Tele-Audiology: Theory to Practice
Virtual Academy Research Conference (ARC) 2020
By De Wet Swanepoel, PhD, ARC 2020 Program Chair
The Academy Research Conference (ARC) 2020 took place virtually in August and focused on tele-audiology. This year’s ARC considered the changing role of technology, patient engagement, and service-delivery in audiological care during COVID-19 and beyond. Leading experts in tele-audiology shared translational and applied research with a strong clinical focus for hearing care in adults.
Telehealth stated very briefly is simply the provision of health care at a distance using information and communication technology. The more comprehensive World Health Organization (WHO) definition states that telehealth is the “delivery of health-care services, where patients and providers are separated by distance. Telehealth uses ICT for the exchange of information for the diagnosis and treatment of diseases and injuries, research and evaluation, and for the continuing education of health professionals.”
It is also useful to briefly consider the variety of terms used in this area. We have the terms telemedicine, telehealth, and eHealth that are largely used interchangeably. More recently the term mHealth has been added which refers more specifically to the use of mobile technologies including smartphones.
Remote care and virtual care have also appeared to refer to the mode of services provided at a distance and using virtual tools connecting professionals and patients. Finally, the term digital health has also emerged as a larger category that encompasses telehealth but include concepts of wellness and prevention too.
The fact that COVID-19 has required physical distance has played right into the purpose of telehealth, i.e. provision of care at a distance. Previously tele-audiology was viewed as a means to improve convenience and accessibility of care as an optional benefit, but COVID-19 has escalated patient safety as the primary driver. As a result, telehealth has seen a tremendous growth spurt both in technologies and uptake with exciting new possibilities for provision of audiological care into the future.
The following abstracts summarize the presentations of ARC’s presenters.
De Wet Swanepoel, PhD, ARC 2020 Program Chair
Professor of Audiology, University of Pretoria, South Africa
The COVID-19 crisis has ushered in a new era in hearing health care that requires a radical rethinking of service delivery in audiology. In the technology-driven field of audiology there are unique opportunities to leverage connected solutions for remote and telehealth services. Where accessibility, convenience and efficiency have been the primary drivers of telehealth, COVID-19 has made it about safety first and foremost considering the vulnerable profile of typical audiology patients.
Low- and no-touch alternatives to traditional care are now necessary for many patients. While traditional diagnostic assessment to differentiate hearing loss due to ear disease, which has a low prevalence, requires a sound-treated environment and a comprehensive test battery, a less controlled environment with fewer tests could suffice for hearing aid fittings. This means that more than 95 percent of adults with hearing loss could be served using alternative low- or no-touch audiological care.
The technologies and service-delivery models that support these new care pathways were explored through this presentation. The COVID-19 pandemic has offered a unique opportunity to redefine and innovate how audiologists reach and serve patients in more responsive, efficient, and person-centered ways.
VA National Audiology and Speech Pathology Program Office
The presentation covered the current state of tele-audiology in VA. Store and forward method of testing that utilizes automated audiometry and image capture to allow for testing in locations without an audiologist was discussed as used in the VA. Remote hearing aid programming apps that allow an audiologist to make programming changes to certain hearing aids via Bluetooth technology and a smart device was discussed and other areas of audiologic rehabilitation provided through virtual care during COVID-19 were also be presented.
Senior Audiologist, Ida Institute
Tele-audiology offers the opportunity to deliver and receive care in flexible and individualized ways. The Ida Institute has developed Ida Telecare, a suite of online tools designed to empower patients to get actively involved in their own hearing care. By reflecting on important communication needs ahead of appointments, patients become able to guide clinicians on the support they need. This helps clinicians save time and ensures more focused and productive conversations in appointments.
Ida Telecare tools are freely available on the Ida Institute website and may also be embedded directly into a clinic’s own website for easier access and use. The Ida Institute has in recent years supported research studies and clinical pilots using the Ida Telecare tools, which have contributed to the body of evidence for the tools’ feasibility and effectiveness in helping patients develop the necessary motivation to take action on their hearing loss, use hearing amplification, and learn to communicate well in daily life. The presentation demonstrated the Ida Telecare tools and easy-to-use resources designed to introduce the tools to patients. It also presented the findings of the research studies and discussed their implications for effective and successful implementation of the tools in daily clinic.
In our rapidly changing world, audiologists are exploring new hearing health care services using patient-centered, telehealth-supported models. Our research tested a hybrid hearing care service delivery model consisting of online and face-to-face modalities along the entire patient journey.
