Transcript Online Audiologic Rehabilitation

Online Audiologic Rehabilitation
Perry C. Hanavan. MA, FAAA
Augustana College
Sioux Falls, SD
ARA Summer Institute 2001
Vancouver, BC
June 7-10, 2001
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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 doesn’t matter whether you’re a lion or a gazelle,
When the Sun comes up in the morning, you’d better be
running.
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Samburu Warrior
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Appointments
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Internet Growth
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Found in ESG Message
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Village ….?
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Traditional AR
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st
21
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Century AR
Not Without Problems
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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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They’re Here!
• “As audiologists we need to adjust our
model…The 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: They’re
here! Audiology Today. 13(2):7.
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Old Technology
It’s not how hard
you work…
It’s 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
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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 doctor’s office (35%),
not having enough time with doctor (29%).
http://www.harrisinteractive.com/about/healthnews/HI_HealthCareNews-V1Issue1.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_HealthCareNewsV1-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
Average (minutes)
Range
Longest time in minutes (mean)
Range
.25-30
0-30
11.95
12.41
2-60
2-75
25.72
26.94
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.
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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.
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Internet Applications of AR
• E-mail
• Electronic Support Groups
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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
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Text
Graphics
Videos
Simulations
Virtual reality
Forms
Interactive programs
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Online AR
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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:
Usefulness=relevance 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. 38:505-13
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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 author’s
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. 157:209-212.
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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.
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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. 157:209-212.
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Why Email and AR?
• Public is well-educated, curious, and used to
seeking health care from printed media
• HMO’s 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
D’Alessandro, DM, D’Alessandro, 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:
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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
Benefits:
Disadvantages:
• getting information,
• sharing experiences,
receiving general support,
• venting feelings,
• gaining accessibility,
• using writing.
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"noise,"
negative emotions,
large volume of mail,
lack of physical contact
and proximity.
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 Suppl:47-59
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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.pdf
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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:
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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
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[email protected]
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
[email protected]
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
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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)
[email protected] 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
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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.
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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.
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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
O’Connor, JB and Johanson, JF. (2000). Use of the web for medical
information by gastroenterology clinic population. JAMA.284:1962-1964.
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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 Symp:780784.
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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
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Professional.orgs and the WWW
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Professional.orgs and the WWW
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Combining Efforts of Orgs
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From Russia with Love
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From Russia with Love
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From Russia with Love
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HA Manufacturers and the Web
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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
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Medline/PubMed
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Web Resellers
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E-Manuals
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Orgs and the Web
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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
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Reimbursement
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Assessing WWW Quality
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Guidelines for AMA Web Sites
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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.
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