Hearing Healthcare 2020 is a column where we explore the forces behind the changing landscape and disruptions impacting the hearing healthcare industry.
In recent weeks, nothing has proven to be more disruptive to societies across the globe as the COVID-19 health crisis. Hearing clinics have found themselves having to shut their physical doors at the direction of health authorities in many countries, and being advised to offer telehealth services to their clients until further notice. This has resulted in a surge of interest among professionals on how to implement telehealth services for hearing practices.
This week, HHTM President and CEO, Kevin Liebe, caught up with Kat Penno, Founder and Audiologist at Hearing Collective, to discuss issues surrounding the use of telehealth in audiology.
KL: Can you tell readers a little bit about your clinical background and how you came to be interested in telehealth?
KP: Sure, clinically, my experience has been fairly diverse, with experience in diagnostic vestibular audiology, paediatric audiology and adult rehabilitation as well as business development. I’ve really valued the diverse skill set I’ve gained along the way and the mentors I’ve had teaching me. They have been pivotal in influencing my attitude and outlook for the future of audiology, including how I deliver my audiological care and message.
Specific to telehealth, when I was undertaking my audiological studies and choosing my thesis topic, I was fortunate to have a very holistic and forward-thinking lecturer who had a range of topics to suit many tastes. There was only one that stood out to me at that time and that was to work with data from a company that was doing self fitting hearing aids. I considered them well ahead of the hearing healthcare industry in terms of leadership, innovation and thought processes, but they did not seem welcomed by the professionals nor the manufacturers. The topic was sort of a double-edged sword at the time but I kept thinking I love a good challenge and working with innovators.
Unfortunately, I never ended up working on that project, however, it piqued my interest and my supervisor was open to me formulating my own hypothesis which was “Online service delivery models”. My research considered the point of view of the client and how clients could utilize our services through online platforms. At the time I could only find one allied health professional in Australia (and the world) that I could use as a case example, and needless to say this physiotherapist has been a leader in the digital health space ever since, with her successful online business going for over 8 years. This combination of outlook, study and wanting to deliver a better service, helps me explore ways that audiological care can be more accessible, sustainable and relevant.
KL: In your experience what do you think is the biggest reason telehealth hasn’t been widely adopted in hearing healthcare to date?
In Australia, restrictions placed on what an audiologist can/can’t get paid for in regard to assessments, hearing aid fittings and follow-ups also hinders the uptake of telehealth and may influence what services a clinic offers.
Additionally, I believe uptake has been slow due to market forces, the oligopoly of the manufacturers and current business model structure. Bundled packages and ‘free’ services are a hard mindset to move away from when every clinic and brand is offering these. I can see the market slowly changing with some clinics offering specialised services, such as a combination of adult rehabilitation and diagnostics, but I am worried that it will come down to a price war between the larger retail owned clinics, forcing smaller independents to compromise or follow.
Similarly, I have noticed that there is an educational process the client needs to undertake prior to embracing telehealth consults. Clinically, I believe most clients are open to a telehealth appointment, however it can be restricting given the current limitations of device adjustments and remote access to hearing devices. I realize the manufacturers need to protect their IP and software, however I can see a lot of value should they follow a similar path that iOS and Android platforms did for open source applications. The clients that initially come to me online are already on a digital journey and their uptake of telehealth and hearing technology is quicker than via the traditional model.
KL: In light of our recent health crisis impacting the globe, there has been a very sudden surge in utilization of telehealth by the medical community and, recently, a lot more discussion about this option among hearing professionals. What advice might you give to a traditional brick and mortar clinic about offering telehealth services?
KP: This is a question I have been approached with a lot recently. Firstly, I ask why the clinic is choosing telehealth and if they want it to be a long-term viable business component. We need to set the tone from the beginning and continue to offer high quality practices to ensure our profession retains its integrity and is valued.
