title: Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), a statewide telemedicine project, on health care delivery to patients with high-risk pregnancies in Arkansas.
  
  
  METHODS
  With institutional review board approval, a Health Insurance Portability and Accountability Act-compliant retrospective review, in which the requirement for informed patient consent was waived, was performed. The population studied is the Arkansas maternal Medicaid population. Data for evaluation were collected from maternal Medicaid claims, ANGELS administrative records, and birth records from the Arkansas Vital Statistics record system. Data collected from before the inception of ANGELS (2001-2003) were compared with data collected after the inception of ANGELS (2004-2007).Antenatal and Neonatal Guidelines, Education, and Learning System is a multidisciplinary, multifaceted telemedicine program designed in Arkansas to enhance high-risk obstetric health care delivery across the state. An essential component of the program is real-time interactive targeted level II ultrasound examination of patients.
  
  
  RESULTS
  Since the inception of the ANGELS program in 2003, a growing number of telemedicine consultations and real-time ultrasound examinations are being performed every year. The number and percentage of high-risk pregnancies identified each year show a slight decrease since inception of the ANGELS program, and findings suggest that identification of high-risk pregnancies is shifting from the second trimester to the first trimester, but trends vary over time.
  
  
  CONCLUSIONS
  Antenatal and Neonatal Guidelines, Education, and Learning System has created a telemedicine network across the state that has made possible, among many other things, access to real-time level II ultrasound examinations and consultations. This program has ultimately led to improved prenatal access across the state.
authors.affiliation: Departments of *Radiology and †Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Megan Chang
authors.initials: MC
authors.lastname: Long
authors.forename: Teresita
authors.initials: T
authors.lastname: Angtuaco
authors.forename: Curtis
authors.initials: C
authors.lastname: Lowery
mesh_terms: D000328:Adult; D001131:Arkansas; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D018566:Pregnancy, High-Risk; D015397:Program Evaluation / Q000379:methods*; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D014463:Ultrasonography / Q000379:methods