The main goal of ehealth and in this case, tele-audiology, is to improve access to care, especially for patients in remote areas or for patients who are unable to come to you. Successful implementation of remote audiology relies on the careful selection of your equipment.
Teleaudiology delivery methods
Before we get into the specific equipment requirements, I think it is fitting that we discuss the different delivery methods of telemedicine as these will directly impact on technology needs.
The current methods of delivering tele audiology services are:
Store and forward (Asynchronous TeleAudiology):
A trained technician or healthcare worker conduct the audiometry assessments - the test results are later forwarded to an audiologist for interpretation. This is generally the famous choice when the remote areas were the services are provided have poor internet connection. Therefore, the technician sends the test results once they have access to the internet.
Live video conferencing (Synchronous TeleAudiology):
This is a real-time, face to face interaction with the patient and clinician by using a computer (audiovisual). The clinician remotely controls the computer at the patient’s site to monitor the status of the patient’s hearing. The clinician will then analyze and interpret the patient data in real-time, and provide recommendations.
This article will focus only on these two specified methods of service delivery since these are the ones that are more relevant to audiologists and are applicable in both developing and the developed world. A 3rd option would be a blend of the two methods above but before you go about designing your particular program, lets focus on these main methodologies.
The Right Tools For TeleAudiology
What is required to implement teleaudiology services?
- It is necessary to ensure that your audiometer is tele-audiology enabled. One way to verify this is to ensure that the equipment can be connected to and controlled by your computer. This will allow the audiologist to control the equipment at the test-site remotely, using third-party applications such as TeamViewer. Additionally, if you are implementing asynchronous services, you will still need a PC-controlled or connected audiometer, to allow for storing of test results to later send them to the audiologist.
- Look out for all-in-one audiology equipment that will allow you to conduct air and bone conduction, speech audiometry and immittance testing with the use of a single device.
- Ambient noise monitoring:
Most remote areas do not have access to a sound booth to rely on for attenuation, in which case, you will need to ensure that the test environment is quiet enough to test accurately. Remember that you will not be physically in the room, so subjective monitoring will not be an option. (nor should one ever rely on this method if quality is high on your agenda). You would purchase a noise level meter and place it in the room to help ensure that background noise is controlled during testing.
BUT, try to procure an audiometer which is able to attenuate as much noise as a sound booth and has a noise monitoring feature (see KUDUwave).
- Speech audiometer with embedded speech materials
- Video otoscopy with computer connectivity.
- Hi-pro or a similar product for hearing aid programming.
- Continuous high-speed and reliable internet connection. Synchronous or live video conferencing interaction needs flawless connectivity as you would not want to be interrupted during your patient consultation. If you will be implementing asynchronous services, internet connectivity will only be necessary when sending and/or receiving information from the audiologist.
- Two computers with HD webcam, a microphone and speaker/s, for yourself and the technician seeing the patients
- Remote desktop control software such as TeamViewer: To control the computer at the test site
- Video Conference software: For live interaction with the technician and patient at the test site (skype, google hangouts or similar)
- Technician/ support personnel: You need to train a technician properly - for example, how to place the audiometer earphones in a patient's ears and how to do otoscopy.
- In order to successfully implement asynchronous teleaudiology, you will need someone or a technician on the other end to facilitate and test the patient. This cannot be stressed enough! The person has to be trained well to ensure that you get accurate and reliable results. This is where procuring devices that have an automation option is key, to ensure valid results.
Why the KUDuwave is the best solution
- The KUDUwave is perfectly suited for teleaudiology and is worth considering as an all-in-one solution. It makes moving around easier and testing quicker with boothless testing capabilities and automated functionality.
The goal of tele-audiology is to ensure that we see all patients who need audiology services - without having to move them around much. With that being said, certain places have resources and some don’t. It is my hope, however, that we can use the resources available at hand to deliver teleaudiology services to those who need it the most.