Tele-Audiology: Ready or Not

Abstract

The use of various forms of tele-audiology exploded during the pandemic. This brief article provides tips and considerations for providing tele-audiology as we move beyond the pandemic. Importantly, audiologists need to document all forms of remote care including audio/visual, telephone (audio only), and email to support movement toward state licensing boards acknowledging that audiologists are qualified to provide this care and for insurers to support reimbursement for care provided via this mechanism. Educators will need to ensure that classroom and clinical education includes tele-audiology.

Tele-audiology typically takes one of two forms. In many instances involving diagnostic testing, a remote location with equipment and a trained technician who can interact with the patient and provide the interface between the patient and the equipment is required. In this situation, the audiologist is in another location and is supervising the technician, directly providing the testing remotely, interpreting results, and making treatment recommendations. Another form includes the audiologist interacting with the patient directly in a virtual visit using video and audio transmission (via computer or smart phone). Several articles have appeared over the years talking about tele-audiology as something coming in the future. Although new to many audiologists, we have colleagues in the Veteran's Administration, working in rural areas and working in other countries who have been using tele-audiology for years. Many audiologists had been considering how tele-audiology might expand their offerings over the past few years but did not believe they were ready. And then COVID-19 appeared, creating a global pandemic and the need for tele-audiology to emerge overnight in many clinics all over the United States and around the world to support our patients. Interestingly, although this was a reaction to a specific situation that put our patients at risk for not receiving care, many audiologists and patients plan to continue to offer and access this mechanism for audiological care well beyond the pandemic. With that in mind, Dr. Zitelli has invited a variety of clinicians who use tele-audiology to support the evaluation and management of patients with hearing, tinnitus, and balance concerns to share their experiences in this edition of Seminars in Hearing . The edition concludes with important information about U.S. policy considerations for telehealth provision in audiology. There is a lot of work to do to support audiologists in providing tele-audiology including the ability to be reimbursed for these activities.

There is needed equipment to provide virtual visits (see the list below). The provider will need a computer/laptop with video and audio input and output. A stable internet connection is needed for both the provider and the patient. The patient may use a computer with video/audio input and output or may use a smart phone. If remote hearing aid programming is needed, the patient will need a smartphone or tablet that is operating the manufacturer app.

Needed equipment for virtual visits includes the following:

• Computer or laptop.

• Internet connection.

• Video input and output.

• Audio input and output.

• Smart phone (for remote hearing aid programming).

It is important that audiologists consider all forms of remote communication as tele-audiology rather than only considering a video/audio interaction as providing remote care. Tele-audiology includes video/audio communication, phone (audio) communication, and email communication. Audiologists need to consistently document these interactions in the e-record. This will support movement toward state licensing boards acknowledging that audiologists are qualified to provide this care and for insurers to support reimbursement for care provided via this mechanism. Table 1 provides examples of language that could be used to document each type of appointment. These are “dot” phrases which means in the e-record you can set it up; so, if you type the label, the entire description will populate. You will see that there are descriptions including the built-in video teleconferencing in the e-record (most have this now) as well as use of other video teleconferencing mechanisms when needed (e.g., when we need captioning we do not use our current e-record mechanism because it does not yet have captioning).

Table 1. Sample Language for Documenting Remote Patient Care.

• .audtelemedphone = This consultation was provided via telemedicine from patient's home using audio telecommunications technology between the patient and the provider. Verbal consent has been received. *** minutes were spent consulting with the patient. • .audtelemedvideo = This consultation was provided via telemedicine from patient's home using two-way, real-time interactive telecommunications technology between the patient and the provider. The interactive telecommunication technology included audio and video. Verbal consent has been received. • .audtelemedemail = This consultation was provided via telemedicine from the patient's home using two-way, asynchronous communication technology between the patient and the provider. This communication took place in written form due to the patient's communication challenge or because the patient needed the information to be presented in a way that they can reference again in the future. This patient is not enrolled in EHR messaging, so the information was provided via secure email. *** minutes were spent creating the message. • .audtelemedEHRmessage = Please see the EHR message in this patient's chart for the details of this conversation. This consultation was provided via telemedicine from the patient's home using two-way, asynchronous communication technology between the patient and the provider. This communication took place in written form due to the patient's communication challenge or because the patient needed the information to be presented in a way that they can reference again in the future. *** minutes were spent creating the message. • .audtelemedother = This consultation occurred during the COVID-19 pandemic and was provided via telemedicine from patient's home using two-way, real-time interactive telecommunications technology between the patient and the provider. The interactive telecommunication technology included audio and video. Verbal consent has been received. The patient is not enrolled in EHR messaging, so the interaction occurred via an alternate platform. *** minutes were spent consulting with the patient.

Audiologists will want to have a set up dedicated to tele-audiology including a computer, video camera, and excellent audio input and output along with internet access. Keep in mind that HIPAA guidelines have to be adhered to in remote care just as it is in in-person care including protected transmission methods. Fig. 1 provides some tips for successful remote patient interactions. If audiologists find that they need to use their personal phone in some circumstances, they will want to be thoughtful to use a mechanism to disguise their personal phone number. There are several ways to accomplish this, including Microsoft Teams providing a unique number that shows up when you call someone. If the patient uses this number to call back, it will ring your mobile phone. There is a monthly fee for this plan. Some cell phones allow you to disable caller ID when you call others or you can use *69 to make caller ID anonymous when you make calls. Doximity is another provider that can provide a way to hide your personal phone number.

Figure 1.

Tips for setting up successful remote patient interactions.

As practicing audiologists move fully into the provision of tele-audiology, audiology educators will need to ensure that the next generation of audiologists are receiving classroom and clinical education in tele-audiology. We hope this edition of Seminars in Hearing will be helpful and there are a variety of online continuing education programs available as well. Audiologists have always done what is needed to support patients and in this past year, tele-audiology was essential to patient care. It is exciting to see tele-audiology develop into an ongoing expansion of services and patient support as we move beyond the pandemic.