The previous article in this series, “Grasping AI,” discussed the basics of artificial intelligence (AI) and introduced you to GenAI. That article explained several ways AI can enhance HHC. Here, we focus on HHC delivery and present promising alternatives to using the time of expert humans, such as audiologists and otologists. We also explain how GenAI’s transformation of HHC provision is a significant stride toward solving its accessibility and affordability problems while freeing AuDs to care for more patients with complex hearing issues that demand their attention and medical approach.
However, first, we must appreciate our patient base’s diversity and varied needs and then the customized solutions we can provide.
Hearing Health Care’s Patient Populations
Figure 1 separates our patient base according to the severity of their hearing loss and the costs and complexity of their treatments. The figure shows that 75% of patients with measurable hearing loss have mild or moderate losses that can be addressed with basic treatments. In contrast, only 5% have profound hearing loss, necessitating complex interventions. It lists the overwhelming differences in the healthcare needs of these patient groups. Much hearing loss is chronic, and as time passes, the hearing loss gets more severe, so treatments and providers must evolve to accommodate those changes.
Figure 1. The distribution of patients according to their degree of hearing loss and the costs and quality of their treatments (Nielsen, 2024a). Adapted from Taylor and Nielsen 2019, with data from Nash 2013, Lin 2011, Wallhagen 2008, Humes 2021, and Edwards 2020.
The key idea is that audiology is experiencing a significant transformation due to utilizing GenAI. This technology allows us to effectively cater to various patient groups by aligning their specific needs with appropriate care, reducing costs and increasing accessibility.
This transformation sharply contrasts the status quo, where audiologists are encouraged to see all patients. Importantly, audiology clinics must serve all types of patients as their hearing changes and to attract, understand and build trust with patients early in their experiences with hearing issues. That should not change. Still, not all clinic patients need to be served by an audiologist. We will elaborate on alternatives below, but first, let’s consider which patients see which providers.
Match the Provider to the Patient’s Needs
Figure 2. Patients in the upper portion of the triangle have complex prescription needs (See Figure 1) that are best met by providers using the medical model. Providers who do not use the medical model best serve patients in the lower part of the triangle.
Figure 2 illustrates that we must split the diverse patient base in Figure 1 into those requiring medical model care (prescription providers) and those who will do well with nonmedical model care (nonprescription providers). This triaging matches the patient’s needs to the appropriate provider and allows us to assign providers most effectively while improving access and affordability. Let’s take a closer look.
Genai’s Roles in Facilitating the Patient/Provider Match
Approximately 40 million people in the U.S. have hearing issues. That demand far exceeds the availability of the 12,000 practicing audiologists. Figure 1 shows HHC patients distributed according to their hearing loss. However, people don’t know where they are in this population distribution or which providers they should see. They require guidance to match their needs with the right provider. AI’s enormous contribution to HHC delivery is its ability to facilitate that match and even create new providers. Our first example will examine how AI can facilitate appropriate HHC provider guidance and selection in primary care clinics.
AI’s Role in Matching HHC Patients and Providers Via Primary Care Providers (Pcps)
Why PCPs matter: PCPs play crucial roles in HHC. PCPs are often the patient’s initial interaction point. They are responsible for identifying hearing loss in older patients’ annual Medicare wellness exams. Kochkin’s 1998 survey showed that people with hearing loss are five times more likely to seek a hearing solution if their PCP gives a positive recommendation for HHC. A March 2021 ASHA YouGov Poll found that 42% of adults report that a recommendation from a medical professional would play the most prominent role in their decision to purchase an over-the-counter hearing aid, with cost being a distant second at 18%. PCPs can play an instrumental role in the early identification of hearing issues, guiding appropriate and timely choices for addressing patients’ recognized or unrealized hearing concerns. This role of the PCP in guiding patients and managing hearing loss can be improved by enlisting the help of GenAI.
Patients’ Points of Entry for Senior Hearing Health Care
Figure 3. PCPs are the largest and most trusted entry point into senior HHC.
The problem: My experienceand observation is that most audiology clinics and audiologists have not established firm relationships with their local PCPs. They have missed an exceptional opportunity to educate PCPs and their staff about chronic hearing issues and their life-altering effects and to expand audiological services to treat more patients. As a result, screening for hearing loss and providing timely referrals are not a top priority for PCPs. Only 15%, or less, refer patients to hearing care (Popp et al., 2002), and many are confused or anxious about identifying the hearing health path their patients should follow. Additional research (Wallhagen et al., 2008) reveals that up to 85% of older patients report having no spontaneous advice from their PCP regarding hearing loss. Consequently, hearing problems may remain undetected and untreated or not be addressed by the best healthcare provider.
