By Dr. Rupa Balachandran, PhD, CCC-A, Assistant Service Chief, Audiology and Speech Pathology, VHA NORCAL, and
Dr. Sunny Burdick, AuD, Teleaudiology Section Chief, VHA NORCAL

Around 4.4 million active military members (a quarter of all Veterans in the United States) return home to rural communities after their service. In 2006, Congress established the Veterans Health Administration (VHA) Office of Rural Health (ORH) https://www.ruralhealth.va.gov/ in order to better serve the growing rural veteran population. Providing hearing healthcare to veterans in a timely manner remains a top priority for the VHA. The use of Teleaudiology has allowed this goal to be met with greater efficiency and without the increased cost of travel pay to veterans and their families or outsourcing veterans to Community Care. Incorporating Teleaudiology into our service has resulted in very positive outcomes for all veterans especially those who live in rural communities.

The VA is recognized as a world leader in the development of telehealth and the addition of audiology to that roster of specialty care has made for improved health care for veterans for over a decade. Several audiology and speech pathology clinics have provided tele services to veterans long before the pandemic. In fact, for most of our Speech Language Pathology colleagues tele services is a routine part of how they provide much needed care to their populations. 

In the majority of VA facilities, space is often the most significant issue when setting up specialty healthcare. Teleaudiology has seemed more formidable especially given the cost of the equipment; a specialized cart to house equipment, IT networks, staff to support the services, and sound treated spaces to provide the services. Most of the above held true before the pandemic and were provided by few clinics within the VA for reaching remote sites in and around the country.  

In the past decade or so computer-based audiometry, combined with web-based connectivity software like Teams and Zoom, advanced noise cancellation techniques, have each contributed to make Teleaudiology more accessible to several clinics. 

Currently at the VHA in California, we serve veterans from all over the state, many of them residing several hundred miles away from a brick-and-mortar audiology clinic. There are several Community Based outpatient clinics (CBOC) where Teleaudiology services are available. Teleaudiology clinics are set up at Out Patient Clinics (OPC) close to the veteran’s home with a specifically trained Telehealth Technician (TCT) on the patient side, who serve as the “hands” of the Teleaudiologist working from anywhere in the United States. The equipment needed; a video otoscope, web-based audiometer, immittance system, OAE and HA verification software are situated in a relatively quiet clinic room away from heavy foot traffic and are all controlled remotely by the audiologist. By using the Ambient Noise Assessor tool on the Aurical Free Fit Collar system the audiologist is able to provide a valid audiologic evaluation, meeting ANSI standards for noise, without the need of a costly, and space inefficient sound booth. The TCT work with the audiologist to perform otoscopy, position and change transducers, clean and check hearing aids, and set up for hearing aid verification and programming all of which are performed remotely by the audiologist. 

A common misconception among many providers is that Teleaudiology is in some way inferior to face-to-face audiology when in reality, with the use of technology, the same exceptional caliber of care is delivered to a veteran that they would receive in a face-to-face VA Audiology Clinic. The added benefits of Teleaudiology are shorter wait times for assessments, local care for hearing aid fittings and repairs, being seen where the rest of their routine care providers are located and less travel time (which can add unwanted stress to vets with transportation deficits and mobility issues).  

Teleaudiology has helped create job opportunities for a new cadre of technical staff to enable the broad reach of Teleaudiology services. TCT’s are trained by audiologists to work together to triage the needs of the veterans while they are in the clinic. They prepare vets for the testing and assist the audiologist with the procedures, while also helping with same day hearing aid trouble shooting and in-house repairs.  

Teleaudiology has also positively impacted the work life of audiologist. Teleaudiologists can work from home. One audiologist can serve several CBOC’s and be combined with face-to-face clinics to cover call outs in a different part of the service. The addition of remote programming for hearing aids also allows veterans to have adjustments made to their devices from the comfort of their home

VHA is a pioneer in innovative patient care and is in a unique position to pilot innovative patient care approaches and identify very quickly best practices for serving patients. The lessons learned from Teleaudiology applications now are available for individual clinics that are looking to expand their foot print and bring more of their services to the communities they serve.  

It is no longer necessary to have expensive carts and other equipment to support Teleaudiology and adding a tele-component to clinical practice allows patient care to continue even when audiologists need more flexibility with their work-life balance. The addition of TCT’s is a highly efficient way of stretching increasingly tight reimbursement to allow for clinics to continue to operate and serve their communities.  

We hope many of you will consider looking at Teleaudiology as a way to increase your ability to serve and have a much broader impact on your communities. Please feel free to contact us if you are interested in adding Teleaudiology to your current practice.