With new technology, more health care services can be provided remotely. The Department of Veterans Affairs is jumping on the trend.
By Taylor Sisk
Charles Alligood sat in the locker room of a U.S. Department of Veterans Affairs community-based outpatient clinic in Greenville listening to a recorded male voice deliver a short exposition on the carrot – that it’s a reddish-yellow root vegetable with several thin leaves on a long stem, belongs to the parsley family, is grown all over the world – most of which he probably already knew and/or couldn’t care less about.
But Alligood, 67, didn’t drive 20-odd miles from his home in Washington for a horticulture lesson. The room where he sat has been fashioned into an audiology lab, and Alligood came to be fitted for hearing aids, focusing his attention on the narrator’s voice.
Last November, the Durham VA Medical Center (VAMC) was selected as one of 10 VA centers to participate in a pilot project that allows veterans to have their hearing aids remotely programmed and fine-tuned.
The objective is to help validate what the VA calls “tele-modality” as an effective means of providing audiology services to rural areas.
In 2010, Secretary of Veterans Affairs Eric Shinseki identified telehealth as one of his “transformation initiatives” for the VA.
While Alligood sat in Greenville, assisted by an audiology health technician, Dr. Nancy Jones, chief of audiology and speech pathology at the Durham VAMC, communicated with him via teleconference from a computer in her office.
A pcAnywhere software application allowed Jones to control the instruments on a “teleaudiology” cart in Greenville. She was able to adjust Alligood’s new hearing aids, and communicate with him face to face, as if she were in the same room.
Appointments are scheduled in Greenville with veterans from the eastern part of the state every Wednesday. Not only does the program reduce travel time and costs (Alligood, for example, would otherwise have to make a five-hour roundtrip journey to Durham), the proximity of the facility means the veterans are more likely to schedule follow-up appointments to maintain the quality of their hearing aids.
Alligood served in the Air Force from 1963 to ’67, working on B-52s, and both he and Jones attribute his loss of hearing to the roar of jet engines.
Some hearing loss was noted in his discharge physical. He was tested again, he said, about 20 years ago, but was told the extent of the loss wasn’t yet sufficiently severe to be treated. With age, it worsened. These will be his first hearing aids.
Before Alligood entered the room in Greenville, Jones pulled up an audiogram of his hearing. She pointed out that he has what’s called a noise notch, which substantiates the claim that his hearing loss was noise induced.
Alligood has difficulty hearing high-frequency sounds. He’s able to hear people talking, but it’s as if they’re mumbling. His ability to discern consonant sounds are muted.
A graph on Jones’ screen indicated the frequencies she targeted to try to program the hearing aids for optimal effect. In a matter of minutes – as Alligood listened to the narrator expound on the virtues of the carrot – Jones adjusted, one ear at a time, and was able to hit those targets pretty well.
For Alligood, the experience was every bit what it would have been had he traveled to the VAMC in Durham – less four hours-plus of driving.
While allowing that the new hearing aids are going to take some getting used to, he said he’s pleased.
“I’ll be giving them a good test tonight though,” he said. “Choir practice.”
The audiology team responded by creating an algorithm-based program designed specifically for music that Alligood can turn on and off with a button on the hearing aids. Other programs can later be provided for a variety of environments.
He left, with time to spare to take the wife to lunch.
“She’ll probably say, ‘You should be able to hear me now. I don’t want to hear anymore of that mess about how you can’t hear me.’”
Alligood will return to the clinic in Greenville in four to six weeks for adjustments.
The next phase of the teleaudiology pilot project will be to provide hearing tests at community-based outpatient clinics – hopefully launching, Jones said, by the end of this month – further extending VA services to rural areas.