Secondly, telehealth in this pandemic needs a safe, fast and reliable implementation period. I ask people to consider how they propose to ensure quality and safety is delivered to the client and the staff? We can’t rely on platforms such as Google Hangouts, Skype or Facetime to deliver our services. Calls on these platforms do not have end-to-end encryption and are therefore at risk of security breaches and release of personal information. Digital literacy and security needs to be top priority and we need to be practical and secure in the choice of platforms we engage with for all parties involved.
Be transparent in what you are offering and what you are charging for. Set the standard early to ensure this is a long-term solution and not a quick-fix panic solution to the pandemic. I’ve said it in a previous article I wrote for Hearing Health Matters stating that traditional practices need to diversify their services to be relevant and sustainable and I stick by this. Even more so now, with many clinics facing temporary closures. I am not necessarily saying businesses need to have a telehealth component, I am saying they need to consider what diversification looks like to their practice and how this can set them apart from the rest.
KL: What do you think are the greatest challenges as a telehearing care provider?
KP: Prior to the pandemic, I would have said mindset and assumptions were the greatest challenges I saw affecting the uptake of telehealth services by clinicians and clinics.
With regard to telehealth, I see the following areas as challenges to audiologists and clinics;
- Digital literacy and governance
- Quality and standard of services
- Measuring outcomes from telehealth services
Now, given the changes and challenges imposed by the pandemic I am also seeing opportunities to take advantage of the positive shift in sentiment toward online services. Businesses are/should;
- Have a willingness to try anything in response to a crisis, offering services to vulnerable clients and minimising the risk to spread of infection.
- Embrace this new paradigm as we re-envision how we can deliver our services, particularly considering clients are expressing discontent with past/current practices (for example, going to work with the risk of passing or getting the virus, safe work practices etc);
- Explore the practical value in telehealth as a part of their business.
KL: Have you seen any trends or patterns in the types of patients who are reaching out to you for care at Hearing Collective?
KP: What I am understanding from my online appointments is, if people are researching online and are already on a digital healthcare journey, they commit to online appointments without hesitation. I haven’t figured out many of the answers to a completely virtual audiological clinic, and yes, I acknowledge the limitations it poses; however there are ways to move around this and work collaboratively.
One of the largest learnings and trends I have seen over the last 12 months, from the point of view of the client, is the value they place on their hearing and how they would like to seek hearing healthcare.
When I get a referral from a colleague who works in a bricks and mortar clinic, there is an educational process to the client about how telehealth can be an effective alternative and the value behind using telehealth. Currently, it’s too early for me to comment on specific trends, however the content I produce and publish seems to appeal to a varied age range.
KL: For clinicians interested in implementing telehealth in their clinic, what resources would you recommend they seek out first?
KP: In no particular order I would consider the digital literacy of your staff and clients, the video consulting software and what your clinic currently uses. Where possible, I like to take the approach that all software systems should be able to work together to help minimize headaches and improve workflow.
If you have an established clinic or at least a database of clients I believe transitioning to telehealth services can be quite effective. Clients and staff may need upskilling in digital literacy and this should be considered as part of your training process for successful change to both your clinic and staff.
I am not versed on the specific laws that govern each state in the USA (Privacy acts, HIPAA compliance and other governing laws) given I am based in Australia. From my basic understanding, you would need to ensure the video interface you select is compliant with what your state mandates. This usually means the free or basic version of a program does not meet the safety or security levels that are required to be ‘as safe or secure’ as a face to face consult, in virtual terms the level of encryption.
I would then assess the ease of flow between the programs your clinic currently uses. For example, do you use an online booking system that can take payments and automate an email and link to the virtual consult. If so I would see if each process throughout your clinic can work together. There are numerous platforms that enable online bookings, payments and email generation that can ‘talk to a third party’ app such as your choice of video interface. There may be some need for a third party to come in to make this happen; however this is not always the case.
KL: Kat, thanks so much for sharing your perspective with our readers. I know many clinicians will appreciate your thoughts and advice as they try to implement telehealth services in their offices.
KP: Kevin, thank you for inviting me to contribute to HHTM again. I really enjoy the content and the diverse contributors you publish. Take care and I wish everyone well in their digital transformation journey.