For a fifteen minute procedure, hearing aid adjustments can create a serious headache for Veterans. Add to those fifteen minutes the long travel often required to reach a VA audiologist. Then take into account the wait time to see the audiologist. Hearing aid adjustments have the longest wait times of any medical specialty at the VA.
With this in mind, the VA Center for Innovation (VACI) ran an industry competition to solicit the best ideas from the private sector aimed at solving this problem.
One of the technologies that resulted the competition has tremendous potential to transform the lives of the Veterans with hearing impairment. Overseen by a VA innovator, Chief of Rehabilitation Services Dr. Lu Beck, hearing aid company Phonak developed a smart phone app that lets audiologists perform adjustments remotely. A Veteran can be anywhere in the world that has wifi and can have his or her hearing aid adjusted. No travel. No waiting.
Veterans lose their hearing for all manner of reasons. A dramatic, singular event, like an explosion, might cause the hearing loss, but often it’s the continuous exposure to loud noises. Michael Cortright is a former active-duty Marine and Army reservist who now serves as Innovations Grassroots Portfolio Manager at the VA. He explains it like this:
“Say you’re a machinist mate on a submarine, constantly surrounded by those engines running all the time…Or, I was on a jet base and at first it was jarring when the jets took off, but by the end it was like ‘Oh a few planes took off.’”
These varied experiences add up to 340,000 Veterans using VA-provided hearing aids. In a given year, the 1,009 audiologists at the VA provide more than 375,000 hearing aid adjustments and care services.
An audiologist at the Cleveland Medical Center adjusts his patient’s hearing aids during an appointment.
Hearing aids don’t simply amplify all sound. Audiologists specifically tune them to help each patient better hear wider ranges and sounds. A necessary and important part of that process is fine tuning the hearing aids each year to better suit the evolving needs of the patient. Without this, the hearing aids becomes less useful and a Veterans’ quality of life diminishes.
Allison Amrhein, Innovation Coordinator at VA, laid out how the current state of things makes that more likely:
“[Veterans are] driving two hours each way to get to an audiology appointment and then wait in the clinic for two hours after that…[with obstacles like this] the likelihood that they’re going to go for an appointment is low, their hearing is going to get worse, and their quality of life is going to diminish.”
This new technology removes that travel time and waiting. A Veteran makes an appointment and, when that time comes, they simply log on to the app. At the same time, the audiologist connects to the patient using software in their office. Communicating over text or telephone, the audiologist asks the Veteran about their hearing in the past year and if they need help with anything. Based on dialogue and feedback, the audiologist makes tweaks to the hearing aid’s settings. The whole process usually lasts less than ten minutes.
The technology on the patient’s end: a tablet with installed software, smartphone with installed app, Phonak hearing aids, and iCube bluetooth device.
This past year, forty-four Veterans became the first to use the technology as part of a pilot at the Louis Stokes Cleveland VA Medical Center. The Veterans stayed at home. The audiologist worked from the medical center.
Generally older, between their fifties and eighties, the Veterans possessed a range of technological ability from beginner to expert. Some were assisted — in one case by someone as young as twelve — some were not. While this new technology may not be a solution for everyone, even some of the Veterans with limited comfort with technology used and enjoyed the process. In the end, almost all of the Veterans involved had positive things to say.
“The process could not have been easier,” said one Veteran. Setting up the technology generally took less than four minutes. Appointments lasted an average of only eleven minutes — and the audiologists reported that the appointments took the same amount of time as would have a similar face-to-face session. With adjustments made, the Veterans logged off, disconnected their device, and went about their day.
“This is great. It saved me 100+ miles and 3 hours of my time. Very convenient and easy…Thank you,” wrote one Veteran. The Veterans, in general, felt relaxed, comfortable, and satisfied with the appointments. They said they would recommend it to other Veterans and preferred using telehealth rather than traveling a long distance.
A Veteran texts his audiologist during the appointment.
Another noted that “this cutting edge tech is a wonderful thing!” We agree. This technology is not yet readily available on the market. Interesting advancements continue to be made in industry and, with Phonak well-situated in the market, we trust and imagine that our project will take telehealth further both for Veterans and others. As Secretary Bob noted in a recent op-ed, VA has helped develop and scale many revolutionary technologies in healthcare, from implantable pacemakers to the nicotine patch. We trust that this and other projects under way at VACI will soon join that list.
In the meantime, we’ll be working over the course of the next few years to scale the use of this app across VA. In 2015, the pilot will expand out to 5 sites and roughly 200 veterans. In 2016, we project over 200,000 Veterans will use the technology, removing wait times and long drives for each of them. We’ve estimated it could save Veterans a combined $52 million in travel expenses, not to mention all the time and headaches.
This is a prime example of how VA works to spur innovation and improve service to and access for our customers, Veterans. Through the industry competition award, VACI provided the catalyst and oversight to bring this technology to Veterans. Not every innovation succeeds this way; we aim to fail fast and small and often, just like industry. But for those that do succeed, the impact and reward are tangible.
Allison notes this innovation as one of her favorites. “It’s about more convenience,” she says excitedly. “It’s about access.” She worked for the VA for multiple years before joining VACI. Now, she oversees multiple innovation projects. It’s the opportunity to improve access for Veterans that excites her, the chance to provide services to Veterans when, where, and how they need them. This app lets her, VA audiologists, and VA do just that.