TeleAudiology and the VA Model: Coming to Civilians in a Town Near You?

by Clifford Carey @ EarQ Group, Inc.



Price Chopper, a northeast-based grocery chain that has long offered retail pharmacy services, is set to test a new telemedicine service at five stores including a Syracuse, NY area location. The stores will be equipped with freestanding health stations to allow customers to get a live, private consultation via videoconference with a board certified physician who can help diagnose and treat minor illnesses.

Why is this important? Well, as we've attempted to look forward to what audiology could become, there has been a dialogue happening for about five years regarding audiology services offered over the phone. This process of remotely programming hearing aids has been dubbed TeleAudiology.

In 2013, under the editorial input of Gus Mueller, Ph.D., Dr. De Wet Swanepoel penned an article for AudiologyOnline titled Audiology to the People - Combining Technology and Connectivity for Services by Telehealth. At the time, Dr. Swanepoel was an audiology professor at the University of Pretoria in South Africa, a senior research fellow at the Ear Science Institute Australia, and co-chair for the American Academy of Audiology Taskforce on TeleAudiology.

According to Swanepoel, telehealth, a relatively new field of healthcare which had experienced substantial growth in information technologies, was revolutionizing the way in which our modern society communicates and exchanges healthcare information. Swanepoel opined that while telehealth was aimed primarily at populations with restricted or limited access, often in remote regions or for underserved populations, it also had implications worthy of consideration as part of more standard healthcare practice.

In fact, hearing aid manufacturers had already attempted to get into the game. In 2010, Starkey Hearing Technologies unveiled a remote hearing aid programming feature named T2 OnDemand. The system utilized dual tone multi frequency (DTMF) tones from a touchtone telephone to make adjustments to the hearing device.

Interesting, yes, but will audiologists here in the U.S. take TeleAudiology seriously? Most point to any attempt to remove the physical interface with a hearing care professional as bordering on sacrilege. In 2012, close to 200 audiologists and audiology students were asked about their readiness for remote hearing aid programming; of that group, only 20% believed they were prepared for this technology. When compared with the 76% of patients surveyed that same year voicing excitement about the evolution in services, the stance of the audiological community seemed to be out of touch with a growing acceptance of information technology in healthcare.

Surprisingly, a long-growing sector in the domestic hearing aid market could again change the playing field for audiologists.

Due to service backlogs and facing a major public relations crisis, the US Department of Veterans Affairs had been seeking a new delivery method for its offerings to service members in need. Enter the VA's telehealth services.

But first, let's rewind to the role that the VA plays in the domestic hearing care marketplace. In 2015, according to the Hearing Industries Association, the VA dispensed over 710,000 hearing aid units to veterans in need, just north of 21% of the total US domestic market. Long reviled by private sector dispensing entities, the VA is seen as benefiting from sweetheart contracts from technology manufacturers while offering substandard service. In fact, claims that audiology services delays for veterans is considered by some to be the “number one issue” in current VA backlogs, claims that the VA says are incorrect.

The US Department of Veterans Affairs says that their beleaguered institution leads the nation in providing timely audiology services.

And what apparatus do they point to as the source of their most significant improvements? You guessed it: TeleAudiology. The VA has been on the forefront of leading the effort to demonstrate how telehealth can be integrated into the specialty of audiology and, according to a recent blog post, the VA now provides audiology telehealth at 176 sites around the country-supplementing its 419 locations offering onsite audiology services in 2015.

The VA's TeleAudiology program is propelled by an ever-growing population of veterans living with hearing loss. VA TeleAudiology services have grown from 1,016 veterans in 2011 to 10,589 in 2014. In 2015, patient appointments for TeleAudiology increased another 46%, totaling 23,561 appointments. From 2014 to 2015, the number of VA hearing health technicians increased 11%, and in that same period, the number of audiologists increased by 8%.

And it's not just audiology services. Veterans like telehealth, the VA claims, and report their satisfaction and outcomes for telehealth appointments are as good as or better than traditional face-to-face appointments.

In a recent press release, the Department of Veterans Affairs announced that its national telehealth programs served more than 690,000 veterans in 2014. That total represented approximately 12% of the overall veteran population enrolled for VA healthcare and accounted for more than 2 million telehealth visits. Of that number, approximately 55% were veterans living in rural areas with limited access to VA healthcare. This means that 45% of veterans with local access to VA clinics chose instead to take advantage of telehealth services rather than visit the VA-echoing the sentiment of those patients surveyed in 2012.

“We have to adapt to meet veterans wherever their needs are,” said VA Secretary Robert A. McDonald. “A brick-and-mortar facility is not the only option for healthcare. We are exploring how we can more efficiently and effectively deliver healthcare services to better serve our veterans and improve their lives. Telehealth is one of those areas we have identified for growth.”

It seems that audiologists should listen carefully to that sentiment. Today's patients want access and ease of use. It's also clear that they'll sacrifice a little privacy in the digital age to get it, and if we're not careful, perhaps they'll sacrifice those healthcare providers who deny that access.

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