The year is 2003 and Brian*, a cancer patient, is having a miserable day, after an even more miserable night. The day before started out alright, but by late morning he was having difficulties breathing and he was unable to hold down any food. On top of that (even though he had remarkably high tolerance) he was beginning to feel real pain. Having had no sleep or rest he was physically exhausted and felt completely unable to cope with the stress brought on by a usual day.
Brian lived 45 miles away from his VA medical center. Because of his medications, he was unable to drive, even if he did have a car. Finances were too tight to call for a taxi and his closest friend, who stayed with him on the weekends, would not arrive until the wee hours the following morning. He just wasn’t sure he would be able to hold on.
He called his oncologist , who told him, “Listen Brian, there’s a shuttle available to your area today so just come on in to the office. You missed your last appointment so, even though it sounds like all you need is a med adjustment, today would be a good day to play ‘catch up’.” Then he added, “Besides, I think have a solution to the problem of scheduling visits.”
Cancer patients who are either trying to deal with their ‘end of life’ issues or are at a stage where they require chemotherapy have always been an underserved demographic. They’re subject to a type of stress that most people cannot understand. Perhaps they’re unable to get transportation when they need it because they are living within a strictly fixed income. Maybe their discomfort or pain level has led them to the point where they ‘just don’t care anymore’. Constant travel back and forth to the doctor, which may only be inconvenient to some, can evolve into severe stress for patients with life threatening conditions like cancer. Either way, care during chemotherapy and end of life has suffered. Some solution has been needed.
Because of collaboration that developed between the National Cancer Institute (NCI) and the Department of Veterans Affairs (VA) from the mid to late 1990’s to the early 2000’s **, the problem was tackled and initial solutions found. Cancer patients were given the option of electronic monitoring of their symptoms so that the unique health problems they encountered could be addressed quickly and effectively. One such solution was a device called the “Health Buddy”, which could be connected to a telephone, giving them immediate access to their care coordinators.
Daily calls to a central terminal would enable the patients to report concerns and issues they may be experiencing, such as pain, breathing problems, depression, nausea or any other symptoms. This would be done through responses to detailed, multiple choice, voice-prompt questions relating to a dozen symptoms, entered on the phone handset numeral buttons. These responses would then be analyzed by the patient’s oncology team provider, whether the oncologist him/herself or the oncology nurse. If responses appeared to indicate complications requiring face-to-face consultation or that intervention such as a change in medications or dosages were needed, such action(s) could be affected immediately rather than having to wait for a consultation appointment.
Getting back to Brian, his visit with his oncologist resulted in the needed change of medication to ease his pain and discomfort but, more importantly, his physician introduced him to the “Health Buddy” system. Brian was soon provided the device to use at home and his stress level, hence other health issues, improved immensely.
The subject of Telemedicine and Telehealth has progressed far beyond this technology since then. It is destined to see increased efficiency, collaboration between facilities in not only cancer care but all other branches of medicine and home health care and accelerated research on a multitude of diseases and genetic conditions.
Thanks to the VA’s decision to pursue this technology, telemedicine has already helped veterans from all walks of life gain more immediate care for their medical conditions. From telephone consultations to web based teleconferencing “doctor visits”, Telemedicine has proven its worth to the health care issues of the day.
*Not his real name. **Sources consulted did not provide exact dates.