The Nuts and Bolts of Preparing for Audiology Telepractice A telepractice expert shares what you need to know before—and how to prepare for—providing online services. Make It Work
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Make It Work  |   March 01, 2017
The Nuts and Bolts of Preparing for Audiology Telepractice
Author Notes
  • Chad Gladden, AuD, CCC-A, is the audiology telehealth coordinator for the VA Audiology and Speech Pathology National Program Office. Gladden is an affiliate of ASHA Special Interest Group 18, Telepractice. chad.gladden2@va.gov
    Chad Gladden, AuD, CCC-A, is the audiology telehealth coordinator for the VA Audiology and Speech Pathology National Program Office. Gladden is an affiliate of ASHA Special Interest Group 18, Telepractice. chad.gladden2@va.gov×
Article Information
Hearing Disorders / Telepractice & Computer-Based Approaches / Make It Work
Make It Work   |   March 01, 2017
The Nuts and Bolts of Preparing for Audiology Telepractice
The ASHA Leader, March 2017, Vol. 22, 28-29. doi:10.1044/leader.MIW.22032017.28
The ASHA Leader, March 2017, Vol. 22, 28-29. doi:10.1044/leader.MIW.22032017.28
The driving forces behind audiology-telepractice innovation are key challenges facing health care globally—issues of access, quality and cost-effectiveness.
Contemporary health care environments increasingly are designed to place the patient at the center of the health care team, enhance patient-provider communication, and support greater control of care based on a person’s needs, values and preferences for accessing care.
With these goals in mind, audiologists may be able to use telepractice to expand their client base and better provide access to care. And although audiology telepractice regulations vary by state, there are a few universal components that all audiologists need to consider before they sit down for their first session in front of the computer.

It is important to not only identify the technology you’ll need, but also to recognize the associated human and financial costs and benefits.

Planning
Several phases and steps are necessary to make telepractice “successful,” meaning that health outcomes reflect high-quality care as perceived and documented by the patient, providers and other key stakeholders:
  • Assessment of patient needs and internal resources for program start-up and sustainability.

  • Support and buy-in (ownership) from clinical staff such as audiologists, other related professional staff and organizational leaders.

  • Commitment to adequate resourcing and staff education and training.

  • Strong partnerships with industry, technical staff and administrative staff.

  • Development of protocols, standards of care, best practices and outcome measures to guide implementation.

When planning the technical aspects of a telehealth infrastructure, it is important to not only identify the technology you’ll need, but also to recognize the associated human and financial costs and benefits. You’ll need to consider the care process for patient safety, infection control, protection of health information, electronic storage of data, and safety contingency plans for critical events. Contingency and emergency planning are also important to avoid disruptions in care, particularly with power outages, difficulties with network connectivity, or other emergent issues.
Ensuring the availability of sufficient internet bandwidth is a critical component—and one that is often overlooked. Synchronous video connection for a clinical encounter requires, at a minimum, 384 Kbps (kilobits per second), though that speed still often fails to adequately transmit data of various remote sharing applications used to run equipment.
To create optimal video-viewing conditions, make sure there is ample lighting and decreased ambient noise levels at provider and patient locations during a patient encounter. (Also try to wear mostly solid-color clothing and avoid workspace clutter to reduce visual distractions.)
Web-based remote-sharing and videoconferencing applications used for live, synchronous services require the highest level of scrutiny to meet privacy and information security standards. Particularly in today’s landscape of heightened risk management of information systems, encryption and quickly expanding software applications, safety cannot be overstated. Audiologists need to comply with HIPAA standards for content and processes for information transmission and storage during the telehealth encounter.

Ensure compliance with HIPAA standards for content and processes used for information transmission and storage during the telehealth encounter.

One size does not fit all
With several options available for telehealth service delivery, facility staff need to evaluate which telehealth or virtual-care service is feasible and can best address the needs of patients. Hearing aid fittings and associated diagnostic testing in satellite clinics where audiology services are currently not available might be the most reasonable first step. A nurse or technician trained on the technology setup can assist on-site.
Newborn hearing screenings and cochlear implant programming are other possibilities for telehealth-based care; each requires a slightly different setup, support personnel, competencies/training, and tools for appropriate implementation.
Educational audiologists serving multiple school sites can address the needs of students and staff through telehealth. A school nurse can be trained to set up a laptop, tablet or other technology equipment, and an audiologist at a remote site takes over that piece of equipment to complete a visit. Educational services enhanced by telehealth allow audiologists in rural and underserved areas to monitor FM (frequency modulation) systems and work with teachers and speech-language pathologists on how to troubleshoot common problems.
Private providers should also consider the different ways telehealth might enhance or expand their service delivery. In some cases, patients are “lost to follow-up,” and providers wish to improve aftercare processes and communication.
Mobile apps are becoming an increasingly popular way to provide self-help and hearing aid maintenance information. Some manufacturers are beginning to create apps that can transmit data, allowing hearing aids to be programmed or adjusted by an audiologist through a smart device. Regardless of the application, tool or delivery model, the focus on continuity, quality and efficiency in patient care are universal goals of public and private sector providers.

State licensure requirements need to be verified for patient and provider locations.

Reimbursement and service payment (or lack thereof) will continue to drive how medical facilities, clinics and audiologists in all settings adopt a given technology or service model. The technology or modality has to be used in ways that are practical, feasible and congruent with nationally acceptable standards for quality and safety. Licensure and license portability are important issues to consider: State licensure requirements need to be verified for patient and provider locations.
What cannot be overstated is the importance of preparation, organization, coordination and training/education to brand audiology telepractice as a quality service-delivery model.
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March 2017
Volume 22, Issue 3