply because we required more sophisticated technology to include diagnostic quality imaging. Most other telemedicine only requires imaging of the patient and the physician. With the assistance of John (Fred) Thomas, PhD, director of telehealth and Gerard Frunzi, telehealth program manager, the program has soared.” 

Frunzi helped the program come together. “In the end, all it took was one cable, coordination assistance, some ingenuity and the skill of the clinicians on both sides,” he said. 

“We love this effort and feel like it is possibly one of the most life altering things we do,” said Fred Thomas, PhD. “We are so glad that Dr. Cuneo is passionate and driven and willing to work with our partner hospitals to make this unique service available to mothers who would otherwise have to travel to Denver and wait and worry in the meantime.”

Empowering Patients and Providers

According to Dr. Cuneo, telemedicine doesn’t just help patients heal from a distance—it empowers health care providers at a distance as well. Telemedicine provides 24/7 backup, which allows referring physicians to continue to care for their patients in their community.  

Dr. Cuneo hopes to expand the services her team offers and close the perinatal cardiology care gap in Colorado.  

“It’s such a win–win situation. We help patients stay close to home where their support network lives,” she said. “It’s a technology whose time has come.”