The AI solution: We need a robust solution that can enhance PCP groups’ involvement in HHC without significantly increasing patient visit duration or requiring them to make decisions outside their comfort zone or training. That sounds impossible, but with your support and involvement, AI is poised to offer that solution. Here is how.
When patients turn 65, they are eligible for Medicare physical exam coverage. Their first exam is called an Initial Preventive Physical Exam, or IPPE. Then, once every 12 months, patients get routine Annual Wellness Visits or AWVs. The IPPE and AWVs provide an opportunity for an AI-based solution.
We can embed AI into the IPPE and periodic AWV patient intake forms to identify hearing loss and whether the patient needs a medical exam to address their hearing problem. For instance, we could embed the RHHI-S (Cassarly et al., 2020) and the CEDRA (Klyn et al., 2019) (Nielsen, D., 2018) and automate the scoring. The embedded AI can also be trained to consider various treatments, including a broad range of hearing devices, from simple nonmedical amplification devices to sophisticated medical devices, and match the patient to the appropriate device or treatment suggestions based on its analysis. It can consider several local providers and suggest the most suitable and accessible providers that the PCP might recommend to the patient. Sarah Sable Antry has developed an initial version of a tool like this at www.hcrpath.com. In the near future, precision medicine will significantly improve this approach by incorporating genomic and additional personal information into the patient’s database and integrating it with the intake form to make better-informed decisions than are now possible. This will enhance and perfect the analysis. See www.hcrpath.com for more details and Nielsen (2024b) for additional information about precision medicine and genomics.
To modernize the provision of HHC, a strong partnership between HHC providers and PCPs is necessary. AI can facilitate and strengthen that relationship. Audiology’s involvement in developing and introducing AI to the PCPs adds expertise, credibility, and sophistication and builds trust. We must work toward integrating AI-enabled HHC in the PCPs domain. This will free audiologists from routine tasks and allow them to provide more complex treatments. Audiologists and ENTs will gain from working with PCPs and their AI systems to be the clinicians or clinics the AI recommends.
Let’s turn to AI’s role in solving other HHC problems centered on matching the patient and provider.
Ai’s Modification of HHC Delivery
The recent blossoming of GenAI and the concurrent proliferation of nonprescription hearing treatments have reshaped how audiologists can serve the lower portion of the patient triangle, who can benefit from nonprescription providers. Audiologists must learn to use these emerging provider types driven by GenAI. Like audiology technicians or assistants, self-help and virtual providers will extend your patient reach and the services you can provide.
A New Generation of AI-Enabled Providers Are Audiology Extenders
Self-Help: Patients as Partners – A limitation to promoting patient self-investigation into their health issues is the traditional perception of patients as passive recipients who only seek medical assistance when necessary. However, increasing offerings improved by GenAI let patients identify and triage medical issues and care for them independently, only bringing in a doctor when necessary.
Patients can test their hearing at home. Meanwhile, many sophisticated medical devices have been customized for self-help and are moving from the doctor’s office to the home, from blood tests to EKGs. Over-the-counter (OTC) hearing aids are self-fit devices. Even cochlear implant recipients can self-test at home to monitor implant performance with smartphones or tablets (Wasmann et al., 2023). We must encourage people to use self-tests and consider them proactive partners in diagnosing and treating their hearing issues. Because of the shortage of audiologists and the demand for audiologists to treat complex medical problems, we have no choice. To lower costs and serve more patients whenever and wherever needed, we must extend our provider base by integrating self-triaging and -testing into our clinic protocols
Virtual Providers: GenAI allows us to provide accessible, competent virtual providers instead of one-on-one in-person medical care. These AI-enabled providers were initially used when patients needed constant or repetitive advice or instructions. With the increased sophistication of GenAI, they can now be used for more sophisticated medical issues. We call the AI that empowers virtual providers telepresence. Let’s take a deeper dive into its operation and use.
Telepresence —These technologies allow people to feel as if they are physically present with someone whom technology represents digitally. Given the widespread use of cell phones and computers, telepresence is rapidly evolving to strengthen health care and increase affordability and accessibility.
Previous virtual technologies, like Internet chat blogs, were not lifelike or personal—questioning and answering required laboriously written interactions with long delays, frustrating misspellings and mistaken interpretations. Notably, the elderly find them challenging and unnatural.
Videos are an improvement over text-based chatbots; however, if you have assembled furniture while watching a YouTube video, you understand the limitations of the video instructional model. Self-help videos give limited instructions, lack interactions, and are often problematic. GenAI allows us to do better.
AMIE is a telepresence-style chatbot created before GPT-4o to provide medical advice to patients. It was compared to human doctors to assess its ability to show empathy and engage in conversations. AIME performed better than doctors in 24 out of 26 aspects of conversation quality, offering patients an equal or higher level of empathy and support as human physicians (Haseltine, W., 2024).
