Reshaping the Delivery of Hearing Care

A case study in motion

Patti Ramos and Joy Glen

Telemedicine continues to gain momentum, particularly for technology players, healthcare delivery systems, employers and health plans.

Although many physicians and audiologists still prefer traditional in-office visits, remote clinical service delivery models cannot be overlooked as more patients seek convenient and costeffective alternatives. In fact, the American Well 2015 Telehealth Survey found that 64% of American consumers surveyed would have a video visit with a doctor.

With the hearing health care industry dabbling in telemedicine for years now, from the VA leading the introduction over 30 years ago, manufacturers providing remote hearing aid programming features, to the impact of technology and connectivity in the face of issues around access, convenience, quality and cost-effectiveness, many ENT and audiology practices are beginning to consider telehealth opportunities.

Telemedicine in the hearing care industry

"...64% of American consumers surveyed would have a video visit with a doctor."

Specifically, many ENT and larger audiology practices continue to debate the best approach to meeting patient testing and consultative needs while balancing costs associated with staffing these satellite locations.

Considering Tele-Audiology

Ear, Nose & Throat of South Florida is investigating the equipment and clinical process requirements involved with staffing a satellite clinic location for tele-audiology. This process is currently being supported with a medical assistant while the audiologist performing the testing is  located at the full-time clinic location.

 

What aspects of tele-audiology are being used in the satellite offices?

We are investigating the use of teleaudiology in real-time, or synchronous tele-audiology, where the audiologist, medical or audiology assistant, and patient are simultaneously engaging in information exchange   in two separate locations. Diagnostic assessments by an audiologist are executed while remotely controlling a computer-operated audiometer that is connected by the medical or audiology assistant via the internet.

These tele-audiology services typically utilize non-specialist  personnel to enable the testing that links the hearing care provider and the patient. These personnel are often nurses, medical or audiology assistants in the ENT clinic. The assistant team does not review test results, make diagnoses or even review the audiologist’s  interpretations but merely to facilitate the process exchange for the specific tele-audiology encounter.

What equipment is being used?

During this investigation, the innovative audiometer and video otoscope used are part of the Primus fitting system, manufactured by Auditdata.

What equipment is needed?

  • Primus Audiometer (in the ENT office)
  • Primus Video Otoscope (in the ENT office)
  • Primus Insert Transducers or TDH 39’s (in the ENT office)
  • Computers (in the Remote Testing Center and the ENT office)
  • Broadband Internet (in the Remote Testing Center and the ENT office)
  • TeamViewer (on the computers in both the Remote Testing Center and ENT office

Who is involved in the process?

  • Audiologist from remote testing center
  • Medical or audiology assistant who is qualified to perform otoscopy
    and place transducers in patient’s ears. This occurs in the ENT office.
  • Patient (in the ENT office)

How is remote testing established?

  • The remote testing center is equipped with the Primus Audiometer and Windows based laptop, which contains the TeamViewer software. The remote testing center has an audiologist on site, who will conduct the Audiometry testing, as well as to view and assess Otoscopy results.
  • The ENT satellite office contains a Windows based computer, which contains the TeamViewer software. This office should have a sound booth for the patient to sit in during tele-audiometry testing. This is the location that will service patients.
  • Medical or audiology assistant in ENT office takes patient into testing room.
  • Medical or audiology assistant explains testing process with patient and obtains connection with audiologist at testing center (using TeamViewer).
  • Audiology assistant conducts video otoscopy, using Primus Otoscope, while the audiologist from remote testing center looks at live streaming video of ear anatomy to check for obstructions, cerumen, and tympanic membrane health.
  • If the audiologist from the testing center feels that otoscopy was unremarkable, they will then instruct the medical or audiology assistant to place the patient in the sound booth and to place either the TDH 39 or insert headphones in the patient’s ears.
  • Once the desired transducers are placed on the patient’s ears, audiometric testing can commence.
  • The audiologist from the testing center will conduct Air, Bone and Speech Audiometry, using the Primus Audiometer. The audiologist will direct and guide the medical or audiology assistant to switch transducers as needed.
  • If the audiologist determines that masking is needed, they will instruct the audiology assistant which headphones to use and how to instruct the patient.
  • At the conclusion of testing, the Audiologist will determine next steps for the patient, including a hearing aid evaluation or further testing

Final Thoughts:

What used to be a concept for the future is now quickly becoming an imminent consideration to meet patient needs for access and convenience and the business demands for productivity and profitability. This tele-audiology operational investigation will continue within this practice  to carve out more modern opportunities for remote care beyond diagnostic testing.