The current Coronavirus threat has introduced us all to new territory. The need to distance ourselves physically from others changes the hearing health care landscape. In Ontario, Canada, the governing college of audiologists has mandated that services are only provided where there are “time sensitive circumstances to avert or avoid negative patient outcomes or to avert or avoid a situation that would have a direct impact on the safety of patients”.
In other words, normal daily clinic routine is to be suspended with the exception of a service that, if withheld, could cause harm to a patient. At the same time, the government is promoting the use of virtual health care delivery where possible.
Clinics face challenges in remaining financially viable while struggling to continue to provide services to patients in the face of the need for both staff and patients to self isolate. There is the immediate situation where clinicians may be without work, and the longer term situation that will see backlogs of patient appointments with staff struggling to catch up.
eAudiology, although not new, is not regularly practiced in many clinics. The tools however, are readily available and can be put into place with minimal preparation and little or no additional expense. As hearing health care professionals, we can be providing adjustments to amplification and providing patient counseling and auditory rehabilitation remotely. Although hearing assessments, both behavioral and evoked potentials, can be performed remotely, this component of eAudiology requires significant preparation and may not be viable as a solution during the current crisis.
The tools to provide hearing aid troubleshooting and adjustment are, for the most part, already in place in any clinic. All hearing aid manufacturers today supply devices that connect to smart phone apps. Adjustments to devices can easily be made through these apps from the manufacturers software. All that is needed on the clinic end is a computer with the appropriate manufacturer software and an internet connection. The patient needs a smartphone with the manufacturer’s app installed. As long as this is in place, the clinician can easily connect to the patient’s hearing aids and perform troubleshooting and adjustment in the same manner as a face-to-face visit. That said, many of our patients might not have a smartphone, or might struggle with operating the phone that they do have.
In this instance, we can use videoconferencing to get the patient to a point where the clinician can connect to the hearing aids. HIPAA compliant videoconferencing software apps are readily available. Many manufacturer’s hearing aid modules might have this built in. Or, you can use a solution such as TeamViewer or DoxyMe. These and other solutions are often free to use and are simple to set up and implement. As long as your patient can access a computer with a webcam, you can interact with the patient to instruct them or a caregiver in connecting the hearing aids to a smartphone. The patient themselves does not need to own a smartphone as you can connect through a caregiver’s device without compromising patient confidentiality. Patients in locked down senior’s facilities will likely have access to a computer with assistance from a staff member. Using both a videoconference link and the hearing aid software connection will allow you to connect with the client in the same manner as a face to face encounter.
New hearing aids can still be provided to patients in most cases where a remote connection is possible. The devices can be pre-programmed using existing patient information and RECD’s (where available) and provided to the patient in a ‘contactless’ manner. This can be done through the use of a courier or, if practical, clinic staff no-contact delivery. Once the patient has the devices, use of a videoconference and manufacturer software link will facilitate fine tuning of the device as well as patient instruction. Provision of new hearing aids is best suited to patients who are experienced hearing aid users and may be especially useful to worker’s compensation recipients.
Use of videoconference solutions will allow a clinician to interact remotely with a patient to assist in counselling and auditory rehabilitation. Using eAudiology in this manner means that you can conduct appointments for hearing aid review, address communication concerns, and conduct structured auditory rehabilitation without the patient having to leave their home. In fact, as long as the setting is HIPAA compliant, the clinician can conduct such sessions from their own home. As mentioned above, all that is required for both the clinician and patient is access to an internet computer with a microphone and webcam. Interacting in this manner will allow a clinic to avoid a backlog of client appointments once the current crisis is over.
HIPAA: Clinicians must ensure client confidentiality when performing eAudiology. The remote links to the patient must be secure, including audio/video and data transfer. Manufacturer software running in stand-alone or a Noah platform can be considered secure. As the data can only be read within the manufacturer software, any intercepted data would not be interpretable.
Video conference links must also be secure. There are many solutions available online. Some solutions are designed specifically for telemedicine, while some are intended for business use. Both types are often acceptable for use. Solution providers will have HIPAA compliance information available to potential users. Many clinics already have solutions in place, or have access through the agency or hospital in which the clinic is housed. If your clinic has an information technology (IT) department, they are a good resource for solutions.
The clinician setting must also be private. Usually an office that can be secured and made private will suffice. It is preferable that the patient setting also be secure, however this is a choice that the patient can make. The patient must be informed of any potential risks to health data and must consent to the session before it can take place.
Videoconference: There are many options available, as indicated above. TeamViewer and DoxyMe are two examples. Microsoft and Google also have solutions available. A business associate agreement (BAA) is required to ensure HIPAA compliance with these solutions, however these are standard practices and are readily obtained. Your IT provider will be able to help secure these if not already in place.
Most computers come with built in web cams and microphones. It is often convenient for the clinician to use a headset with built in microphone. This avoids audio echo, common in many videoconference situations. The patient, if so equipped, can connect to their computer audio through an adjunct FM device. They can also use a tablet or smartphone for the session, as these have built in cameras and microphones.
Whatever solution you decide to use, test it first by connecting to a clinic staff to ensure the audio/video and data link is working properly.
Resources: There are many resources available that will assist clinicians in setting up an eAudiology solution in short order. A great starting point is Phonak’s ABC’s of eAudiology, available online.
Health Insurance Portability and Accountability Act (HIPAA) is a US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers.
Real-ear-to-coupler difference (RED) takes into account a person’s unique ear canal or earmold characteristics in comparison to a coupler that stimulates an average adult’s ear canal.
To get up and running with eAudiology, check out our quick guides here.