Tele-audiology has created quite a buzz in the industry ever since Dr. Gregg Givens coined the term in 1999 in reference to a system being developed at East Carolina University. Considering the challenges hearing care professionals currently face due to the COVID-19 outbreak, there hasn’t been a more reasonable time to consider remote hearing care options.
Below are some best practices and steps to consider when implementing tele-audiology for in-home patient appointments and remote office applications.
Set-up scenarios for In-Home Patient Appointments
Step 1: Identify Your Clinic’s Current Interactive Equipment
Remote Programming Apps:
- Leading hearing aid manufacturers such as Phonak, Resound, Signia, Starkey, and Oticon offer remote hearing aid programming apps for smartphones. If you’ve yet to explore these apps, now is a good time to learn about the ways in which they can benefit you and your patients.
- Process
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- Have patient download appropriate app on their smartphone
- Obtain patient’s email address and register on manufacturer’s website (if necessary)
- Provider has access to website, a desktop/laptop, and headset and/or webcam
Desktop or Laptop with Windows 10 OS, Internet Connection, and Email Capability
Smartphone or Tablet
Other
- PC monitor
- Webcam with access to audio (microphone and speaker)
- Headset with boom mic
- A practice management system with atelehealth connectivity feature (Sycle, CounselEAR, BluePrint, etc.), or, anon-public facing audio/video platform.A non-public facing remote communication product is one that, as a default, allows only the intended parties to participate in the communication, such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, WhatsApp video chat, Zoom, Skype, etc.
Step 2: Identify Your Patient's Current Equipment and Needs
Home Video Chat Appointment:
- Smartphone or tablet
- Desktop or laptop with access to a webcam, microphone, and speaker
- Have appropriate hearing aid manufacture’s app already downloaded or need to download it or another A/V platform app
Step 3: Identify Patient's Desire for Home Video Appointment
The below example is of a front office staff (FOS) interviewing a patient for initial “triage” appointment. Here’s a basic script you can follow:
FOS:Good morning, how may I assist you today?
Patient:I am having problems with _____________________
NOTE: Pending patient’s response, FOS may be able to assist with issue over the telephone. If the FOS determines the patient requires more comprehensive assistance, proceed to next questions.
FOS: With today’s concern about COVID-19, we are using technology to provide you services.This will protect you and reduce your exposure to other people.Would you like an in-home video appointment with your provider?
Patient:Oh, yes.If I don’t have to come into the office, that would be wonderful.
FOS:Great!May I ask you some questions about the types of technology available to you at home?
- Do you have a smartphone? If yes, what type?Are you familiar with usingvideo chat, email, texting, and web browsers on your phone?
- Do you have a tablet, such as an iPad?If yes are you familiar with using video chat, email, and web browsers on it?
- Do you have adesktop computer or laptop? If yes are you familiar with using video chat, email, and web browsers on it? Does it have a webcam, microphone, and speaker?
After gathering this information, the FOS should use the grid below to determine if the patient should be scheduled for a telephoneappointment or an audio/video appointment.
NOTE: It's recommended that a spouse or other third party attend the appointment as communication through this environment can be challenging for the hearing impaired.
Patient Says Yes To
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Uses it For
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Appointment Type
|
|
iPhone and/or iPad
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Facetime, Email
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Audio-Video Appointment via Facetime
|
|
Android phone/tablet
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Email, Internet Search
|
Audio-Video Appointment via video chat platform
|
|
Smartphone and/or Tablet
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Phone, Text, Pictures
|
Telephone Appointment
|
|
Desktop and/or Laptop with webcam, microphone and speaker
|
Email, Internet Search
|
Audio-Video Appointment via platform
|
|
Desktop without webcam, microphone and speaker
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N/A
|
Telephone Appointment
|
NOTE: Following the telephone or A/V appointment, the patient may need an appointment for in-office programming services at provider's discretion.
NOTE: Using a smartphone or tablet for this communication will drain the device's battery. Please inform the patient to have their device fully charged or charging for appointment.
Step 4: Completing the Patient-in-Home and Provider-in-Home Appointment
Initial Telephone/AV Conferencing (Facetime, Skype, etc.)
Front Office Staff Tasks:
Identifies patient’s specific need through telephone interview (sample above) and may be able to guide patient through basic troubleshooting without additional appointment.
A. Charger is not working:
- Ensure hearing aids are in the correct cradle and in the correct direction
- Ensure charger is plugged into outlet
B. Hearing aid is dead/noisy/weak:
- Clean receiver end and microphone with brush
- Change battery pill
- Check if battery charger is working
- For dome or filter changing instructions, arrange for provider to call.Provider may attempt to explain steps over phone, but may do better with a video consultation.
Provider Tasks:
Either telephone or video conferencing at provider’s discretion and patient’s equipment availability.
- Hearing aid new fit follow-up (discussion and review of use and maintenance, etc.)
- Six-month checkup (identify any current needs, review, maintenance, etc.)
- Dome or filter changing
- Insertion orpainissues
- Volume or programming control manipulation concerns
- App downloads for use of volume and basic program options
- Sale or instruction of new assistive devices for TV, remote mics
Step 5: Completing the Patient-in-Office and Provider-at-Home Appointment
In-office programming by remote provider through video conferencing platform (Skype, Zoom, etc.). Uses an on-site staff member as “Facilitator” to assist remote provider with patient sitting near computer and manipulating programming equipment.
Examples of Applicable Scenarios:
- Amplification clarity or noise comfort issues
- Volume or programming control changes
- General hearing aid preferred settings
- Activate acclimatization (if applicable) feature
- Add or remove programs due to newly identified hearing need
Set Up:
1. Train facilitator on connecting hearing aids to programming device (different methods for different types of hearing aids and manufacturers)
2. Provider in off-site/remote location with laptop or desktop (phone/tablets do not work)
- Instruct facilitator on how to connect hearing aid to appropriate programmer
- Install remote access A/V platform. Be sure computer's volume and camera is activated.
- Activate the microphone and video camera in the A/V platform.
- Use telephone/cellphone to communicate with office facilitator and patient if microphone not available on desktop
- Video use through laptop or desktop camera is ideal,butoptional
3. Patient in clinic where hearing aid programming software and facilitator is located
- Install remote access A/V platform onto desktop with programming software
- Use telephone/cellphone to communicate with remote provider if microphone not available on desktop
- Video use through desktop camera is ideal, but, optional
Patient Interaction:
- Facilitator initiates remote access by inviting provider to conference
- Provider accepts invitation
- Facilitator selects “Share Screen” (or similar command) so provider can view clinic’s programming screen
- Facilitator selects “Give Control” (or similar command) so provider can manipulate keyboard and mouse of clinic’s programming computer
- Facilitator and provider connect via audio through computer mics or telephone/cellphone
- Facilitator sits patient in front of programming computer and monitor
- Facilitator introduces patient to provider via audio interaction explaining that even though provider is in another location, provider is very capable of making appropriate adjustments to hearing aids as needed
- Provider acknowledges patient and assures appropriate care will be given even though provider is not physically in the office
- Consultation between provider and patient commences via audio communication in a typical manner to identify patient’s need
- Provider instructs Facilitator to connect hearing aids to programmer
- Provider manipulates computer software (NOAH, manufacturer software, etc.) in usual manner
- Provider makes programming changes in usual manner
- Provider may use Facilitator or third-party (if applicable) as an onsite voice tester to confirm changes were applied and an improvement was made as expected
- Conclude appointment with usual salutations
- Make follow up appointment for further programming or telephone follow up as needed