Telepractice/Telehealth Preparation in Graduate Education: Status 2015 Telepractice/Telehealth Preparation in Graduate Education: Status 2015? (An Audiology Perspective) Andrew Stuart, Ph.D., CCC-A, Aud(C) Department of Communication Sciences & Disorders East Carolina University

Disclaimer I have no relevant financial or nonfinancial relationship within the products or services described, reviewed, evaluated or compared in this presentation.

Overview Some observation about telepractice and graduate education. Telemedicine/teleaudiology project and experiences at East Carolina University in North Carolina.

Telemedicine/Teleaudiology Is A New Field Telemedicine/Teleaudiology Is A New Field! Medline Search (11-2015): Telemedicine & Hearing or Hearing Loss

Early Position Statements: ASHA (2005); CASLPA (2006), & AAA (2008)

Who’s keeping house? Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) of the ASHA accredits clinical programs in audiology and speech- language pathology. The charge to the CAA is to: Formulate standards for the accreditation of graduate education programs that provide entry-level professional preparation in audiology and/or speech-language pathology.

Where is graduate education moving? Present – No telepractice in curriculum (Standard 3.0A/B)! Proposed – No telepractice in curriculum (Standard 3.0A/B)!

Where are we? Didactic curriculum. Clinical practicum. What about the course work? Clinical practicum. Where are the clinical experiences?

Unfortunately… Less than ½ of current program directors, who responded to a survey of telepractice in university Au.D. Programs, reported they offer teleaudiology course work or clinical training. Wilson & Seal (2015) Only 4% of training programs used this technology to deliver audiology services. Grogan-Johnson et al. (2015) Of 52% of audiologist who provide services through telepractice, only 11% are in college/university facilities. ASHA (2014)

Telemedicine At East Carolina University (ECU) ECU’s telemedicine program has been in continuous operation since its inception in 1992, making it one of the longest running clinical telemedicine operations in the US. Clinical telemedicine services include: Dermatology, cardiology, pediatrics, psychiatry, rehabilitation medicine, and teleaudiology.

Teleaudiology at ECU Teleaudiology was coined by Dr. Gregg Givens at ECU in 2003 for system for real-time assessment of auditory thresholds using computer driven control of a remote audiometer via the Internet. Givens, G.D. et al. (2003). Internet-based teleaudiometry system for the assessment of hearing: A pilot study. Telemedicine Journal and eHealth, 9, 375-378.

Teleaudiology at ECU For Infants In 2010 a project began with the Early Hearing Detection and Intervention Program of the NC Division of Public Health and East Carolina University to provide diagnostic evaluations of infants living in the rural underserved northeastern part of the state. The partners included ECU’s established Telemedicine Center and Communication Science and Disorders Department.

http://www.nc-climate.ncsu.edu/thrips/ http://www.outerbankschamber.com/ http://www.city-data.com/picfilesv/picv23021.php Catchment Area: Extremely rural, high % below poverty level, and infant diagnostic sites are not easily accessible.

ECU Hybrid Teleaudiology Model Synchronous services to clients in real time. Asynchronous store-and- forward of audiometric data.

Remote ECU Telemedicine Sites

ECU Teleaudiology Provider Technical Configuration Polycom HDX with document sharing. Pan/Zoom/Tilt camera w/far- end control in patient room. Picture-in-picture layout control. Directory Dialed. Up to 6M calls. Mobile desktop capability. Dual audio/microphone capability.

Opportunities For ECU AuD Students Students were involved in the program setup from the beginning including: Test protocol development, duel site preparation (i.e., remote test site and teleaudiology clinic), and continuing evaluation/changes of protocol. Students can be placed in the teleaudiology “clinic block.” This involves preliminary visits to the ECU Telemedicine Center and remote site(s). Familiarization with teleaudiology Polycom units and protocols.

Future Opportunities Operation Reentry North Carolina is a military support program that bring together researchers and projects that focus on the concerns and needs of returning service men and women. It is a cooperative program between East Carolina University and the Telemedicine & Advanced Research Center of the U.S. Army Medical Research and Materiel Command.

Lingering Issues at ECU… Diagnostic instrumentation interface? Billing? Who maintains service at remote sites? Hospital personnel or audiology technicians? Medical records? Health Insurance Portability and Accountability Act (HIPAA)

Language interpretation? Liability insurance? Language interpretation? Can licensed audiologist provide services within and between states? 21 NCAC 64 .0219 TELEPRACTICE defines service in NC only. Are these services sustainable?

Questions?