Tele-Toddlers: Potential Applications of Telepractice in Pediatric Fitting  Jean Anne Jordan (USA)

1. Tele-toddlers: Potential Applications of Telepractice in
Pediatric Fitting
Jean Anne Jordan, Au.D.
Phonak AG

2. Acknowledgement
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Acknowledgement
Anne Simon, Au.D.
University of California-
Davis
Erica Friedland, Au.D.
Sherry Rauh
Nova Southeastern University
Darcy Stowe, M.S., CCC-SLP
Hearts for Hearing
Anne Marie Tharpe, Ph.D.
Gina Angley, Au.D.
Vanderbilt University
Stefan Launer, Ph.D.
Michael Boretzki, Ph.D.
Martina Wolf
Phonak AG
Ned Carter
All Ears Cambodia

3. Agenda
• Telemedicine/Telepractice
• Disruptive Innovation
• Using Teleaudiology/Telepractice to Increase Access
– Current Applications
– Future Possibilities
• Challenges
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4. Knowledge is Power
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“We must start to manage knowledge as if it were money. The application of what we
know will have a bigger impact on our futures than any drug or technology.”
- Sir Muir Gray, Director of BVHC, United Kingdom

5. What is Telemedicine/Telepractice?
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• Telemedicine is the use of medical information exchanged from one site to
another via electronic communications to improve patients' health status.
• Includes applications and services using 2 way video, email, smartphones,
wireless tools, and other forms of telecommunication technology.

6. Telemedicine
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Conventional With telemedicine
ACCESS & CONVENIENCE

7. Smart Diapers
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• Parent scans QR code on a wet
diaper.
• Smart Diapers can reveal signs of :
1. Urinary tract infection
2. Prolonged dehydration
3. Developing kidney problems
• In clinical trial period, awaiting FDA
approval.

8. CellScope
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• Developed at University of California- Berkley
• Parents take a picture of the tympanic membrane using the special
attachment for the iPhone and an app
• Image is sent to the physician through a HIPPA compliant website
• Ear infections can be diagnosed and treated from home

9. Agenda
• Telemedicine/Telepractice
• Disruptive Innovation
• Using Teleaudiology/Telepractice to Increase Access
– Current Applications
– Future Possibilities
• Challenges
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10. History of Mobile Phones
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» In the beginnig cell phones weighed almost 2 pounds and were expensive. Today’s technolgy is small,
affordable and has opened up limitless possibilites.

11. • WDRC
• Analog to digital
Disruptive Innovation in Audiology
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12. Agenda
• Telemedicine/Telepractice
• Disruptive Innovation
• Using Teleaudiology/Telepractice to Increase Access
– Current Applications
– Future Possibilities
• Challenges
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13. Telehealth in Audiology
Swanepoel and Hall 2010
• Audiological screening
• Audiological diagnosis
• Audiological intervention
• Patient and clinician Perceptions
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14. Overcoming Geographical Barriers
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Audiologist
Patient

15. University of California, Davis
Teleaudiology Program
15
• Tele-audiology program developed to reduce loss to follow up
• Target Population
– Infants not passing newborn screen
– Four months of age and younger
– Must qualify geographically based on residence
• Far N. California inland counties
• where loss to follow up rate was 20% (compared to 4.5% across California)
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Anne Simon, Au.D., Dec. 2013

16. University of California, Davis
Teleaudiology Program
16
• Comprehensive diagnostic infant hearing evaluations
– History
– View structures (pinna and symmetry of face)
– Video Otoscopy
– Immittance
– Otoacoustic Emissions
– Auditory Brainstem Response
– Auditory Steady State Response (as needed)
– Counseling/Recommendations
• Audiologist performs all testing from expert site
• Audiology assistant is at the originating site with patient, technical analyst &
medical interpreter as needed
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Anne Simon, Au.D., Dec. 2013

17. University of California, Davis
Teleaudiology Program
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Anne Simon, Au.D., Dec. 2013
• Parent Satisfaction
– Positive response
– Pleased not to travel as far
– Not concerned about the remote environment
– Participate openly with history, discussion of evaluation findings, and recommendations

18. Hearts for Hearing
Teletherapy IHEAR
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• Auditory verbal therapy, HIPPA compliant
• Established in 2005
– Motivation: family 3 hours, 1 car, dad working
• Most have face to face therapy before beginning teletherapy
• IT specialist works with parents to prepare for first session
– Equipment: computer & webcam
– Parents are technologically savvy
• Challenges:
– Internet Stability
– Audio
– Licensing
Darcy Stowe, M.S., CCC-SLP, Dec.13

19. Hearts for Hearing
Teletherapy IHEAR
19 2013-12-10 A Sound Foundation 2013
Darcy Stowe, M.S., CCC-SLP, Dec.13
• Benefits of teletherapy
– Providing regular intervention to patients who would not be able to travel frequently.
– Child can keep the same provider if they move.
– Working flexibility for the therapist.

