The document discusses the potential applications of telepractice in pediatric audiology, outlining various telemedicine technologies that increase accessibility and improve patient care. It emphasizes challenges such as licensing, reimbursement, and infrastructure, while providing examples like tele-audiology programs and innovations like smart diapers and the CellScope. The findings indicate that telehealth can significantly reduce barriers to care and enhance patient satisfaction and follow-up rates.

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
A Sound
Foundation
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
28
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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
29
• 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
30
• 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
32
• 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
33
• 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
36
• 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