By Lori Zitelli, Au.D., CH-TM, Manager, UPMC Audiology Department
While audiologists are licensed healthcare providers qualified to provide diagnostic and rehabilitative hearing and balance services, there is currently a shortage of audiologists in our country, forcing many clinics to consider alternate options to expand their capabilities to provide hearing care. UPMC Audiology is addressing this issue locally by developing and piloting two programs aimed at improving access to both diagnostic hearing evaluation services and rehabilitative services for individuals living in the Commonwealth of Pennsylvania.
Remote Hearing Testing
When a person comes into the clinic for an appointment, they may complete testing that provides information about the status of their hearing system. This testing typically requires a person to respond when they hear beeps of differing pitches and repeat words that are presented to them through headphones. Many pieces of equipment used to produce the sounds are now computer-based. The UPMC Audiology team has used this computer-based system to their advantage by creating a protocol in which a person not physically located within the walls of a Pittsburgh-based clinic can complete a hearing test using equipment that is operated remotely. This process is being piloted in partnership with our colleagues in the UPMC Hanover and Gettysburg ENT clinics (both located in Central Pennsylvania), where there is not yet an audiologist on staff. Completing testing on the same day as the ENT appointment prevents barriers to care that people may experience when they need to schedule multiple appointments to receive comprehensive care (for example, taking additional time off work or arranging transportation and childcare).
In certain situations, screening activities and basic testing can be completed by trained staff. When the hearing loss meets certain criteria (for example, if one ear is better than the other or if specific types of hearing loss are suspected), a provider with extensive training in the proper procedures for hearing evaluation should be completing the testing. When more extensive testing is needed, secure messaging and remote login services are used to provide remote access to the test equipment. In the clinic (in this case, located in Central PA), an assistant will prepare the patient by providing instructions and placing the earphones in their ears. The tester (located in Pittsburgh, PA) will operate the equipment remotely, presenting the tones and words necessary to complete the hearing test while monitoring the patient’s responses via a secure telemedicine video chat. These remote services are available select days and times each week. Thirty-nine patients were tested remotely using this protocol within the first month of its existence, with continued utilization planned until our new audiologist is situated in the Central PA locations. We will be offering these services at other locations in the next few months where we are short staffed. In addition, our goal is to expand these remote services to centers that are supported by nurses and technicians in rural areas where there is no ENT/Audiology clinic.
Remote Device Fitting
UPMC participates with a variety of programs that increase access to hearing care for those in need of amplification (hearing aids). Among these are the Lion’s Club, the Squirrel Hill Health Center, the Birmingham Clinic, Catholic Charities, and the Office of Vocational Rehabilitation. Currently, there is a need for such programs and services in Northwestern Pennsylvania, where UPMC has fewer clinic locations than in Southwestern Pennsylvania. We are starting this program in collaboration with the Lion’s Foundation, but plan to expand this given that there are people everywhere who have barriers to physically coming into the clinic.
Under the new program that facilitates remote device fitting, an interested individual in the Northwestern area of the state will reach out to the local Lion’s Club International to verify their financial eligibility for funding assistance. After approval is obtained, a Lion’s Club representative will reach out to the Audiology Team at UPMC (in the Pittsburgh location) to provide the patient’s contact information. In Pennsylvania, state law dictates that in most situations a person must have had a hearing test within the six months prior to obtaining new on-ear devices from an audiologist. The UPMC Audiology Team will assist the patient in obtaining updated results. This can take multiple forms, as the patient may already have a recent audiogram in-hand, opt to complete remote testing procedures, or choose to visit a local ENT/Audiology clinic to obtain audiometric testing.
Once the appropriate testing (and, if indicated, medical evaluation) has taken place, the UPMC Audiology team will determine the patient’s candidacy for a remote fitting protocol. If they are eligible based on their hearing thresholds, the audiologist will order, pre-program, and mail the device to the patient. A telemedicine appointment (video or phone) will be scheduled to orient the patient to their new device. The patient will be provided with a variety of resources that will help them to troubleshoot, care for, and maintain the devices. Follow-up care (including remote programming services) can be provided via telemedicine as needed.
Individuals who are not eligible for remote fitting services (either because of an ear problem that requires medical management or severe levels of hearing loss that require more customized care) will be referred to a local office, where appropriate care can be obtained.
Take Home Points
Telemedicine can improve access to care that enhances quality of life and leads to higher levels of overall health. The UPMC Audiology Team is dedicated to the development of innovative programs that expand access to hearing care for all in need. Please reach out to us at 412-647-2030 with questions about our remote programs or to schedule an appointment.