powerpoint presentation · 2018-04-04 · social media …or a convergence of game changers?...
TRANSCRIPT
09/15/17
1
2017
Game Changers in Hearing Aids
What is the Impact of Game Changers in the Hearing World?
• Paradigm Shifting
• Connectivity • To Audio Sources
• To Apps
• Between Hearing Aids
• To Professional Services
A Paradox of Game Changers?
Internet Research
Personalization
“Maker Culture”/
DIY
Connectivity
Social Media
…Or a Convergence of Game Changers?
Internet Research
Personalization
“Maker Culture”/
DIY
Connectivity
Social Media
What are the Capabilities of Connectivity Today?
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2
Connectivity in Amplification
• Environmental classification
• Feedback suppression
• Directionality
• Noise reduction
The Hearing Aid
Sound Connectivity
Made for iPhone®
Personalization
Accessories
• Remote control
• Tinnitus masking
• Special functions
(frequency shaping, geo-
tagging, Find My Hearing
Aid, etc.)
Marketrak 9
76% 78% 80% 82% 84% 86% 88% 90% 92%
Hearing Aid Only
Hearing Aid+Accessory
Hearing Aid+Accessory+App
Satisfaction: Hearing Aid Alone vs. Hearing System
%Satisfaction
Connectivity to Audio Sources and Apps
The challenge
Listening in noise
Listening over distance
Listening in environments with reverberation
And…listening without visual cues
(e.g., phone)
11
An Effective Solution…
12
Improving Signal-to-Noise Ratio (SNR)
Via Wireless Signal Transmission
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Wireless Signal Transmission via Accessories
Wireless accessories overcome many problems that hearing aids alone cannot address:
• Hearing aids continue to become smaller causing difficulty handling controls for people with dexterity issues
• Many hearing aid users have difficulty hearing or understanding television and prefer volume levels that are uncomfortably loud for others in the room
• Hearing aid users often have difficulty hearing on the telephone, particularly mobile phones
• Difficulty hearing in noise where the hearing aid directional microphones are not enough to help the user
Benefit
Users can understand speech in noisy reverberant environments with the addition of accessories to their hearing system.
Signal Transmission
Signal Transmission
Analog Digital
Telecoil
FM
Infrared
NFMI + Bluetooth (open platform RF)
Proprietary radio frequency (RF) 900 MHz
Proprietary radio frequency (RF) 2.4 GHz
Digital wireless can be used for transmission with extra devices and/or between hearing aids (ear-to-ear)
Telecoils
Looping and T-coils
The signal is transmitted electromagnetically, and requires a telecoil in the hearing instrument.
Trans-
mitter
Receiver
Telecoil
Advantages Drawbacks
Improved signal-to-noise ratio
Can install loops pretty much anywhere, including at home
Telephone
Integrated seamlessly into HA
Can still use with earphones with no hearing aid
Convenient
Uses programmable HA frequency shaping
Loop systems in public venues are expensive and require installation of loop
More expensive than FM or IR system
Cannot be used in more than one location at a time, or else interference will occur
Telecoil strength varies across HA models, telephones
FM Systems
Uses radio frequency transmission
Modified or modulates a electromagnetic wave as a carrier of the signal
The transmitter selects the carrier frequency and the receiver must tune to the carrier
Long range (1000’)
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Advantages
Improved SNR
Used personally or with a group
Uses HA frequency shaping
Can separate multiple transmission signals via channels
Doesn’t require installation of loop (like telecoil loop systems)
Drawbacks
Requires use of extra equipment (receiver) even when used with Has
Personal receivers are expensive
Not always secure
Must be tuned into correct channel
FM Systems & Benefits Infrared (IR)
Similar to FM but uses a much higher carrier frequency
Uses AM instead of FM by pulsing the signal through the wave
Operates at almost the same frequency as light, so acts like light
Infrared
Advantages Drawbacks
Improved SNR
More secure than FM
Can be used personally or with a group
Inexpensive (~$40 home, $3000 group)
Can be used with or without HAs
Need line of sight
Does not take advantage of HA frequency shaping
Requires use of extra equipment (receiver, neckloop) even when used with HAs
Prone to interference from other light sources
#1: Automatic Soap Dispenser vs. Wall Heater Remote Control
2 Fun Examples of Interference in Daily Life
#2: “Trick-Or-Treat” Bowl vs. the Sun
Analog vs. Digital
An “apple to oranges” comparison
Both types have pros and cons
Analog- less power consumption, may be better for large environments like theaters or lecture halls, “universal”
Digital- Opens up the world of modern technology to be used with hearing aids, may not require as much “extra equipment”
Listeners can successfully use both types!
