Online Audiologic Rehabilitation

1
Online Audiologic Rehabilitation

• Perry C. Hanavan. MA, FAAA
• Augustana College
• Sioux Falls, SD
• ARA Summer Institute 2001
• Vancouver, BC
• June 7-10, 2001

2
Africa

• Every morning in Africa, a gazelle wakes up.
• It knows that it must run faster than the fastest
  lion,
• Or it will be killed.

• Every morning in Africa, a lion wakes up,
• It knows that it must outrun the slowest gazelle,
• Or it will starve to death.

It doesnt matter whether youre a lion or a
gazelle, When the Sun comes up in the morning,
youd better be running.
3
Samburu Warrior
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Appointments
5
Internet Growth
6
Found in ESG Message
7
Village .?
8
Traditional AR
9
21st Century AR
10
Not Without Problems
11
Experimental System
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Web for AR
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World E-Commerce and Internet Market Report

• Top five countries in each new-economy indicator
  category
• Financial transactions - Amount of credit cards
  issued per person, per year and credit card
  spending -- Iceland, Luxembourg, U.K., US and
  Canada.
• Literacy and education rates - Ability to meet
  the educational needs of a competitive economy --
  Finland, Australia, Canada, Iceland and the US.
• Market potential - Measures standard of living
  and retail sales -- US, Finland, Iceland, Canada
  and Taiwan.
• Globalization - Willingness to accept foreign
  economic influence and embrace the global capital
  market -- Netherlands, Hong Kong, Finland,
  Ireland and Sweden.
• Technological sophistication -- Number of
  computers and Internet connections US, Finland,
  Iceland, Canada and Taiwan.

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What is the Internet

• "The Internet isn't about wires and tubes. In
  effect, it's about change. A whole host of
  things in our world are just waiting to be
  changed, longing for better solutions, and the
  Internet is the stimulus, and perhaps the means,
  to unleashing these pent-up desires, trends, and
  forces to their next natural state.
• Weintaub, JN. (1997) Capital thoughts. Internet
  World, March

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Theyre Here!

• As audiologists we need to adjust our modelThe
  internet is the tool not the solution that will
  pave the way for the new model. (Glen Meier)

Northern, JL. (2001) Hearing services on the
internet Theyre here! Audiology Today. 13(2)7.
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Old Technology
Its not how hard you work
Its how much work you get done.
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Why Consider Online AR?

• Online AR information is apart of the global
  resources that constitute the Internet
• Online AR information is easily accessed
• Search engines (Google, AltaVista, HotBot)
• Directory services (Yahoo) (SearchWave)
• Professionals, organizations, business,
  government, laypersons have created resources
• Consumers, professionals, and others want access
  to online AR information
• Improve audiologist-patient relationships

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High Tech High Touch Service

• Healthcare consumers experiences before, during
  or after visits to their physicians
• forgetting to ask all their questions during
  doctor visit (60),
• having to see doctor in person to ask questions
  that could be answered by telephone or e-mail
  (41),
• getting through to someone who could answer
  questions (35),
• providing the same information over and over
  again each visit to doctors office (35),
• not having enough time with doctor (29).

http//www.harrisinteractive.com/about/healthnews/
HI_HealthCareNews-V1-Issue1.pdf
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High Tech High Touch

• Online population would like to receive e-mail
  reminders for preventive care (81),
• Follow-up e-mails after visits to doctors (83)
• For their doctors to be able to access and
  monitor their lab tests online (84).

http//www.harrisinteractive.com/about/healthnews/
HI_HealthCareNews-V1-Issue1.pdf
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Time Spent by Professionals

• Average Amount of Time Professionals Spend
  Explaining Details of Hearing Test Results
• --------------------------------------------------
  --------------------------------
• Topic Oto Aud
• --------------------------------------------------
  --------------------------------
• Shortest time in minutes (mean) 5.86 5.94
• Range .25-30 0-30
• Average (minutes) 11.95 12.41
• Range 2-60 2-75
• Longest time in minutes (mean) 25.72 26.94
• Range 3-120 4-120

Martin, FN, Bar, MM, and Bernstein, M. (1992).
Professional attitudes regarding counseling of
hearing-impaired adults. American Journal of
Otolaryngology. 13(3) 979-287.
21
Time Spent by Professionals

