WELCOME LEND Pediatric Audiology Meeting. March 4, 2012 St. Louis, Missouri

Transcription

1 WELCOME 2012 LEND Pediatric Audiology Meeting March 4, 2012 St. Louis, Missouri

2 2012 LEND Pediatric Audiology Planning Group Diane Behl (National Center for Hearing Assessment and Management, NCHAM) Jon Douglas (Waisman Center, WI) Irene Forsman (Maternal and Child Health Bureau, MCHB) Robert Fifer (Mailman Center for Child Development, FL) Anne Harris (Waisman Center, WI) Anne Marie Tharpe (Vanderbilt LEND, TN) Diane Sabo (UCLID Center at the Children s Hospital of Pittsburgh, PA)

3 Thank you! Maternal and Child Health Bureau: Irene Forsman Panelist: Diane Behl, Bob Fifer & Michelle Reiter Logistical Support: Hillary Davis, Andrea Fowler, Jessica Cosey, Lindsay Diethorn & Elizabeth Aspell

4 Small Group Discussions

5 Panel Discussions: Tele-Audiology

6 Tele-What? Diane D. Behl, M.Ed. Senior Research Scientist Utah State University 2011 EHDI Conference Atlanta, GA

7 Which term to use? Orginal term: Telemedicine (physicians, medical focus) Telehealth (incl. other health providers) Telepractice (incl. non-health) Telerehabilitation Tele-audiology Tele-intervention

8 What do they have in common? Providing services via telecommunications technology Used to overcome access barriers due to: Distance Shortage of specialists Impaired mobility Culture/linguistics

9 Other general terms Synchronous: Live interactions in real time Asynchronous: Store and forward Host site/hub: Where professional is located Remote site/spoke: Where client is located VoIP: Voice over Internet Protocols VPN: Virtual Private Network: secure connection Application sharing software: remote operation of another computer

10 What do we know about tele-audiology with infants & young children? 2010 Systematic Review (Swanepoel & Wall, 2010) Screening: OAE, AABR Diagnosis: ABR s, video-otoscopy, audiometry Intervention: CI mapping, HA fitting V. little published research involving infants & young children

11 How are EHDI systems involved in Telehealth/Telepractice? NCHAM survey conducted in Aug./Sept Inquired re: telehealth/tele-intervention/therapies for hearing-related services Administered to EHDI coordinators, forwarded to partners Obtained responses from 49 states, 2 territories

12 NCHAM Survey Results 42% had some telehealth efforts underway or planned Telehealth services were primarily Diagnostic ABR s Telepractice services were primarily early intervention and communication-related therapies

13 How far along is your telehealth effort in its development? Apx. 1/3 in pilot phase Most in planning phase Other : preplanning phase or multiple efforts underway but in different phases

14 What are the issues surrounding telehealth that respondents found challenging?

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16 What are the Benefits of T-I over Traditional HV s? Bring specialized services to rural areas T-I lends itself to coaching model Fewer cancellations Facilitate live teaming Can use ear bud or texted prompts Record sessions for sharing with providers, other family members Self-evaluate with recorded sessions Preservice & inservice training

17 What is needed to do TI? Stronger skill set of therapist needed for T-I Requires understanding adult learning concepts Remote management skills Being prepared with options, faster timing Cognitive demand on therapists with addition to attending to technology Physical Environment must be friendly for T-I

18 Range of Technologies Cisco Tandberg (similar to Polycom, Sony systems) Includes MOVI Cisco umi (you-me) Microsoft XBox 360 Kinect Videophones Skype (also Oovoo, Logitech SightSpeed)

19 Technology Considerations Up-front costs Ongoing costs (e.g., monthly service fees) Technology maintenance & support Ease of use Quality (video quality, size, camera pan and zoom) Reliability Bandwidth (i.e., consistency) Security (firewalls, hacking, viruses) Sustainability (will technology be around in a year?) Recording (staff self-assessment, family sharing/review) Group calling (e.g., 3-way, 8-way)?

20 Bandwidth is the KEY Issue All technology systems, regardless of cost, are effected by bandwidth Bandwidth is an issue in all geographical locations (urban and rural) Bandwidth is traffic dependent Traffic is dependent on time of day, weather, location Bandwidth is increasing dramatically nation-wide, but so is traffic (thanks, Netflix and youtube!) Need at least 2.0 Mbps to get decent, usable video upstream and downstream

21 NCHAM Tele-Audiology Learning Community Bring together those involved in using telehealth Primarily diagnostic ABR s (8 sites to date) Looking for others involved in CI mapping, HA management with infants/young children Address challenges pertaining to: Reimbursement & licensing Training of staff at remote sites Family-centered communication Measuring effectiveness

22 What are the big unknowns to investigate? Is Telehealth cost effective? How much acoustic and visual clarity needed? Can you emotionally connect & provide support to families? Does Telehealth work for various interventions? Are some parents/children a better fit? Are some interveners a better fit?

23 What are the challenges to having Telepractice go viral? Funding for equipment & maintenance Staff training Security & privacy issues Reimbursement Licensure

24 Resources & Networking Opportunities Go to infanthearing.org/telehealth & Infanthearing.org/ti-guide ASHA guidelines for telepractice, skill sets American Telemedicine Association National Telehealth Resource Centers Practical tools for implementation Attend EHDI sessions: Cynthia See, Mon.11:30, Behl, et al Tues., 11:00; others? Contact to learn more, share efforts

25 Telehealth Services for Audiology Robert Fifer, Ph.D. University of Miami Mailman Center for Child Development

26 Standards of Telehealth Comply with regulatory requirements Use billing and coding processes that designate telehealth services (i.e., modifier) GQ VIA ASYNCHRONOUS TELECOMMUNICATIONS SYSTEM GT VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS Advanced requirements for privacy Training, orientation, education re tele-services

27 Standards of Telehealth Type and quality of service must be equivalent to that provided face to face in an office or facility Clear communication Appropriate technology on each end Appropriate services will be delivered via telehealth procedures Use of ancillary personnel

28 HIPAA Considerations of Telehealth Secure connection for privacy Encrypted vs. non-encrypted Extraneous persons in the area Type of service provided Synchronous vs. store and forward Skype-type of technology Not secure Readily available Consent notification

29 Reimbursement Issues for Teleaudiology Not recognized by Medicare for payment State by state recognition for Medicaid State by state and company by company recognition for commercial payers Within system versus to the home Authorized specialties for Medicare payment: Psychology / psychiatry / clinical social worker Medical nutrition MD/DO, PA, NP

30 Considerations Before Initiating Telehealth Services Type of service Counseling Hearing aid / CI programming Diagnostics Special equipment to accommodate T-H Svcs Use of ancillary personnel Secure transmission line for data (diagnostics) Mobile equipment costs / overhead

31 Conclusion: Telehealth Not inexpensive to begin Requires modified skill set regarding telecommunications Once established, increase in cost efficiency Particularly suited for rural areas Be mindful of licensure / state line issues

32 Telehealth Services for Audiology: A Trainees Perspective Michelle Reiter 4 th year AuD student at the University of North Carolina Extern at Marion Downs Hearing Center at the University of Colorado Hospital 32

33 THANK YOU!