1. WHAT IS TELE-AUDIOLOGY?
Frances Lockhart

2. LEARNING OBJECTIVE Goal:
Understand what tele-practice in audiology looks like and what forms it can take.
The goal of this module is to understand what tele-practice in audiology looks like and what forms it can take.

3. WHAT IS TELE-AUDIOLOGY?
Whenever you see or assist a person with their hearing and communication needs that is not occurring in the same physical space.
Tele-practice or tele-audiology or tele-health all relate to one another. The term simply explains the medium through which you provide a type of health care. For our purposes, we will refer to “tele-audiology.”
For more information on the various terms of tele-practice, tele-health, and tele-audiology, please see this WHO report (pages 8-9):
Tele-audiology is a very broad definition and can incorporate lots of types of person and clinician interactions that can be as complex or simple as needed. It is a term used whenever the clinician and person are not in the same physical room at the same time during knowledge sharing, counselling, and audiology appointments. It can also be when the clinician and person are interacting at different times. It can also just be a platform provided in order for clients to select what information or services they require.

4. WHAT IS TELE-AUDIOLOGY?
Lets explore what tele-audiology is.
Think about what you know so far about tele-audiology and what you may have seen. How would you explain what tele-audiology is to someone?
What does it look like?
Examples: Skype calls, online chats ,blogs, maybe desktop or mobile apps, SMS, , website interactions.
Do you think that phone calls and website interaction is also considered tele- audiology? In most cases, yes.
What if it is only used to provide audiological services such as counselling/hearing loss awareness and knowledge and support, but not hearing tests and hearing aid fittings? Again, in most cases, yes.
As homework, read:
World Health Organization report "Telemedicine: Opportunities and Developments in Member States"
“What is e-health?”
"20Q: Audiology to the People – Combining Technology and Connectivity for Services by Telehealth"

5. EXAMPLES OF TELE-AUDIOLOGY
Lets look at 6 recent examples of tele-audiology--
Watch the “Veteran Affairs Tele-audiology” video about a drop-in service for rural patients that live a long way from their audiologist. Watch the video to see how most people would think of tele-audiology and how it is used.
Find the video on the “Module 5: Handouts and Videos” page:

6. EXAMPLES OF TELE-AUDIOLOGY
HearDigits can be embedded into your website. It is an awareness raising tool for accurate detection of hearing loss. It includes decision support from the Ida Institute, and links the user directly to a hearing health provider.
HearDigits: an embeddable widget from HearZA for potential clients/patients to see if they need to arrange a formal hearing assessment

7. EXAMPLES OF TELE-AUDIOLOGY
Ida Telecare: Online tools to help clients/patients prepare for their upcoming appointments
Another example, but in a different context—
-An online check to see if you need to arrange a formal hearing assessment, supplemented with online tools to help you prepare for upcoming appointments
Activity: Click on the link and explore the various tools:
-Living Well online
-My Turn to Talk for Adults
-Why Improve My Hearing?
-Tinnitus Thermometer
-Dilemma Game
-Telecare for Teens
-Transitions Management

8. EXAMPLES OF TELE-AUDIOLOGY
Example 3: HearingHelp, a website from Australian Hearing, offers a live chat service. This live chat allows you to chat with hearing care professionals about your hearing concerns in real time, when you are ready, and get directed to help.
What do you think of virtual assistants?
Activity: Click on the link to explore.
Hearing Help: Australian Hearing offers online help, including a live chat function with hearing care professionals.

9. EXAMPLES OF TELE-AUDIOLOGY
A hearing check performed by a (remote) audiologist and a clinical assistant local to the patient.
Example 4: A hearing check performed by a remote audiologist that is not local to the patient. The patient goes to a clinic that is convenient for them, and the clinical assistant acts as the hands of the clinician (in this case a specialist in audiology) in the appointment.
In this case the audiologist and the person were over 2000km away from each other.
Watch the “Tele-Audiology: Rocky to Sydney” video to see how the appointment flows. Find the video on the “Module 5: Handouts and Videos” page:

10. EXAMPLES OF TELE-AUDIOLOGY
“Ready when you are” hearing checks and hearing health information
5: “Ready when you are” checks and ways to learn about how to keep your hearing healthy:
You can logon any time from anywhere to see whether you should be concerned about your hearing and whether to take the next step. No pressure, just ready when you are.
Activity: Visit to take the 7 steps quiz.

11. EXAMPLES OF TELE-AUDIOLOGY
HearZA - public awareness tool for accurate detection of hearing loss
Animal Sounds - a handy app for those with hearing aids or a Cochlear Implant
Ava - instant captioning app is great for group conversation
6: Apps that can be considered tele-audiology include:
The hearZA app :a strategic public awareness tool for accurate detection of hearing loss that allows for personalized hearing health tracking, in-app decision support, and a referral network to their closest hearing health providers. Available for iOS and Android, free.
Sound log Noise Dosimeter (by NAL/Australian Hearing) measures your noise exposure and estimates how long you can stay in your environment before reaching your maximum noise exposure limit. It also records sound duration and peak sound level using a simple results screen. Available for iOS, free:
Animal sounds: A handy app for those with hearing aids or a Cochlear Implant. Learn to distinguish between over 100 different animal sounds, using flashcards. Great for auditory training Available for iOS and Android, free
Ava (by Transcense; pictured here) - This instant captioning app is great for group conversations. It uses your phone’s microphone to transcribe what is said word by word in real time. Color-coded and easy to follow iOS and Android, free for 5 hours/month, more time for purchase:
This is just a small sample of thousands that are available.
Have a look at some of these apps and think about whether they would be easily accessible to your patients.
Can you think of anything else that would now be considered Tele-audiology? What about some hearing aids that have online aid adjustment features?
And so much more…