• Average Amount of Time Professionals Spend
  Explaining Implications of the Hearing Impairment
• --------------------------------------------------
  --------------------------------
• Topic Oto Aud
• --------------------------------------------------
  --------------------------------
• Shortest time in minutes (mean) 6.91 6.81
• Range 0-7.4 0-30
• Average (minutes) 13.57 13.89
• Range 1-300 2-75
• Longest time in minutes (mean) 31.32 32.55
• Range 2-600 4-240

Martin, FN, Bar, MM, and Bernstein, M. (1992).
Professional attitudes regarding counseling of
hearing-impaired adults. American Journal of
Otolaryngology. 13(3) 979-287.
22
Internet Applications of AR

• E-mail
• Electronic Support Groups
• Discussion groups
• Listservs
• Forums
• Chats
• World Wide Web

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E-mail and AR

• Person to person communication
• TeleAR
• Video clip attachments
• Digital photo attachments
• Document (forms) attachment

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Electronic Support Groups

• Professional to consumer
• Consumer to consumer

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WWW

• Text
• Graphics
• Videos
• Simulations
• Virtual reality
• Forms
• Interactive programs

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Online AR

• Patient diaries
• Educational information
• FAQs
• Electronic support groups
• Forms
• Scheduling information
• Maps (directions)
• Resources

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Profusion of Web Content

• Information is only as useful when relevant to
  problem, valid, and easy to access
• Slawson formula
• Usefulnessrelevance x validity/work to access

Slawson, DC, Shaughnessy, AF, and Bennet, JH.
(1994). Becoming a medical information master
feeling good about not knowing everything.
Journal of Family Practice. 38505-13
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Telemedicine applications

• Video-otoscopy captures the image
• The use of live video teleconferencing to
  evaluate and treat patients in-house preliminary
  results show no difference in outcomes
• Burgess LP, Holtel MR, Syms MJ, Birkmire-Peters
  DP, Peters LJ, Mashima PA. (1999) Overview of
  telemedicine applications for otolaryngology.
  Laryngoscope. 109(9)1433-7

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Email and AR
Last accessed June 4, 2001
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Email and AR
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Email and AR
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Email and AR
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Email and AR
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Electronic Mail

• 70 inquiries from published web site
• 39 patient inquiries
• 20 family inquiries
• 11 unknown relationship
• 1.3 (avg) inquires per week
• 2 (avg) messages to follow-up (range 1-10)
• 2 (avg) number of replies (range 1-9)

• 96 identified qualified consultant in area of
  cardiology
• 74 - identified the authors expertise of
  arrhythmias
• 70 sought a second opinion
• 21 sought advice whether to consult a physician

Widman, LE and Tong, DA. (1997) Request for
medical advice from patients and families to
health care providers who publish on the world
wide web. Archives of Internal Medicine.
157209-212.
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Electronic Mail

• 44 - diagnosis and management of cardiac
  arrhythmias
• 8 - recording procedures
• 5 - diagnosis and management of coronary artery
  disease
• 10 - other areas of clinical cardiology
• 2 - general internal medicine
• 1 - neurology

• 15 - help in establishing a diagnosis
• 14 - select or understand therapy for established
  diagnosis
• 1 - understand prognosis
• 6 - obtain information about a disease or
  medication

Widman, LE and Tong, DA. (1997) Request for
medical advice from patients and families to
health care providers who publish on the world
wide web. Archives of Internal Medicine.
157.209-212.
36
Electronic Mail

• Conclusions
• Individuals can identify qualified consultants
  outside local health care system and communicate
  directly with provider

Widman, LE and Tong, DA. (1997) Request for
medical advice from patients and families to
health care providers who publish on the world
wide web. Archives of Internal Medicine.
157209-212.
37
Why Email and AR?

• Public is well-educated, curious, and used to
  seeking health care from printed media
• HMOs have financial disincentives to provide
  needed treatments, lack referrals to specialists,
  etc.
• Traditional insurance plans may not pay for or
  pay only a portion of services, therefore,
  patients are verifying necessity of proposed
  evaluations
• Lack of resources in rural or remote areas,
  globally

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Electronic Mail

• Ethical issues duty to respond, increasing
  growth of Internet users
• Compensatory issues overhead, academic credit,
  professional societies
• Legal issues no legal responsibility to
  respond, disclaimer, saved as medical record,
  state and foreign country laws
• Confidentiality issues non-encrypted records,
  printed and saved as medical record, not released
  to others without consent
• Information Quality issues expert source,
  educate layperson about information quality on
  the Internet

DAlessandro, DM, DAlessandro, MP, Colbert SI.
(2000) A proposed solution for addressing the
challenge of patient cries for help through an
analysis of unsolicited electronic mail.
Pediatrics. 105(6) http//www.pediatrics.org/cgi/
reprint/105/6/e74.pdf
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E-mail from VT of the Ear
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Electronic Support Groups

• Six-level system in information-age health care,
  patient-consumers may seek what they need in the
  following order
• individual self-care,
• family and friends,
• informal self-help networks,
• the professional as coach,
• the professional as partner,
• professional as authority.