Services included online screening and engagement, face-to-face diagnostic evaluation and hearing aid provision with online support and rehabilitation. We reached new patients using online marketing followed by a validated online hearing screening test and readiness management tools. Data from 930 patients who completed online hearing screening and online motivational engagement, of which 53 were seen for a face-to-face diagnostic evaluation over a period of 24 months, was presented.
Results indicate that online screening of new patients and assessment of their readiness to receive hearing services is successful. Patients’ digital proficiency did not influence the uptake of hybrid hearing care services. Positive patient experience and satisfaction of hearing services received through this hybrid model, which complements the traditional hearing care model, was discussed.
Knowledge is key to patient self-management and empowerment. C2Hear is an evidence-based online multimedia educational intervention designed for hearing aids users. C2Hear is effective in improving knowledge of hearing aids and communication, and increasing hearing aid handling skills, self-efficacy and use in new hearing aid users. C2Hear is freely available (c2hearonline.com), viewed greater than 300,000 times globally.
To take advantage of the greater personalization and user-engagement afforded by mHealth technologies, C2Hear was repurposed for mobile technologies, known as m2Hear. The result was 42 short videos, tailored to meet individual needs, and embedded with activities. A mixed-methods study trialed m2Hear in 77 first-time hearing aid users in their everyday life. Qualitative data was analyzed deductively using the COM-B model.
There were significant improvements in social engagement, self-efficacy and hearing aid outcomes. m2Hear provided useful ‘on-the-go’ reminders and new information, which improved knowledge of hearing aids and communication (Capability). m2Hear was simple and straight forward to use, and improved personalization and accessibility (Opportunity). Provision of support and reassurance improved confidence and empowered participants to self-manage their hearing loss (Motivation).
President, Premier Consulting
Adjunct Professor, Texas Tech University Health Sciences
The concept of tele-audiology practice was not a popular term among audiologists due to reimbursement issues and concern that a lack of face-to-face to encounter was not conducive to optimal care. However, COVID-19 has made audiologists revisit their thinking and help accelerate telecare in audiology. The presentation focused on the flexibility and sustainability of tele-audiology in the future.
Professor and Vice Chair of Graduate Studies, Vanderbilt University Medical Center
The Over-the-Counter (OTC) Hearing Aid Law of August 2017, which authorized the FDA to create a category of OTC hearing aids for treatment of mild-moderate hearing loss in adults within three years is currently being realized. As part of the discussions leading to this law, unbundling of professional services in the pricing of hearing aids was also recommended. What will OTC mean for hearing health care professionals? How will it impact our current services? Reimbursement? Patient satisfaction and outcomes? Current data regarding patient’s ability to self-diagnose, self-fit and self-orient to amplification was presented when considering these questions. In addition, a multi-layer service model was discussed that includes, at its highest level, individualized application of technology. Within this framework, individualizing selection and application of hearing aid technologies including limited service models which are aimed at providing better outcomes than true OTC, but are still price competitive, were discussed.
Director, The Connected Hearing Healthcare Lab, Western University
Assistant Professor, The School of Communication Sciences & Disorders, Faculty of Health Sciences
Remote service delivery models, including those offering hearing aid management and support services, have gained considerable interest in the field of audiology and are rapidly being implemented into clinical practice around the world. This relates to (1) recent technological advancements enabling service provision at a distance; (2) the growing need for alternate delivery models to improve access to audiology services globally; and (3) efforts to mitigate current and future effects of global pandemics. This presentation reviewed important clinical uptake and readiness factors emerging from research in Canada for researchers and clinicians to consider when implementing remote audiology services specific to hearing aid fitting.
Audiologist and Clinical Informatics Lead, Norton Sound Health Corporation
An overview of telehealth models with a focus on adult assessment and intervention were reviewed. Practical solutions were provided for various types of services and situations using different telehealth models including asynchronous, real time, remote control, mHealth, clinic to clinic, and direct to consumer. Real practical solutions and case examples for audiology services provided in remote northwest Alaska were described.
Nearly 300 individuals participated in the virtual ARC, attesting to the importance and timeliness of this topic. A post-COVID19 world will see telehealth persist and increase as an essential part of audiological care.
A recording of ARC 2020 will become available on October 1 through eAudiology, the Academy’s online learning platform.
ARC is worth 0.6/Tier 1 CEUs and will be included free of charge in the 2021 All-Inclusive Web Seminar Package that can be purchased at a discounted rate of $99 when members renew their 2021 Academy membership.