Reduce clinic visits without sacrificing outcomes

If you’ve been using hearing aids for a while, you’ll know that they need some attention from time to time. If you haven’t, then you need to be aware that the initial settings on your hearing aid won’t necessarily be the same settings a year or two down the track.

There are several reasons for this, such as changes to your hearing, your lifestyle, or your hearing needs. Sometimes the hearing aids just fail and a clinical visit is needed to fix the issue. At other times you just need to be shown something again, as there is a lot to remember the first time you get your ears on some hearing aids.

For most part, these sorts of changes requires an in-clinic visit. That starts with finding a time that works for both you and the clinic. Then you have to get in your car, drive to the clinic, find parking, wait for, and see the clinician, and do the same over again to get home. Some adjustments might only take 10 minutes, but could cost you half a day of travel to get it done.

Limiting or eliminating in clinic visits

Wouldn’t it be nice not to have to go through all that effort for what could be a very quick little tweak to your hearing aids?

Blamey and Saunders were one of the first companies in Australia to deal with these issues. They created an innovative model where hearing aids could be remotely adjusted. However, their system is quite cumbersome.

You still need to arrange an appointment with the clinician for a time to meet face-to-face via video conferencing. Then you need to get your hearing aids connected to your computer via wires. The clinician would then connect to your computer  to make the changes to your hearing aids (using special software you will have had to install). This requires, despite their claims, a reasonable knowledge of computers and quite a bit of fiddling. You would also need a pretty good internet connection.

It is better than nothing, but it only works with their own brand of hearing aid. So you miss out on modern features like beam forming for better hearing in noise, tinnitus control features, built-in Bluetooth for phone and audio streaming, automatic program switching for less fiddling, Lithium-Ion rechargeability for long-term convenience, IP68 rating for moisture and dust proofing, and more.

Even Blamey and Saunders have started setting up face-to-face clinics. I suspect this might be because remote assistance is not for everybody and remote assist really comes into its own, if the initial face to face settings are done well. 

Remote assistance is now becoming mainstream

Oticon_Connectivity_ON_App_iPhone_7Major hearing aid brands have taken note. Now you can have your high quality, big brand hearing aids adjusted remotely. The big if is: ‘does you clinic support this?’.

It requires a change in the way things are done for your audiologist or audiometrist to make this a part of their workflow. Many clinics are slow to change, so you need to check to make sure this is on offer.

There are two main types of remote assistance available on the market right now.

Asynchronous (not in real time) and Synchronous (real time) remote assistance.

As a general rule, these kinds of remote assistance only requires a compatible Bluetooth-enabled hearing aid and a compatible smartphone capable of running the app for remote connection.

Both methods require the clinic to register with the supplier in order to perform remote assistance. You are also registered as a user, and you sign a privacy agreement to share the required information to make the remote assistance possible. Data is sent securely via the internet between you, the manufacturer, and the clinician providing the remote assistance.

Asynchronous (Not Real Time) Remote Assistance

This method has you, the hearing user, request assistance using the smartphone app.

You have an opportunity to describe the issues you experience and also go through a troubleshooting checklist. Once you click submit, an email is sent to your hearing professional notifying them that there is a request for assistance, (no details are given in the email for privacy reasons). Your hearing professional then opens the manufacturer portal to check the issues, and then uses the fitting software on their computer to make changes to your hearing aid settings on the software.

Once they have finished saving the new settings, you receive a notification via your smartphone app, that there are new settings to download. You can then elect to install the settings and try them for a bit. If you like them, then it ends there. If you don’t, then you have the opportunity to roll back to your previous settings. You would then need to submit another request to get another set of changes to try.

Synchronous (Real Time) Remote Assistance

This method is similar to the model Blamey and Saunders have been using. However, as it runs via your smartphone, things are a lot simpler. This method uses your phone’s 4G connection, which means your internet speed should be up to the job as long as you are connected to 4G. This also means there is no need to install fiddly software on your computer or needing a webcam for video calling. It is all built into your phone.

Basically, you arrange an appointment time with the hearing professional. At the predetermined time, you log into the remote assistance app on your smartphone. The clinician logs into the remote assistance section of the manufacturer’s hearing aid fitting software.

A video call is established via the phone app and your hearing aids are connected via Bluetooth to your smartphone. The clinician can talk to you and show you via video how to clean the aids or check for any issues. The clinician is also able to make a full range of adjustments to your hearing aids, while you are able to hear those changes in real time. This could even be done in the situation where you tend to have difficulties, as long as you and the clinician can hear each other well enough and there is a 4G phone data connection available.

Once you and the clinician are happy with the changes, they are saved to your hearing aids and the session and call is ended.

Pros and Cons of these methods

Pros

SynchronousAsynchronous
You and the clinician are able to try multiple settings in one sessionYou don’t need to wait for a specific time to request the assistance
You can try these settings in the actual situation you are having difficulties in, while the clinician makes the changesYou can roll back the changes if you don’t like them.
Your hearing care professional can also show you how to manage and clean the hearing aids via the video You don’t need to travel to the clinic to have the changes made.
You can ask questions in real time as they come up and get them answered straight awayDoes not require a strong internet connection
As your remote support is scheduled, it is highly unlikely that you will be forgottenYou can request the changes the moment you are having difficulties, so you don’t forget the details of the issue.
You don’t need to travel to the clinic each time you require a tweak or need to be shown something. It can all be done via the video call.

