Views and Vision brings together diverse voices from the hearing industry to comment on relevant issues affecting audiology and hearing health. This month, the spotlight is on Teleaudiology: Weighing the Benefits and Challenges.
Gabrielle Saunders, PhD
Dr. Saunders is the associate director of the National Center for Rehabilitative Auditory Research, VA Portland Health Care System, and an associate professor in the Department of Otolaryngology at Oregon Health and Science University.
Views about teleaudiology are mixed, like those about the current political climate; everyone has a fervent opinion one direction or the other. I hope to make a few points that will sway the hesitant reader toward thinking of teleaudiology as a blessing rather than a curse.
Consider the point made by Elizabeth Krupinksi, past president of the American Telemedicine Association, who said that “…telemedicine is not a separate medical specialty. It is simply the delivery of health care using techniques and technologies that reduce geographic and other barriers to receiving care in an efficient and effective manner” (J Am Acad Audiol 2015;26:761 http://bit.ly/2bcjZqc). She emphasized that teleaudiology is simply the practice of traditional audiology using new technologies to improve services and outcomes. There is no change in the scope of practice, nor has a new field arisen–audiology is simply being conducted using tools such as the internet and smartphones. There are of course barriers that must be dealt with, such as figuring out how to build and manage patient-provider relationships, maintaining patient privacy and data security, handling patient expectations, having contingency plans to cover for technological failures, and dealing with licensing across jurisdictions, but these are manageable and will likely be overcome. Don't let them detract from the positive aspects of teleaudiology, such as increased access to services, decreased wait times, potentially decreased costs, and convenience for the patient and clinician alike.
Give teleaudiology a chance for at least three reasons. First, while practitioners are often uneasy about providing services through telemedicine, patients tend to have a positive view of receiving services in this manner (Boeldt. J Med Internet Res 2015;17:e21 http://bit.ly/2bcyI4p) thus, be a patient-centered practitioner and listen to your clients. Further, attitudes toward telemedicine seem to become more positive with experience (Singh. Int J Audiol 2014;53:850 http://bit.ly/2bcBaYA), so withhold judgement until you've tried it.
Second, many studies have shown that teleaudiology outcomes are at least as good as those obtained from face-to-face practice (e.g., Pross. Otol Neurotol 2016;37:847 http://bit.ly/2bczmyz; Wesarg. Acta Otolaryngol 2010;130:1379 http://bit.ly/2bcziiB); thus, if patients prefer it, why not use it?
Finally, telepractice can facilitate the involvement of other members of the patient's support team, such as family, medical practitioners, social workers, etc. who otherwise may be unable to participate. There is little doubt that an interdisciplinary team approach to rehabilitation is advantageous—especially when dealing with a pediatric population (de Raeve. Cochlear Implants Int 2010;11 Suppl 1:7 http://bit.ly/2bcAr9K). I urge those of you with reservations to try teleaudiology in your practice when the appropriate opportunity arises.
Mr. Brennan-Jones is a senior research fellow at the Ear Science Institute Australia and a senior audiologist at the Princess Margaret Hospital for Children in Perth, Western Australia.
Teleaudiology has the potential to deliver huge benefits, but it is not without its challenges. Like any clinical service, there are a number of key ingredients needed to make it a success.
A broad range of audiology services can be provided via telehealth to broad population groups. Young and old, metropolitan and remote, everyone can benefit in different from teleaudiology. However, services must match the needs of the target population to be effective. My work has been focused in the outback of Western Australia, where the rates of childhood chronic otitis media and hearing loss are some of the highest in the world and the availability of services can be very poor. Therefore, we have focused on diagnosis and intervention for otitis media and hearing loss in children, as this is the biggest issue for the population. The location of the service also makes a difference. For specialized work like pediatrics, it can be better to have strategically placed regional telehealth hubs. In many cases, patients will happily travel 60 miles for a telehealth appointment if it means they can avoid a 600-mile trip for a face-to-face consultation.
There also needs to be appropriate technology and infrastructure to support telehealth services. This is integral and often more difficult than you can imagine. Much of my work and that of my colleagues has focused on utilizing automated audiometry and asynchronous (store-and-forward) telehealth models to provide services where connectivity is poor (Brennan- Jones. Telemed Telecare 2016;Apr:ii http://bit.ly/2aHxxgv). Test automation has benefits, as regional telehealth facilitators can be trained to perform some tests. However, other tests require specialized equipment and expert skills. Know the limitations of your service; do not over-promise and under-deliver. For some patients, telehealth may not be suitable and face-to-face appointment may be required in a tertiary center. Inform patients of the limitations of this service from the start.
Finally, people are at the heart of everything we do as audiologists and clinicians. My clinical experience has shown that a blended telehealth service, which combines either synchronous or asynchronous telehealth sessions with face-to-face visiting service, delivers the best results. However, different populations may have different needs. Some patient groups (e.g., pediatrics and minority groups) need to feel that there is a tangible relationship with their service providers, as clinical interactions may feel “less real” when only delivered remotely or through a screen. This can be amended by having a local facilitator or by regularly visiting the community.
To be successful, teleaudiology services need to have relevance to the population they are serving and be practical in terms of the equipment, infrastructure, and human resources available. Despite the challenges, teleaudiology offers an excellent solution to minimize disruption to patients and maximize coverage of services for people who otherwise may not receive treatment.
I'd like to acknowledge the contributions of Robert Eikelboom, PhD, De Wet Swanepoel, PhD, and the Ear Science Institute Australia's Healthy Ears team.