Ferguson T. (1997) Health online and the
empowered medical consumer. Jt Comm J Qual Improv
23(5)251-7
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Electronic Support Groups

• Disadvantages
• "noise,"
• negative emotions,
• large volume of mail,
• lack of physical contact and proximity.

• Benefits
• getting information,
• sharing experiences, receiving general support,
• venting feelings,
• gaining accessibility,
• using writing.

Han, HR and Belcher, AE. (2001) Computer-mediated
support group use among parents of children with
cancer--an exploratory study. Computers in
Nursing 19(1)27-33.
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Electronic Support Groups

• Impact of Internet use on coping ability of HIV
  patients found three themes
• Internet promotes empowerment,
• augments social support,
• facilitates helping others

Reeves, PM. (2000) Coping in cyberspace the
impact of Internet use on the ability of
HIV-positive individuals to deal with their
illness. J Health Commun. 5 Suppl47-59
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ESG CF Teens

• Teenagers with chronic disease will actively
  participate in ESG
• ESG helped meet psychosocial needs
• Management of ESG was extremely easy
• ESG utilized inexpensive technology
• Patients who are difficult to assemble in one
  physical location may benefit from participating
  in an electronic support group (ESG).

Johnson KB, Ravert RD, Everton AE. (2001).
Hopkins teen central Assessment of an
internet-based support system for children with
cystic fibrosis. Pediatrics. 107(2) E24
http//www.pediatrics.org/cgi/reprint/107/2/e24.pd
f
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ESG - CF
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ESG HH/D Teens
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Electronic vs Traditional SG

• Traditional Support Group Barriers
• Practical -- travel, transportation, schedules
• Medical -- health factors, weakness
• Stylistic -- incongruent attitudes
• Electronic Support Group Barriers
• Computer with Internet connection
• Computer skills
• Visual acuity and finger dexterity
• Lack of non-verbal communication

Weinberg, N Schmale, J, Uken, J, Wessel, K.
(1995) Computer- mediated support groups Social
work with groups. Social Work with Groups.
17(4)43-45.
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Electronic Support Groups

• http//groups.yahoo.com
• http//groups.google.com/ (fomerly www.deja.com)
• http//www.topica.com/

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CI Electronic Support Groups

• forum_at_nucleusci.com
• http//groups.yahoo.com/group/ci
• http//groups.yahoo.com/group/cifamily
• http//groups.yahoo.com/group/CI-Prelinguals
• http//groups.yahoo.com/group/citeens-preteens
• http//groups.yahoo.com/group/ProblemCI
• listserv_at_yorku.ca
• http//www.delphi.com/parentsclarion/start/
• http//www.topica.com/lists/cochlearimplants/

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Specialty Electronic Support Groups

• http//groups.yahoo.com/group/AuditoryNeuropathy
• http//www.topica.com/lists/menicircle/

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HOH Electronic Support Groups

• http//groups.yahoo.com/group/HOH-LD-News/
• http//groups.yahoo.com/group/LDAchat/join
• http//groups.yahoo.com/group/Hearing_Aids
• http//groups.yahoo.com/group/Listen-Up
• http//groups.yahoo.com/group/USA-L_News
• http//groups.yahoo.com/group/hear
• http//groups.yahoo.com/group/bhNEWS
• http//www.hearinglossweb.com/
• alt.support.hearing-loss (groups.google.com)
• majordomo_at_duke.edu subscribe beyond-hearing
• The Hard of Hearing / Deafened Live Forum (AOL)

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Web Content

• assessed quality of information a lay person
  could obtain from Internet sources regarding the
  treatment of childhood diarrhea
• low percentage of concurrence with the AAP
  guidelines
• medical institutions, schools, and hospitals need
  to devise ways to carefully monitor and establish
  quality control of what is being distributed from
  their home pages
• patients must be warned about the voluminous
  misinformation available on medical subjects on
  the Net

McClung, HJ, Murray, RD, and Heitlinger, LA.
(1998). The internet as a source of current
patient information. Pediatrics. 101(6)
http//www.pediatrics.org/cgi/reprint/101/6/e2.pdf
52
Therapy and WWW

