New opportunities and challenges for teleaudiology within Department of Veterans Affairs (2014)

INTRODUCTION Teleaudiology is the delivery of audiology services and information via telecommunications technologies. In recent years, technological advances have resulted in a dramatic increase in the possibilities offered by teleaudiology--from diagnostic audiology and remote hearing aid fittings to downloadable hearing aid applications and real-time rehabilitation interventions. Teleaudiology has the capacity to provide access to audiological services to individuals living in rural locations, to those in inner urban populations who cannot afford or access the services of a professional, and to others who choose to self-manage their hearing impairment. With broader access and new models of service delivery come vast possibilities but also new challenges and questions for patients and professionals alike. Teleaudiology can be conducted using at least four models of telemedicine practice: 1.Synchronous/real-time data collection, referred to by the Department of Veterans Affairs (VA) as clinical video telehealth, in which face-to-face video-conferencing between patients and providers takes place. Synchronous/real-time data collection can be used to conduct hearing tests, hearing aid fittings, and audiologist-directed real-ear measures, and for hearing-aid counseling and tinnitus management. 2. Store and forward telehealth, in which data are acquired and stored by a technician at a remote facility and later forwarded to a specialist for interpretation and diagnosis. This form of telemedicine can be used to interpret video otoscopy, audiometry, immittence, otoacoustic emissions, and auditorybrainstem response readings. 3. Remote monitoring, referred to by VA as home telehealth, in which mobile devices are used to collect data that can be monitored by healthcare providers. Remote monitoring can be used to monitor hearing aid use or changes in hearing over time. 4. Mobile health, in which smartphone applications (apps) or other software is used for self-management of health conditions independent of a practitioner. Mobile health apps for hearing testing, auditory training, tinnitus management, and hearing aid counseling are readily available, as are apps that can turn a smartphone into a sophisticated amplification device. Without question, teleaudiology has effectively overcome barriers such as distance, cost, and the lack of specialist providers in remote locations, to increase access to audiological services. Data from the World Health Organization (WHO) illustrate this considerable need. According to WHO, there are almost 300 million people with moderate-to-profound hearing loss, but of these only about 10% use any form of hearing assistive technology. This number drops to 2.5 percent for developing countries [1]. Several countries have well-established teleaudiology programs, including Brazil, South Africa, and Australia. In the United States, teleaudiology services are becoming available through programs implemented by the VA and other organizations, such as the Alaska Federal Health Care Access Network (AFHCAN). These programs are driven by need. An estimated 37 percent of enrolled Veterans live in rural areas and 2 percent live in highly rural areas, * with 47 percent of rural and 95 percent of highly rural Veterans living 2 or more hours travel time from a VA clinic [2]. Likewise, 75 percent of Alaskan communities are unconnected by road to a hospital, 25 percent of communities have no airport, and 59 percent of the Alaskan population live in medically underserved areas. Furthermore, 60 percent of the state's physicians live and practice in Anchorage, while only 40 percent of the population resides there, with many locations having few or no specialist practitioners [3]. VA TELEAUDIOLOGY The VA teleaudiology pilot program began in 2009 as a joint effort between VA Telehealth Services, Office of Rehabilitation Services, and the Audiology and Speech Pathology National Program Office. …