Cons

SynchronousAsynchronous
Requires a strong internet connection – uses 4G, which is widely available on Telstra, but not on all service providers. It can create anxiety with the provider when they get a support email, but cannot see what the issue is, or act on it, until they are back in front of their office computer.
You still need a designated time to “meet” over video call with the clinicianYou are not a priority, as your support request is not scheduled. Your request might even be forgotten as it disappears in a full inbox.
Initial fittings cannot and should not be made using this method. It is purely for follow-up visits.There is no way for the clinician to show you how to manage the aids. This would still require an in-clinic visit.
Does not entirely replace in-clinic visits. e.g. visits are still required to look in your ears and retest your hearing, etc. Only one change can be made at a time. If you aren’t happy with the changes, you need to request more assistance, which may delay things further.

Which brands and models do which?

Most newer models from the big brands are introducing remote support.

Synchronous

Asynchronous

  • Gn Resound – Linx, Enzo, Quattro

Which way is the future?

I would place my bet on real time (Synchronous) remote assistance. It allows for much more flexibility in the session as you are able to see and speak to your hearing healthcare provider. Not only can they make adjustments, but they can also see you and your hearing aids and troubleshoot management and cleaning issues on the spot.

If you look at Signia’s roll out of the technology, they started with an asynchronous model in version one of their “Telecare”. With version 3.0, they now offer synchronous remote assistance.

I am confident that other brands will follow suit. Starkey will be launching a synchronous system with their new Livio AI range of hearing aids.

What should the clinic have in place for this to work?

Your hearing specialist will need fast internet connection and additional training in order to make remote hearing aid adjustments feasible.

The clinic needs several technologies and processes in place to make this work effectively.

Blamey and Saunders has set up a good model for this, which could be an example to follow.

For the rest of the discussion, we will only be considering real time (Synchronous) remote assistance.

The clinic needs fast reliable internet

They would require at least NBN or preferably, a fast fibre internet connection to their clinics.

Some clinics may still be limited to ADSL or similar, which would not allow the video calling component of Synchronous remote assistance.

Their clinicians need to be trained well

Remote assistance is the way of the future, but it brings with it many teething issues.

A clinician’s day currently consists of seeing several clients in the clinic, many with different problems, capabilities and hearing aid technologies. They have to think on their feet and change their mindset quickly between one client and the next.

If you suddenly throw remote assistance into their daily mix, overwhelm could quickly take hold. This is especially true if it only forms a very small part of their experience or work day.

The kinds of issues they have to deal with on a remote support call extends further than covering day-to-day issues. They will also need to contend with technical connection issues and issues relating to not being right there with the client.

The clinic would need special procedures to accommodate this kind of client interaction

As the kind of interaction available during a remote assistance visit is limited, compared to a face-to-face consultation, the clinic needs to establish very specific processes to accommodate remote assistance properly.

This would most likely mean that they would need to roll it out using clinicians who are technologically savvy, as well as technically strong, and are able to think on their feet. These kind of clinicians are few and far between.

The right clinician will then determine the opportunities and limitations of this kind of client interaction and document them for further roll out to other clinicians.

You also need training and guidance

Your audiologist or audiometrist will need to help you setup the remote support app on your phone during a face-to-face visit (fitting or follow-up). It would be particularly helpful if they are able to connect to you using the remote support system, while you are there face-to-face, to give you some familiarity with the process.

Remote assistance may be limited to certain days or times

In order to keep the clinician sane, some clinics may choose to limit remote assistance to certain days or specific times during a day. This may reduce the benefit which remote assistance promises.

It is only for follow-ups, not initial fittings

Despite Blamey and Saunders sending new hearing aids over the internet without an in-person consultation (then supporting them remotely), the best practice would be to perform the initial consultation and fitting face-to-face.

By seeing you in the clinical setting, we can ensure that the testing, which is the foundation of any rehabilitation, is accurate. We can also check for any health concerns and refer you if you need other types of care.

We can assist you in finding a fit that is comfortable and also verify the fit in clinic. We can then go through management of your solution and help you connect the hearing aids to your phone. We will also help you install the apps and show you how remote assist works.

Once you have the foundations strongly in place, remote assistance becomes a very useful tool to ensure you’re getting the very best possible from your hearing aids.  Without proper foundations, however, you are unlikely to ever experience optimal hearing benefit. So beware of the models where everything is done remotely.

Our commitment to remote assistance

There is no doubt that remote assistance is the way of the future. One needs to be careful not to compromise your long term outcomes by making unproven assumptions of the benefits.

Value Hearing will be working to install a remote assistance service within the next few months that will be the best-in-class. We are mindful to still keep true to our purpose which is: to empower individuals to engage and thrive through optimised hearing. Long-term client outcomes are critical to us, so we won’t do anything to compromise this.  

We will update this article as we roll out our remote assistance program in 2019.

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3 Comments to “ Reduce clinic visits without sacrificing outcomes”

  1. Klaus Korgitta says :Reply

    I HAVE A PHONACK MARVEL AID.HOW DO I GET THE REMOTE CONNECTION

    1. Hi Klaus,

      Your provider needs to send you an invite via email. It has the instructions on setting this up. For now we are still doing follow-ups face to face as a lot of initial issues do better one-on-one. That is the sort of processes we still need to iron out before rolling this out to a wider audience.

  2. Peter Reynolds says :Reply

    Very interesting and real at a future date. Thanks for the news much appreciated.

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