Current and Developing Technology 2014
Telehealth services can be grouped into two different models that are based upon the timing of the information exchange and the interaction between patient and professional or professional and professional.
Real Time (synchronous)
With these services, both users have constant contact. This type of communication will require Internet access for both the provider and the patient.
Current use examples:
- Requires camera on phone/tablet/computer –not all computers have a camera, nearly all smartphones and tablets do
- At this time, most setups involve
- Technician as intermediary between provider and patient
- Common meeting place where cameras and monitors are set up
- Secure patient portals through certain Web sites
- Support groups through Web sites
- Both traditional Web sites and connected versions
- Hearing aid programming on smart phones
- Cochlear implant remote mapping
- Professional-to-professional communications, typically videoconference
- Both parties need Internet connection
Cloud Based (asynchronous, self-guided, offline)
With these services, files, data, and information are transmitted and stored for review or discussion at a later time. Results may be conveyed online, via e-mail, text, or by other asynchronous means.
Current use examples:
- Self-testing, “data-logging” measures, screening, and self-paced rehabilitative tasks that are completed independently, reviewed, or interpreted by a professional.
- Auditory rehabilitation programs are online/computer-based (e.g., LACE can be used in DVD format or through a cloud version and downloaded onto a computer if the patient has a tablet).
Many audiology services can be performed either live or cloud based, such as
- Video otoscopy
- Case History/Questionnaires
Remote Hearing Test Real World Examples
- East Carolina University developed a Web-based system to act as a medium between the audiologist and the patient to deliver the hearing test. With this system, the audiologist and the remote site are using videoconferencing to communicate. The patient is set up by the facilitator onsite to a computer that is connected via blue tooth to an OTOPod audiometer. The patient is seated inside a traditional sound booth. The audiologist administers the hearing test remotely. Remote hearing tests were compared to the same hearing test performed face-to-face. The results were within 10 dB and the time per assessment was equal.
- A tele-audiology clinic in South Africa is using the the KUDUwave audiometer that is software controlled and operated via a computer notebook. The patient is seated in a quiet room and is set up by a facilitator. The audiometer hardware is encased in each circumaural earcup and is powered by a USB cable plugged into the notebook. The transducers include custom insert earphones, which are covered by circumaural cups after insertion, and a bone oscillator placed on the forehead with a headband. The attenuation values achieved through the inserts and circumaural cups exceed those of typical transportable sound treated booths. Furthermore, the use of two microphones on the outside of each circumaural cup monitors the environmental noise across octave bands during testing and is visually represented on the software. The notebook computer uploads all test information to a secure server using a 3G cellular Internet connection for asynchronous interpretation. Remote hearing tests were compared to the same hearing test performed face-to-face and no difference was found.
Current Tele-audiology Technological Limitations
- Both parties need Internet access
- Specific phone, tablet, computer and/or software/application will be required for the information to be transferred from provider to patient (some tech-savvy is required).
- Wireless hearing aids will be required to connect the audiologist to the patient.
- Calibration issues will arise when performing diagnostics remotely.
- When a technician is required, several concerns arise: cost effectiveness, privacy issues, HIPPA, and less control by the audiologist.
- When all hearing aids, regardless of technology level, become wireless and connect to a phone application, then all patients will have ability for remote hearing aid programming.
- When patients become more familiar and comfortable with the telemedicine process, or when only simple counseling is needed, technicians may not need to be present.
- When technicians are not needed, patients can connect from their homes.
Full diagnostic tests, including bone conduction and speech testing, will be completed reliably and remotely.