Digital wireless transmission
Audio source to accessory
Analog-to-digital conversion (ADC)
Greater the information being sent, the more energy/time it takes to be sent
Must code digital signal to reduce size
Send digital signal to transmitter/receiver
Get the signal from the first device, send the signal to second device
Decode audio signal
Digital-to-analog conversion (DAC)
Hearing aid
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What Else Is There to Know about the
Evolution of Wireless Signal Transmission?
Let’s Talk about Digital Delay!
Delay of Transmission
What is an acceptable delay?
An undesirable lip-sync effect occurs at
120 ms when the visual occurs before
the audio
Sound Delayed with respect to Vision
An undesirable effect occurs at 120 ms when the visual
occurs before the audio
Delay of Transmission
How about an open ear?
So as wireless technology evolved, it became necessary to ensure that the delay was less than 40 ms.
Transmission delay of 40 ms interferes with speech
intelligibility benefit of wireless transmission for
open fittings due to echo (Whitmer et al., 2011)
NFMI
Near Field Magnetic Induction
NFMI systems contain strong transmission energy within the localized magnetic field
The power density of near-field transmissions is extremely restrictive – once you leave the transmission area, the signal strength rapidly deteriorates
The carrier frequency is generally 10-14MHz
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NFMI
NFMI is great for HA-to-device (such as remote control) or ear to ear transmission of audio signals because transmission takes place within a small area (around 1m)
Acceptable power consumption for hearing aid
Signal is strong within transmission area, is weak enough outside area to decrease chance of interference with other WL signals
BUT- long-range signals cannot be transmitted using this technique
NMFI combined with Bluetooth (RF)
Bluetooth radio frequency is used for communication between audio source (such as cell phone) and a gateway device (streamer)
NFMI transmission is used between the streamer and hearing aids
Streamer is typically worn around the neck as the hearing aids/user needs to be within the NFMI field
Near Field Magnetic Induction (NFMI)
A/D
Bluetooth
Coding
Bluetooth
Decoding
NFMI
Coding
2.4 GHz 2.4 GHz
Bluetooth radio frequency is used for communication between an
accessory and a “Gateway device” and NFMI transmission is used
from the “Gateway device” to the hearing instruments.
NFMI Combined with Bluetooth
• Considerations for this approach:
• Need to wear the gateway device around the neck
• Sound quality can be affected by orientation of the gateway device and HA
• Sound quality can also be affected by the delay of additional components
Why is it called Bluetooth?
Fun facts:
Named for the 10th century Danish King, Harald "Bluetooth" Gormsson, that united warring tribes
His initials (in runic alphabet) make the logo
His nickname is thought to have come from a darkened front tooth as a result of fight or battle
The Bluetooth technology was developed by Ericsson in 1994
What is Bluetooth?
Bluetooth is a unique wireless technology intended to realize three objectives:
Eliminate the connection of wires
Allow multiple devices to be connected at the same time, and to function as an intelligent whole
Make location centric connectivity seamless
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Proprietary Radio Frequency Systems
A/D
Proprietary
Coding
Proprietary
Decoding
2.4 GHz
900 MHz
866 MHz
2.4 GHz
900 MHz
866 MHz
Wireless Systems based on Proprietary Radio Frequency (RF)
• The proprietary RF system uses a radio to generate an electrical wave and an antenna to send the information. This type of transmission is referred to as “far-field”
• The electrical wave carries the information
• Uses ISM bands - Industrial, Scientific and Medical Frequency Band
ISM Bands
• ISM bandwidth is defined by the ITU-R (International Telecommunications Union) for radio communication.
