1. Dr. Dr. h.c. Monika Lehnhardt
EFAS Budapest, June 2013
Time for Paradigm Change
in Clinical Care

2. Situation Analysis
World
population is
growing
World
population is
ageing
Technological
advances at
an increased
speed
Open, easy,
cost free access
to information
via Internet
Participative
decision making
in health care
Incidence of
deafness
unchanged
Quality of life
an important
factor
Macro Level

3. Situation Analysis
 Indication broadening constantly (e.g. elderly population, severely
hearing impaired, single sided deafness …)
 Awareness of availability of effective treatment for deafness
spreading (candidates, parents, children of parents searching in the
Internet for objective information and exchange experience on social
Platforms)
 Self-confidence of candidates and their spokesmen improving based
on acquisition of knowledge and social interaction
 Establishment of CI programs in countries with a high population and
lack of infrastructure
Increasing number of CI candidates every year
Exponential growth of existing CI recipients pool demanding life-long care
Micro Level

4. Impact on traditional Clinical Care
Lack of
specialized
therapists
Overload
on
clinics
Too many
new clinics
with small
numbers
Neither efficent
nor sufficently effective
any longer
Poorer outcomes

5. Developments of
Internet-based
technologies
Organizational models
New dimensions
of scalability
Do nothing = unacceptable  damage CI concept
Add personnel and equipment = unrealistic  too expensive
Call for Clinical Care Innovations
Faster, safer and cheaper Internet connections

6. Tele-Practice
Swanepoel & Hall 2010:
Teleconsulation is feasible and reliable for hearing sreening,
diagnosis and intervention
Definition by ASHA
Todd Houston:
“Rapid advances in the evolution of telecommunication and distance
technology are creating new opportunities to provide direct services to
meet the audiological, speech and language needs of young children
and adults with hearing loss”
Tele-Practice is a Videoconferencing Service Delivery Model

7. Registration Online
Share intra-opertive data
Tele-fitting
Failure Reporting Online
Remote support
Exchange of experience
Online Consultation
Tele-Practice The Future has begun

8. Tele-Practice
Registration Online
￭ No need of manually filling in cards,
mailing, collecting, copying …
￭ Central Computing of data at an
independent organization to get
reliable statistics about CI recipients
(e.g. Switzerland, Belgium,
Netherlands, Denmark, Sweden)

9. Tele-Practice
Cooperation between clinic / operating
room and fitting centre
Share intra-operative measurement data to create first maps

10. Tele-Practice
Experienced expert maneuvers the
software programme on the hardware
of the less experienced in another
location
fitting of new speech processor via
Internet
connection between the experienced
and less experienced audiologist
Upgrades
Tele-fitting
Visualisierung aus einem Beitrag von Medincus Group auf YouTube

11. Tele-Practice
CI systems will report about their functionality and
about eventual problems online and will receive
online instructions how to fix the problem or suggest
competent resources where to find a solution
Failure Reporting Online

12. Tele-Practice
Experienced therapist counsels less
experienced via Skype and video
camera
Remote Support
Visualisierung aus einem Beitrag von Todd Houston

13. Amongst parents via Skype or in
LiveOnline Rooms across countries and
language barriers.
Voskresnyj Poldnik – Sunday meetings
for Russian speaking parents
Tele-Practice
Exchange of experience
Weblogs – Interactive Communities

14. Amongst experts via Skype or in Live
Online Rooms across countries an
language barriers
PORA Live Online Seminars for
Russian speaking therapists
Tele-Practice
Exchange of experience
Increase the sustainability of conferences by
continuing in the Internet environment
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15. Online consultation of surgeons, therapists and
other experts for parents, patients and
stakeholders seeking advice
Tele-Practice

16. Teaching how to use Tele-Practice Service Delivery Models
Preparing a Platform for Special Interest Goups
PORA! Live Online Seminars for Russian Speaking Therapists since 2009
Voskresnyj Poldnik for Russian Speaking Parents since 2010
The Lehnhardt Foundation

17.  Access for patients/parents to highly qualified and experienced experts from remote
places
 Support for less experienced professionals with all modes of communication
(speaking/listening; writing/reading; seeing/demonstrating;)
 Virtual presence of world renowned personalities in conferences
 Increase sustainability of conferences, work-shops and other meetings
 Parallel interpretation into several languages
 Higher level of team-work
 Whole family can participate in therapy sessions without disturbing
 Reduction of costs for travel
 Time savings
 Reduction of therapy cancellation due to health problems
 Easy establishment of special interest groups
Tele-Practice Benefits

18.  Access to high-speed bi-directional Internet connection for video links
(upload speed)
 Costs for equipment – laptops, monitors, cameras, loudspeakers
 Training for experts to feel comfortable with handling the technology
 Basic knowledge for patients / families to make them feel confident
 Additional time effort to prepare tele-practice sessions
Tele-Practise Obstacles / Challenges
 Provision of additional material / toys for the remote place
 Resolve reimbursement issues
Tele-Practice
Accept that Tele-Practice is not for everybody!

19. Conclusion & Appeal
EMPATHY
Tele-Practice is not meant to replace but to complement traditional clinical
care to enhance quality and ensure a broader reach and coverage at
reasonable costs
Todd Houston:
„Looking forward we can foresee that
tele-practice service delivery models will become
standards of care for families seeking early
intervention and / or speech and language
services“.
Free human resources and
have them concentrate on providing
what can only be provided by human
beings: Empathy for people in need!

20. Thank you for your attention and
please feel free to comment
in my personal weblog
www.monika-lehnhardt.net