Project: Health-e-Access
Organization: University of Rochester Medical Center
Rochester, NY
Story submitted by Kenneth McConnochie, Project Director of Rochester's Child Care TeleHealth Access Network

Resolving Lakeisha's Dilemma

To get to her new job on the assembly line at Kodak, Lakeisha drops baby Jayquan off at the Volunteers of American Children’s Center at 6:30, when it’s still cold and dark. Jayquan, the light of her life, is only 10 months. Lakeisha worries about him even more because his cough gradually seems to be getting worse. He’s already had one bad episode of wheezing, involving an 8 hour ordeal in the emergency room.

When the cough became so bad that he (and she) couldn’t sleep, Lakeisha tried the asthma “quick fix medicine” left over from that wheezing episode. Thankfully, it worked enough to let them both get back to sleep.

That’s become the routine these past 2 weeks. When she lays awake at night listening to Jayquan’s cough, she wonders if another trip to emergency might solve the problem. But if she brings him in now, he might not even be coughing. After hours of waiting, they’d be dismissed by ER staff with a diagnosis of “cute baby with a cold and an overanxious young mom”. Instead, next morning Lakeisha calls the clinic looking for telephone advice that might solve the problem. She’s told she’ll need to bring him in for a bad, persistent cough like that.

Some choice: Option 1, the ER will take all night and won’t take her seriously. Option 2, with the clinic she’ll miss a day’s pay and maybe lose her welfare-to-work job.

Harriet, Jayquan’s surrogate mom at VOA, has been worried these past 2 weeks as well. Every afternoon, Jayquan has had fits of coughing, protracted and severe enough to induce vomiting. Harriet wants what’s best for Jayquan and his mom, but she isn’t sure what IS best. Lakeisha has been dropping off the “quick fix” medicine when she drops of Jayquan, instructing Harriet, “Just keep giving ‘Quan the asthma medicine. He’ll be fine.” The “quick fix” works, but - next afternoon - here’s the cough again. And she wonders whether Jayquan’s cough puts her other babies at risk. There’s been this stuff in the news recently about new cases of whooping cough.

Today, Harriet wonders whether the only way to get Jayquan seen by a doctor is to call Lakeisha at work to come pick him and keep him out until seen. At lunch break, she reluctantly asks the VOA director about this. She hates to do it, because excluding Jayquan will mean Lakeisha will miss a day or two of work and pay. The director says that normally this kind of problem needs exclusion, but maybe now they had another alternative. They went and spoke with the telehealth assistant.

Health-e-Access involvement started with a question after we finished a telehealth visit for another child. Responding to discussion with Harriet and the director, the telehealth assistant at VOA asked us whether something more could be done about a cough like this, and whether Jayquan’s cough fell within the scope of telehealth.

Probably yes was the answer to both questions, but permission from Lakeisha was required before a telehealth visit could be conducted. Lakeisha had been curious about the new telehealth program when it started 2 months ago, but had decided against participation. She and Harriet both had felt that good moms make time to get their children to the doctor when they’re sick. That was before her new job. When asked again now, she eagerly agreed.

The telehealth doctor connected with the VOA telehealth assistant and Jayquan. The physician could readily see, on his PC monitor, that Jayquan was a robust and curious child, breathing comfortably. Sitting on the lap of the telehealth assistant, Jayquan saw and heard a person talking on his PC monitor, and checked him out by leaning forward and licking the screen. The doctor quickly assimilated the medical history by glancing at the completed electronic forms and asking a few supplementary questions. Digital images of Jayquan’s ear drums and throat looked fine. A digital recording of lung sounds was entirely normal, except for a few squeaks and whistles.

And that was all it took for the doctor to conclude that Jayquan certainly posed no risk to other children, and very likely needed only more aggressive asthma treatment to be rid of his troublesome cough. The telehealth doctor phoned Jayquan’s primary care doctor. They agreed that an inhaled anti-inflammatory “control” medicine was indicated for his asthma. The medicine was started, 2 days later the cough stopped entirely, and the “quick fix” medication was no longer needed.

Lakeisha’s dilemma, which seemed to have no solution through the usual system of care, was resolved. The telehealth solution enabled Lakeisha and Harriet to work together for Jayquan, and they were delighted. For Jayquan, Lakeisha, Harriet, the VOA Children’s Center, mom’s employer, and public assistance rolls telehealth was clearly better than usual care.

The moral of this story is not just that Health-e-Access telehealth resolved the dilemmas of Lakeisha and Harriet. It’s also that this innovation can resolve similar dilemmas that play out thousands of times every day, accounting for 40% of work absence, in the majority of US parents that use some form of childcare.

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