The use of teleaudiology to deliver care and services remotely via telecommunications technology appears to be gaining traction. It has fast become a proven approach to overcoming cost and access barriers, plus it addresses the shortage of audiologists in several areas of the world. Although there are several crucial details that need to be clarified, such as billing across state lines, teleaudiology has tremendous potential to lower the cost of care and improve access to care. If you’re in a medical practice with multiple satellite offices, now is a great time to consider your telehealth options.
There are three categories of patients who are considered ideal candidates for teleaudiology. They include patients who:
- Live in rural areas where it takes more than an hour to drive to the clinic and cannot afford to take an entire day off work to drive back and forth to your clinic.
- Are urban population dwellers, particularly those who cannot afford services.
- Prefer to self-manage their condition and want to reduce the number of visits to a clinic for care.
Each of these groups might be better served by teleaudiology. By using teleaudiology to bring care to these three categories of patients, clinics can feel good that they are better meeting the needs of people with hearing loss and other medical conditions involving the ear. According to Jacobs & Saunders (2014), there are four types of teleaudiology services that can be used to provide care to patients.
- Synchronous/real-time data collection between patients and providers. Using face-to-face video conferencing, such as Skype, a comprehensive hearing assessment can be completed remotely with the assistance of a technician. While the licensed professional works from the main clinic, the technician inserts earphones, a probe microphone or impedance tip into the patient’s ears. From the main clinic, the licensed professional conducts a comprehensive test battery, including tympanometry, acoustic reflex testing, pure tone air & bone conduction audiometry and speech testing. Using face-to-face video conferencing, the patient and provider can see each other and converse over the remote connection.A range of services, including hearing aid fitting and adjustments, can be completed in this manner. Tinnitus management and other types of counseling also can be provided using this approach. The VA system has been a pioneer in this area, as they have employed real-time synchronous communication in their remote hearing testing since 2009. Recently, Interacoustics introduced a teleaudiology remote testing suite for the commercial market.
- Store and forward telehealth. Using mobile devices, data can be acquired and stored by a technician in a remote facility and later forwarded to a specialist for interpretation and diagnosis. This type of teleaudiology service is commercially available on the Interacoustic system mentioned above, as it allows for otoscopy, immittance and pure tone audiometry data collected by a technician to be uploaded and sent to a licensed professional for interpretation.
- Remote monitoring & adjustment of hearing aids. Another facet of teleaudiology is remote programming and adjustment of hearing aids. This includes the ability to monitor hearing aid use and changes in hearing over time. A growing number of hearing aid manufacturers, including GN Resound, enable end users to remotely connect with a licensed professional who can fine-tune and program their hearing aids remotely. Data collected in the VA system from 1,170 patients shows that patient outcomes with remote hearing aid programming are as good or better than patient outcomes from a traditional face-to-face visit with a provider (Gladden, 2013).
- Mobile health. The use of smartphone apps to self-manage health conditions. Today, there are several apps for hearing testing, auditory training, tinnitus management and hearing aid counseling that can be used by patients to better monitor their condition from the comforts of home. Audiologists are encouraged to identify apps that get patients more involved in monitoring their progress after a hearing aid fitting or other intervention. Some mobile health apps, such as those that provide remote auditory training, could be used to improve outcomes with hearing aids.
All four models of teleaudiology have been used by organizations that work with rural populations where there is a shortage of audiologists. The Veterans Administration (VA) and the Alaska Federal Health Care Access Network (AFHCAN) are pioneers in the specialty of t teleaudiology. You can learn more about the AFHCAN teleaudiology cart at http://www.afhcan.org/cart.aspx
How Practices Might Benefit from Teleaudiology
If you’re in a medical practice that wants to increase access to care and contain costs, teleaudiology might be a worthy investment. Moving into the future, teleaudiology could be a vital part of a comprehensive business strategy. Here are three considerations:
- You’re in a medical center with one primary hub and one or more smaller satellite offices. In addition to improving access to care for patients who have a tough time getting to the main hub, teleaudiology has the potential to eliminate travel expenses for the licensed professional who must drive to a satellite to provide care. A technician, who oversees the use of the teleaudiology test suite, can be employed at each satellite location, thus lowering the cost of personnel. The technician can either complete the testing and upload it to the professional for interpretation, or set up the test and enable the licensed professional to conduct the test remotely in real time from the central location.
- Audiologists who want to spend more time at home with their families could still be directly involved in patient care. Rather than conducting remote testing from the central office, it is feasible for the audiologist to complete testing from anywhere that has a laptop computer and high-speed internet connection. This approach is a terrific way to provide experienced audiologists who might otherwise decide to stay home full-time with the ability to remain involved in direct patient care.
- Counseling services that do not require direct face-to-face care. The use of teleaudiology would be especially beneficial for patients who have an established relationship with a provider who periodically needs to check in with the clinic. Routine hearing aid follow-up appointments and tinnitus counseling services would be particularly ripe for teleaudiology alternatives. For example, some of the scheduled hearing aid check appointments that require the patient to block off at least a few hours of their time to make an appointment in your office could be replaced with a Skype connection that takes just a few minutes of time.
Next Steps: Start Getting Familiar with Teleaudiology
The use of teleaudiology is not without its challenges. The cost of the equipment is still relatively high and there are a variety of third party billing and HIPAA rules that need to be clarified. To learn more about the details of setting up teleaudiology in your practice, this article is a good stating place: Critical Steps in Establishing a Teleaudiology Practice
Another excellent article from VA Audiologist, Chris Gladden can be found here: 20Q: Teleaudiology – The Future is Now
For more details on teleaudiology equipment and how it can create efficiencies in your practice, contact me at firstname.lastname@example.org
Gladden, C. (2013) The current status of VA audiology. NCRAR Conference, Portland, OR
Jacobs, P & Saunders, G. (2014) New opportunities and challenges for teleaudiology with the Department of Veterans Affairs. JRRD. 51, 5.