12. ACTIVITY Explore GooglePlay or your App store.
Type “hearing” or “hearing loss” and see what you find
Would any of these be useful to refer patients to complement your audiology services?
Explore Google play or the AppStore on your phone:
Type in “Hearing” or “Hearing loss” and see what else you can find.
Would any of these be useful to refer patients to, to complement your audiology services?
(Pictured: SoundCheck app– crowd-sourced ratings of noise levels in public places like restaurants and bars)

13. UNDERSTANDING TELE-AUDIOLOGY
Tele-audiology can take many forms.
3 categories of service delivery:
1: Synchronous
2: Asynchronous
3: Hybrid
So now that we know what tele-audiology looks like, how can we understand it better? Tele-audiology, as you can see, can take many forms. In addition, audiology's dependence on technology, makes it uniquely suited for telehealth.
Most of these forms of service delivery can be broken into 3 categories, which we will use going forward.
1: Synchronous
2: Asynchronous
3. Hybrid
These terms are slightly different in tele-health than in IT circles, but the terms above are those generally used in tele-health.

14. TYPES OF TELE-AUDIOLOGY
Synchronous: Events that occur within the same time window, in “real-time”
Asynchronous (AKA “store and forward”): Events that occur within different time windows.
Hybrid: A mix of synchronous and asynchronous
Let’s take a look at the different types of tele-audiology.
Synchronous: Describes events that occur within the same time window; those occurring in “real-time.” For example, a two-way consult between a patient and their audiologist at a distant site.
Asynchronous (also called store and forward), is the opposite of synchronous. It describes events that occur within different time windows. For example, the patient and clinician may communicate at times that suit them both via or chat or website interaction, but not necessarily at the same time.
HYBRID: Just a mix of 1 and 2

15. ACTIVITY Is it synchronous, asynchronous, or hybrid?:
A patient s you for advice
You call a patient and talk to them over the phone about some tactics they might use to help them further in noise
Your patient sends you online tools they have filled in to prepare for your appointment
Activity:
Identify whether each of these scenarios is synchronous, asynchronous, or hybrid
ANSWERS:
A patient s you for advice. Asynchronous
You call a patient and talk to them over the phone about some tactics they might use to help them further in noise. Synchronous
Your patient sends you online tools they have filled in to prepare for your appointment. Asynchronous

16. ACTIVITY Is it synchronous, asynchronous, or hybrid?:
Your patient spends time researching and reading the pros and cons of hearing aids on your website
Your patient sends you a message and asks questions which you reply to straight away using web chat
A patient writes about their experiences with hearing aids on an online forum you own and you reply to their comments
Your patient spends time researching and reading the pros and cons of hearing aids on your website. Asynchronous
Your patient sends you a message and asks questions which you reply to straight away using web chat. Synchronous
A patient writes about their experiences with hearing aids on an online forum you own and you reply to their comments. Usually Asynchronous, unless the forum is live.

17. ACTIVITY Is it synchronous, asynchronous, or hybrid?:
Individual and group aural rehabilitation and tinnitus counselling
Hearing aid fittings
Aftercare services
Remote diagnostic testing
Individual and group aural rehabilitation and tinnitus counselling. Hybrid, depending on how this information is provided.
Hearing aid fittings. Usually synchronous if done in consultation with an audiologist, or could be asynchronous if using automated fitting software and the aid is ordered online.
Aftercare services. Could be either, or a hybrid depending on how it is delivered.
Remote diagnostic testing. Usually synchronous but could be asynchronous if the software is an app.

18. ACTIVITY Is it synchronous, asynchronous, or hybrid?:
Remote programming of cochlear implants
The use of video and mobile technology to make hearing aid programming adjustments in the home or at remote clinics
Your patients tests their hearing using an automated pure tone hearing test using an app on their phone and sends you the results 
Remote programming of cochlear implants. Usually synchronous at the moment, but could change in future.
The use of video and mobile technology to make hearing aid programming adjustments in the home or at remote clinics. Could be either, or a hybrid depending on whether the patients makes adjustments via an app that you see later or synchronous if you are making the adjustments in real time.
Your patients tests their hearing using an automated pure tone hearing testing using an app on their phone and sends you the results.  Asynchronous in this scenario

19. ACTIVITY
Research what tele-audiology services are available in your country:
List each one according to which patient group it is available to, and describe what form it takes
If there aren’t many available, explore what other tele-health services are available. Who runs them, and which patient groups do they service?
Check whether there are costs involved-- are they free, government funded, pay-to-use?
Get online and start researching what additional tele-audiology services are available in your country.
Research what tele-audiology services are available in your country:
List each one according to which patient group it is available to, and describe what form it takes
If there aren’t many available, explore what other tele-health services are available. Who runs them, and which patient groups do they service?
Check whether there are costs involved-- are they free, government funded, pay-to-use?
Share with each other– what surprised you?