• WWW resources, structured behavior components,
  weekly contact, individualized therapist feedback
  delivered via e-mail (best)
• WWW resources alone (produced results)
• Conclusions Internet appears to be a viable
  method for delivery of structured program

Tate, DF, Wing, RR and Winett, RA. (2001) Using
internet technology to deliver a behavioral
weight loss program. JAMA. 285(9)1172-1177.
53
WWW and ESG

• New mode of communication that will play vital
  role for nurses
• Site helps users learn about their disease and
  become active in their own management
• Site provides nurses with a means to teach
  patients in a supportive environment
• Site serves as patient advocate
• Potential to contribute to the development of a
  new nursing knowledge base in the form of nursing
  informatics

Bliss, J, Allibone, C, Bontempo, B, Flynn, T and
Valvono. NE. Creating a Web site for on-line
social support melanocyte. Computers in Nursing.
16(4)203-207.
54
WWW for Med Information

• 924 gastroenterology patients surveyed
• 50 reported access to Web
• 51 of those with access had searched the web for
  medical information
• 60 of surveyed intended to use web for searching
  medical information
• 4 (35) had ever been referred to the Web by
  their physician

OConnor, JB and Johanson, JF. (2000). Use of the
web for medical information by gastroenterology
clinic population. JAMA.2841962-1964.
55
Web and Consumer Voice

• Compared professional, commercial and consumer
  generated Web sites
• 53 different treatment types were mentioned
• Antidepressant medication and psychotherapy were
  noted by almost all sites
• Consumer sites mentioned psychological therapies
  less frequently
• Consumer sites provide a voice to inform
  psychiatrists and GPs about preferred treatments
  and side effects

Christensen, H, Griffiths, KM and Medway J.
(2000). Sites for depression on the web a
comparison of consumer, professional and
commercial sites. Aust N Z J Public Health.
24(4)396-400.
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JIT, Web, and Healthcare

• Provided educational information via the Web to
  reduce postoperative pain following surgery
• Patients who had access to the pain management
  information on the Web site reported
  significantly less postoperative on arrival to
  their home after surgery
• Concluded that using the Internet to provide just
  in time patient education can significantly
  effect the clinical outcome of care

Goldsmith, DM and Safran, C. (1999). Using the
web to reduce postoperative pain following
ambulatory surgery. Proc AMIA Symp780-784.
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Web Based AR

• John Tracy Clinic (online correspondence)
• hear-it.org (youth, medical, adult, political
  versions- IFHOH)
• HearingAidHelp.com (Hearing Planet)
• www.hearing411.com (Siemens)

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Web Based Evaluations
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AR and the Web
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Professional.orgs and the WWW
61
Professional.orgs and the WWW
62
Professional.orgs and the WWW
63
Combining Efforts of Orgs
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From Russia with Love
65
From Russia with Love
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From Russia with Love
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HA Manufacturers and the Web
68
HA Manufacturers and the Web
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Audiologists and the Web
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Government/Health/Web
Stephenson, J. (2000) National library of
medicine to help consumers use online health
data. JAMA. 283(13)1675-1676.
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Government/Health/Web
72
Medline/PubMed
73
Web Resellers
74
E-Manuals
75
Orgs and the Web
76
World Orgs
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Assessment on the WWW
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Internet and Telemedicine
Gray, JE., et al. (2000) Baby CareLink Using
the internet and telemedicine to improve care for
high-risk infants. Pediatrics. 106(6)1318-1324.
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Reimbursement
80
Reimbursement
81
Assessing WWW Quality
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Guidelines for AMA Web Sites

• Principles for content
• Principles for advertising and sponsorship
• Principles for privacy and confidentiality
• Principles for e-commerce

Winker, MA, et al. (2000) Guidelines for medical
and health information sites on the internet
principles governing AMA web sites. JAMA.
283(12)1600-1606).
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Conclusion

• Online healthcare is having a growing cultural
  impact
• Effecting the image of the practitioner-patient
  relationship
• Consumers are bringing new strategies into their
  acquisition of health information and care
• Professions are attempting to establish norms for
  proper use of the Internet for consumers
• Healthcare communities should establish
  approaches that empower consumers to use Internet
  as part of healthcare (AR) strategy
• Statuses of professionals may be bolstered as
  they develop ways to empower and support
  consumers use of the Internet

Oravec, JA. (2001). On the proper use of the
internet self-help medical information and
on-line health care. J Health Soc Policy.
14(1)37-60.