Betty is a 69 year-old patient with systolic heart failure. She was discharged from the hospital after a 10-day admission for volume overload. She lives in a remote rural area. Weekly visits with a home health nurse were set up on discharge. Betty is on more than ten medications a day, most of which need to be taken twice a day. She lives alone and is experiencing a progressive vision impairment. Her niece and her neighbor visit her frequently. Betty had used a computer at her workplace before she retired, but now does not have a computer at home. She likes to listen to music and no longer reads books like she used to, because of her progressive vision loss. She wants to stay at her home for as long as possible and remain her independence while managing her condition.
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We need to consider the fact that the patient may not be able to operate sophisticated devices by herself given her limited computer experience and her vision impairment. This calls for technologies that would be easy to use.
Additionally, we could envision the family member or neighbor playing a supportive role in a home telehealth system when they visit, if they were willing to do so.
Given the rural area of residence we need to explore the benefits of telehealth (e.g., increased access, reduction of travel time or more efficient triage before in person visits) and challenges (e.g., potentially less than ideal digital infrastructure).
Consider these questions: What are the support resources? What is the residential infrastructure and how easy would it be to install home telehealth equipment? Would Betty be interested and willing to have a telehealth system installed and to participate?
Overall, this case calls for an ongoing dialogue with the patient to assess their perspective and preferences as well as an assessment of practical challenges. It is also important to consider who else may be involved in a potential telehealth system (e.g., pharmacist, social worker, dietician, rehabilitation medicine).
