June 11, 2002 Feature

Bridging the Service Gap . . .Through Audiology Telepractice

Audiologists generally have embraced new technology as inevitable and desirable—yet technology has consequences. As the capacity of technology grows, issues concerning validity and application arise. In response, seasoned clinicians have learned to accept new technologies with a healthy skepticism until they have shown their worth in the field.

A new form of technology on the horizon in audiology is telepractice (telehealth or telemedicine). Telepractice is a method of providing hearing health services to people in remote locations using a telecommunication medium. Audiologists have already used telepractice on a regular basis in a limited manner for diagnostics, hearing aid fittings, and counseling. Each time an audiologist faxes consumer information, sends email for consultation, uses the phone for counseling, or engages in online learning, some element of telepractice is employed.

Consumers living in isolated or rural communities who have poor access to hearing health care will probably realize the greatest benefit from audiology telepractice. If consumers must journey long distances, dealing with other hardships such as snow storms, lost wages, and travel expenses, these barriers may seem to outweigh any benefits from services, and they simply will not come to the audiology clinic. For audiologists, even a two-hour trek to see a consumer is a deterrent, as half a day is lost to travel.

In these circumstances, telepractice acts as a technology bridge. This medium brings the consumer "face-to-face" with the clinician even when they are hundreds of miles apart. Increasingly, telepractice is a realistic consideration for audiology practitioners, as this kind of technology is becoming more available and cost-effective for health service delivery. But audiologists will need to determine the "boundaries" of telepractice applications in service delivery.

One form of telepractice uses synchronous communication for "real-time" diagnosis and treatment through interactive video. A common model of synchronous telepractice used by other professions employs high-quality interactive video so that the clinician can supervise testing or treatment conducted by a technician at a remote site. In this model, the technician becomes an extension of the clinician.

Another form of synchronous telepractice incorporates remote control computing that enables the clinician to test individuals at distant locations. Remote control software applications permit the clinician to control computers and their peripherals, such as otoacoustic emission systems, located at consumer sites. The advantage of remote control computing is that the clinician can test the consumer directly without an intermediate technician. However, a facilitator is needed at the remote site to provide services such as headphone placement, troubleshooting, or video-otoscopy manipulation to view the tympanic membrane. This form of telepractice shows promise as an alternative method for providing synchronous services and is in the process of being validated as audiologists have successfully administered objective and behavioral hearing tests over a distance of several hundred miles.

However, before audiologists can be certain of the benefits of telepractice, extensive additional validation appears to be warranted. Even common telepractice applications such as store and forward technology (which is the act of sending client data through fax, email, or pre-recorded video) requires substantial research as few researchers have attempted validation of this procedure. The more complex media for providing synchronous telepractice services must also undergo research and validation.

Telepractice seems to be a desirable form of technology for audiologists to use in rural or underserved areas, and audiologists have already begun to implement limited forms of telepractice. But this medium requires rigorous validation (including store and forward and synchronous services) to determine the proper scope of telepractice applications.

Mark Krumm, is an assistant professor at Utah State University (USU) in the department of communicative disorders and deaf education. He has been the primary investigator for two federally funded telepractice projects. Contact him by email at mkrumm@coe.usu.edu.

John Ribera, is an associate professor at USU in the department of communicative disorders and deaf education and has been a co-investigator in two telepractice projects involving otoacoustic emissions and pure-tone audiometry, and speech in noise tests. Contact him by email at jribera@coe.usu.edu.

Thomas Froelich, is an assistant professor at Minot State University in the department of communication disorders and special education and is currently the primary investigator of the Minot State University Telehealth project. Contact him by email at froelich@misu.nodak.edu.

cite as: Krumm, M. , Ribera, J.  & Froelich, T. (2002, June 11). Bridging the Service Gap . . .Through Audiology Telepractice. The ASHA Leader.


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