title: US and territory telemedicine policies: identifying gaps in perinatal care.
abstract: BACKGROUND
  Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories).
  
  
  OBJECTIVE
  We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified.
  
  
  METHODS
  We conducted a 2014 systematic World Wide Web-based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N = 59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis.
  
  
  RESULTS
  Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care.
  
  
  CONCLUSIONS
  The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource-challenged jurisdictions.
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: eokoroh@cdc.gov.
authors: Ekwutosi M
authors: EM
authors: Okoroh
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Charlan D
authors: CD
authors: Kroelinger
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Alexander M
authors: AM
authors: Smith
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: David A
authors: DA
authors: Goodman
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Wanda D
authors: WD
authors: Barfield
mesh_terms: D018948:American Samoa; D002497:Centralized Hospital Services; D019468:Disease Management; D005260:Female; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000331:legislation & jurisprudence*; D008849:Micronesia; D009774:Obstetrics / Q000331:legislation & jurisprudence*; D018743:Perinatal Care / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D011647:Puerto Rico; D012017:Referral and Consultation; D018570:Risk Assessment; D017216:Telemedicine / Q000331:legislation & jurisprudence*; D014481:United States; D014767:United States Virgin Islands
keywords: maternal; neonate; perinatal regionalization; policy; risk-appropriate care; telemedicine