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  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. 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. Africa 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.

  3. Samburu Warrior

  4. 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

  12. Web for AR

  13. 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.

  14. 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

  15. 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.

  16. Old Technology It’s not how hard you work… It’s how much work you get done.

  17. 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

  18. 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 doctor’s office (35%), • not having enough time with doctor (29%).

  19. 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%).

  20. 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

  23. E-mail and AR • Person to person communication • TeleAR • Video clip attachments • Digital photo attachments • Document (forms) attachment

  24. Electronic Support Groups • Professional to consumer • Consumer to consumer

  25. WWW • Text • Graphics • Videos • Simulations • Virtual reality • Forms • Interactive programs

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

  27. 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

  28. 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

  29. Email and AR Last accessed June 4, 2001

  30. Email and AR

  31. Email and AR

  32. Email and AR

  33. Email and AR

  34. Electronic Mail • 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 • 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) 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.

  35. Electronic Mail • 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 • 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 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. 157:209-212.

  37. 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

  38. 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):

  39. E-mail from VT of the Ear

  40. 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

  41. Benefits: getting information, sharing experiences, receiving general support, venting feelings, gaining accessibility, using writing. Disadvantages: "noise," negative emotions, large volume of mail, lack of physical contact and proximity. Electronic Support Groups • 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.

  42. 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

  43. 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

  44. ESG - CF

  45. ESG – HH/D Teens

  46. 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.

  47. Electronic Support Groups • • (fomerly •

  48. CI Electronic Support Groups • • • • • • • • •

  49. Specialty Electronic Support Groups • •

  50. HOH Electronic Support Groups • • • • • • • • • ( • subscribe beyond-hearing • The Hard of Hearing / Deafened Live Forum (AOL)