Virtual providers using GenAI, like AIME, can learn, converse, and problem-solve like humans. Still, with the advent of GPT-4o, they can do better because GPT-4o is natively multimodal, which means it can “see,” “hear” and “speak” in an integrated way with almost no delays. It can blend all these modes together. It can see what you are doing, react to it, respond to interruptions, use realistic voice tones and create images. Virtual providers can react like humans and influence patients as humans do (Mollick, E. 2024). GPT-4o is free. Experiment with it to discover its many attributes and imagine its use with 3D virtual providers. Virtual providers can exceed routine human communication by adding captioning, clear speech, synced in—focus, and accurate lip movements. They have quickly evolved to be competent coworkers.
Contrary to popular belief, AI can express emotions by reacting to the feelings of others. GenAI-based systems can determine a patient’s emotional state by analyzing speech patterns and other cues, such as facial expressions and physiological measures. These systems can help inform a virtual provider in real time if the patient is or is not engaged and what material is resonating. The virtual presenter could slow down, show more empathy or make other changes. Patients will develop relationships with 3D virtual providers as they do now with friendly front office staff and providers.
GenAI facilitates the development of new care delivery capabilities that fundamentally change how HHC teams spend their most valuable resource: time. Now, we can provide patients with needed information 24/7 from a 3D virtual person who can answer any verbal or written question and present a pleasant, empathetic personality. Virtual providers will be a critical driver of increased accessibility and affordability of HHC.
AI’s Effects on Prescription HHC
In-Office AI-Enabled Audiology Extenders: While self-help and remote virtual providers will improve HHC access, in-office AI-enabled providers like AMTAS Pro will also be needed to accompany prescription care.
The AMTAS Pro is a robust tool that ensures reliable results. It conducts diagnostic audiograms, including air conduction, bone conduction and speech, all with appropriate masking, if necessary, without needing an audiologist. A trained team member, such as an audiology technician, can room the patient, provide minimal instructions, and place the earphones appropriately. Testing takes under 30 minutes, and results are scored for reliability by the AMTAS Pro, providing high confidence in its accuracy.
While the AMTAS Pro is a valuable addition to a practice, it’s important to remember that it’s not suitable for all patients. Each practice should develop criteria to determine who could be scheduled for the AMTAS Pro versus those who should be scheduled with an audiologist or tech and when results would automatically trigger an additional test with an audiologist. This responsibility ensures that each patient receives the most appropriate care. For example, if the AMTAS Pro qualified the patient’s response reliability as “poor,” the patient would see an audiologist for an audiogram.
Introducing audiology extenders, like the AMTAS Pro, into an established clinic process flow is a significant change that requires careful planning. Fuel Medical Group, with its expertise, can help design criteria for scheduling and protocols and coach communication strategies that will increase internal and external acceptance, ensuring a smooth and successful integration process. Fuel builds with its members, not just for them, encouraging its members to acquire the necessary capabilities to thrive through rapid change.
Genai’s Influence on OTC Delivery and Acceptance
The FDA promoted OTC hearing aids to provide high-quality hearing aids that people with mild to moderate hearing loss could buy online or at local pharmacies and big-box stores. However, acquiring hearing aids over the counter can still feel challenging. Not everyone with hearing loss is comfortable with online sales or do-it-yourself adjustments via apps. ASHA’s OTC Hearing Aid Survey, 2023, found that only 24% of those patients who were at least somewhat confident an OTC device could assist them were satisfied they could choose the correct device. They want help.
AI-enabled platforms could be the key to patients adopting more OTC care options. Consider how helpful interactive dialog with a quality virtual provider could be in informing patients about OTC devices and monitoring their reactions. Patients could discuss whether the devices are appropriate treatments for their hearing issues. If so, they can also get suggestions about which OTC device to purchase and how to unbox, fit and maintain it. This system would introduce patients to HHC in a less expensive, more accessible, more prosperous and more rewarding way than it currently does.
AI-powered virtual health care has the potential to be both convenient and cost-effective. Patients no longer need to schedule appointments, travel to a healthcare provider or wait for an in-person, one-on-one meeting with their provider.
Conlusion
PCPs, audiologists and patients will use AI to diagnose and triage hearing issues. By directing the appropriate patients to new GenAI-equipped channels to empathetically diagnose and treat their nonprescription HHC needs, GenAI will streamline patient triage so only those needing qualified prescription-capable providers will see physicians and audiologists. This liberation of prescription providers will result in more patients with prescription needs being appropriately seen and treated, significantly improving HHC while simultaneously increasing its accessibility and affordability.
Resource for Further Study
References
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