20. Agenda
• Telemedicine/Telepractice
• Disruptive Innovation
• Using Teleaudiology/Telepractice to Increase Access
– Current Applications
– Future Possibilities
• Challenges
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21. Is this a Pipe?
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22. Telemedicine Delivery Models
Facilitator
Patient
Remote Site
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2013
Audiologist
Expert Site
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23. Audiologist
Expert Site
Patient
Remote Site
Telemedicine Delivery Models
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24. Phonak Distance Support Prototype
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Distance Support Client
Internet
Phone Video
Fitter HI user
Phonak Target

25. Vanderbilt University
Distance Support: Phase I
25
• Goals:
– Were clients able to install the software on a laptop?
– Was the audiologist able to connect to the hearing aids?
– Audiologist and client experiences?
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26. Vanderbilt Pilot Study
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Distance Support Client
Internet
Phone Video
Fitter
Phonak Target
HI user
Phonak Target

27. Vanderbilt University Phase I Results
Client Software Installation
27
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0
2
4
6
8
10
12
14
16
32 38 54 58 64 67 68 69 72 74 75 77 80
Minutes
Age
Vanderbilt Client Software Installation
Time installation software Average time= 8 min

28. Vanderbilt University Phase I Results
Acclimatization to Prototype
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0
10
20
30
40
50
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Minutes
Appointment Number
Vanderbilt- First Half Appts
Appt. Length Average time=19 min
0
10
20
30
40
50
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 43 42 44 45 46 47 48 49 50
Minutes
Appointment Number
Vanderbilt- Second Half Appts
Appt. Length Average time= 13 min

29. Vanderbilt University Phase I Results
Subject Experience
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• 90% listed a strength related directly to accessibility and convenience
• 20% had concerns about loss of face to face contact
• 4% had concerns about using technology
• 92% would recommend to friends and family.
• Preference for Distance Support :
• 64% prefer Distance Support appointments in the future if possible
• 32% were neutral
• 4% preferred face to face
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30. Vanderbilt University Phase I Results
Audiologist Experience
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• Generally satisfied with 76% of appointments, the remaining 24% were rated
as neutral.
• Needed real ear
• Connection problems
• Hearing aid batteries dead
• Visual inspection of the hearing aid needed
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31. Vanderbilt University
Patient Benefit
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32. Vanderbilt University
Clinician/Clinic Benefit
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• Efficiency scheduling
• High cost on efficiency for no shows
• Possibly more likely to replace no shows with Distance Support patients
• Remote fitting appointments were shorter, saving clinic time so more
patients can be seen
• Face to face visits can be used for patients with issues that can not be
solved remotely or prefer face to face.
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33. Vanderbilt University
Clinical Outcomes
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• Convenience may equate to patients seeking services more often
when they need them.
• 40% of clients in Phase I reported they would seek services more often.
• Possibly increase satisfaction
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34. Vanderbilt University Phase II
Preliminary Results
34
• 62% of clients preferred using a webcam instead of telephone only
• Audiologist was able to connect to 87% of patient’s hearing aids.
• More to come…….
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35. Possible Pediatric Applications
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• Datalogging
• Feedback manager
• Adding a phone program

36. All Ears Cambodia
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• NGO- only ear and hearing clinic in Cambodia
• Greatest need: Education and training of local staff/ volunteers
– Satallite clinics have to close for trainings
• Greatest challenge: infrastructure
– Urban/rural divide
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37. 37
• Fifteen children, ranging from 2-9 years old, will be fit with hearing aids by an audiology
team from Nova Southeastern University in winter 2014.
• Follow up visits are planned on an annual basis.
• Nova will test Phonak Distance Support as part of remote follow-up care provided to
families and clinics in between face to face visits.
– Start with small conservative steps such as reading datalogging
– Will provide feedback to Phonak on what tasks are not solvable or appropriate through
the current functionalities of Phonak Distance Support.
Nova Southeastern University & Los Pipitos
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38. Agenda
• Telemedicine/Telepractice
• Disruptive Innovation
• Using Teleaudiology/Telepractice to Increase Access
– Current Applications
– Future Possibilities
• Challenges
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39. Key Challenges
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• Licensing
• Reimbursement
• Real ear measurements
• Infrastructure
• Inability to physically inspect ear and equipment

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41. Thank you!
Jeananne.jordan@phonak.com