By Sara Bondell - May 09, 2020
Timothy Haifley was due to begin another round of chemotherapy for testicular cancer at Moffitt Cancer Center when a high fever landed the 45-year-old in a Tallahassee hospital.
Haifley needed to see his medical oncologist to make sure his doctors were on the same page.
He made an appointment, and a few days later met with his doctor to go over his recent hospitalization and treatment plan.
But Haifley didn’t have to travel from his Tallahassee home to Moffitt. Thanks to telemedicine, he and his wife had the appointment from home.
“Sitting in front of a computer was just like we were talking to him in person,” Hailfley said of his oncology visit. “I said everything I wanted to say and asked anything I wanted to ask. It was just like we were sitting across the table from him, just without the four-hour drive.”
It not only saved time, but also stress. Haifley is severely immunocompromised because of his treatment, so a virtual visit got him the care he needed without the long trip and face-to-face appointment that may have increased his risk of contracting COVID-19.
The visit also allowed Haifley’s wife to be at the appointment, which would have been impossible since Moffitt has instituted a no-visitor policy to cut down on foot traffic during the pandemic.
Virtual cancer care
Telemedicine isn’t a new concept. In the 1950s, a few hospitals started experimenting with it, using a telephone to reach patients in remote locations. As times changed, so did the technology; two-way interactive television sets and eventually the Internet made delivering virtual health care even easier.
Today, patients with a smart phone or computer can access video chat applications.
While primary care medicine has been using telemedicine for years, consultation with cancer patients has lagged behind.
“What we do is highly specialized,” said Dr. Philippe Spiess, medical director of Virtual Health at Moffitt. “There may be unique aspects to caring for cancer patients that may be only captured through a face-to-face interaction.”
Then came the COVID-19 pandemic, sending health providers scrambling to find ways to deliver care while reducing the risk of infection. And cancer patients were no exception.
Moffitt launched telemedicine about two years ago, with 30 providers offering virtual visits to select cancer patients as part of a pilot program. The pandemic spurred Moffitt to ramp up its efforts, and the virtual health team quickly identified the best platform, trained staff and assembled educational information for patients.
Outpatient clinics combed through schedules to identify which upcoming appointments could be converted to virtual visits. While patients still have to come to the cancer center for treatment, they can use telemedicine for post-operative appointments, treatment planning consultations and follow-up appointments.
Moffitt also launched a virtual visit option for new patients and those seeking a second opinion on their cancer diagnosis.
At the end of February, 76 Moffitt providers were performing virtual visits. A month later, there were almost 200. Telemedicine visits began to grow exponentially. On March 15 there were 189 virtual visits across the cancer center; a week later it had grown to 409.
On April 5, 1,330 patients were seen virtually, an almost 1,600% increase from the 80 visits held on the same day last year.
Spiess praised the work of the virtual team for developing a telemedicine platform that met the needs of patients and their families and resulted in almost 5,000% increase in virtual visits in three weeks.
“This is far beyond what we expected and the credit goes out to health care team members who worked relentlessly to make sure patient care was as minimally disrupted as possible in the setting of a global pandemic,” he said.
Relaxed state and federal telemedicine regulations have allowed providers to extend virtual care to patients outside of Florida for the first time. Moffitt can now virtually see patients in Arizona, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Indiana, Iowa, Mississippi, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Tennessee, Washington D.C., and West Virginia.
Insurance companies have also acted quickly to make telemedicine a covered service.
To reduce the risk of infections, Moffitt has had to prohibit visitors to the cancer center, except in special cases. Going to appointments alone can be difficult for patients who have to digest large amounts of information about their disease.
“It’s so important to have someone with a patient who is undergoing treatment or receiving a diagnosis because patients are so anxious and overwhelmed about what is going to happen,” said Dr. Margarita Bobonis, a psychiatrist in Moffitt’s Supportive Care Program. “Bringing a family member to an appointment is like having a peripheral memory.”
Moffitt is now applying the virtual visit concept to connect patients and family members. A video call application or phone call can bring a caretaker into a room virtually, providing support and an opportunity to hear all the information, ultimately making for a more successful appointment.
“Family members often allow the patient the freedom to be more relaxed,” said Bobonis. “They know the patient’s values, beliefs and fears and they can support the patient during the discussion about the illness, treatment plan and how to tackle it.”
While the pandemic won’t last forever, some of the changes it forced upon the medical community could. Moffitt now has a more robust telemedicine program, and can use the technology in the future to deliver care to patients who are too sick to travel. It can also help limit the number of trips an out-of-town patient has to make to Tampa, as in Timothy Haifley’s case.
Getting a treatment via computer won’t work, “but talking to your doctor in the comfort of your own home can,” he said. “Virtual visits are a fantastic opportunity. I don’t have to sit in a waiting room and take up a doctor’s time.”
Moffitt is working to continue improving its virtual visit program through its Frontline Response Fund. The fund will help the cancer center’s response to the pandemic through patient support, telemedicine and research. To learn more, visit the fund’s website.