Telehealth and Telepractice
Telemedicine (telepractice) is defined as the provision of health services over a telecommunications network. In practice, telemedicine uses high-speed interactive video and remote computing applications to provide speech-language and hearing services to consumers living in underserved areas.
Responding to the growing utilization of telemedicine technology, ASHA published position statements and technical reports in 2005 indicating that telemedicine was appropriate for speech-language pathologists and audiologists. A key principle of the 2005 ASHA telepractice position statements is that the quality of telepractice services should be equal to that of services dispensed face-to-face. ASHA policy documents concerning SLP and audiology telemedicine applications are available at the ASHA website.
SLP Telemedicine Applications
Additional research has shown that SLP diagnoses and assessments performed remotely are equivalent to those conducted in traditional face-to-face settings. There is less literature, however, related to outcomes from SLP therapeutic interventions delivered at a distance. This difference may be due to a lack of technology to facilitate dynamic interaction between clinician and client during a remote session.
The National Rehabilitation Hospital (NRH) in Washington, DC, has long been involved with SLP research. The present goal at this facility is to develop and evaluate a videoconference-based telehealth system through a user-centered design approach that will allow a wide range of interactive SLP therapeutic interventions to be delivered to remote clients. Past research and development activities in the area of SLP telemedicine illustrate the potential for expanding interaction between a clinician and a remote client during a telemedicine session. Specifically, investigators at NRH have developed a method for delivering digitized versions of existing paper-and-pencil therapy worksheets in real time between locations. Through additional research, investigators have found that videoconference-based SLP telehealth interventions for adults with neurological impairments yield a high level of satisfaction and acceptance and results in outcomes consistent with those from face-to-face service delivery.
Audiology Telemedicine Applications
The audiology telemedicine research base is relatively modest although studies have identified a broad range of applications. Specifically, studies have been published exploring telemedicine and tinnitus, video nystagmography, cochlear implants, pure tone threshold testing, infant hearing screenings, and auditory brainstem response testing. However, these studies have limited generalization due to small N sizes, the lack of subjects with hearing impairments, and the use of laboratory settings instead of authentic health care environments. More specifically, the 2005 ASHA technical report indicated the following areas needing further investigation in audiology telemedicine:
- Identification of appropriate telepractice applications in audiology
- Development and validation of telepractice clinical protocols
- Development of appropriate reliability and validation techniques to ensure quality of service
- Establishment of increased advocacy for reimbursement
- Investigation of the efficacy and effectiveness of clinical outcomes, client and clinician satisfaction, quality of care, cost, and cost effectiveness of telepractice applications
- Establishment of minimal acceptable technical specifications to support clinical procedures and the application of service delivery models
Telemedicine applications are increasingly feasible for speech-language pathologists and audiologists. However, long-term outcome measures are needed in both disciplines to determine efficacy and cost effectiveness of telemedicine applications. Also, the lack of insurance reimbursement for telemedicine services continues to be a significant obstacle. Nevertheless, telemedicine appears to be a practical and progressive method to meet the needs of clients who need greater access to speech-language and hearing services.
About the Authors
Amy C. Georgeadis is at the National Rehabilitation Hospital (NRH) in Washington, DC. Contact her at Amy.C.Georgeadis@medstar.net.
Mark Krumm is at Kent State University in Kent, Ohio. Contact him at email@example.com.