• Higher frequency transmission allows for greater data transmission.
• A trade off exists between amount of data transferred and current consumption.
• 900 MHz (US, Greenland, & some eastern Pacific Islands)
• 868 MHz (EU)
• 2.4 GHz (Worldwide, no geographical limitations)
• Primary drawbacks are:
• Battery drain or power requirements
ISM Bands
Why Doesn’t 2.4 GHz or Proprietary RF Require
a Body-Worn Streamer?
Conventional wireless transmission hits the thermal noise floor at 1 meter.2.4 GHz transmits as far as 10 meters before it hits the thermal noise floor.
Uses frequency hopping to transmit packets of data
Can use up to 79 frequencies (1MHz intervals) in the 2.4GHz spectrum
Personal network for up to 7 devices in theory
2.4 GHz radio frequency
09/15/17
8
freq
uen
cies
headset
Wireless mouse
Mp3 player
Cell phone
HAs
HAs
headset
Mp3 player
Mp3 player
HAs
Wireless mouse
Cell phoneCell phone
Cell phone
HAs
headset
headset
Devices agree on transmission frequency to send
and receive each small data packet
time
2.4 GHz radio frequency Antenna in Hearing Instrument
HI built-in
antenna
The Reception
“Doughnut”
Flexible antennaAntenna45 mm long
Antenna in Proprietary 2.4 GHz TV / Audio Streamer
Hold it!
• So what is the difference between proprietary 2.4 GHz wireless and Bluetooth?
• They are transmitting in the same frequency band (2.4 GHz), they are both based on radio frequency
• But the protocols, or the rules guiding the data transmission, makes our RF transmission proprietary
• Bluetooth is an open platform, meaning many devices can use it
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Bluetooth Smart
• Introduced in 2011
• Contains a low energy feature that has enabled a new breed of products that can communicate wirelessly for long periods of time without requiring much power
• Products include fitness monitors and many others. They can transmit data to Bluetooth Smart Ready devices, such as PCs, tablets and smartphones.
Digital Wireless Transmission: Bluetooth Low Energy
2014
Bluetooth & Bluetooth Smart
• Latency for Bluetooth protocol exceeds 40ms and is often up to 125ms depending on the audio compression technique used
• Combinations of the streamed sound with amplified sound or direct sound of this magnitude are perceptible as echoes and even lip synch issues when watching television
• Even small delays, though not consciously perceived, will cause a mismatch between audio and visual signals has a significant negative impact on the television viewing experience (Reeves & Voelker, 1993)
• Bluetooth Smart eliminated the ‘audio’ channel to allow for fast and efficient transmission of data
Some 2.4 GHz Languages
2.4 GHz
Proprietary
Language
Apple
Audio
Streaming
Bluetooth
Smart
End User Benefits
Wireless Fitting: Benefits for Fitter and Patient
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NEW Noahlink Wireless Who can benefit?
Problems Solutions
Feedback on the phone
Family member says TV is still too loud/can’t hear TV
Can’t hear speaker in church/lecture/meetings
Can’t hear in noise (car or restaurant)
No need to hold the phone to the ear
Sound is processed through the HAs
Listen can receive the signal of interest from mouth to ear
Impact of Improving Multiple Environmental Listening
Utility (MELU) on Overall Satisfaction
(All hearing aid owners n=2,572)
918 19
27
37
5158 56
66
78 7782
89 90 89
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Number of Listening Situations Satisfied
% S
ati
sfa
cti
on
Kochkin (2005) MarkeTrak VII
Who Would Benefit from a TV Streamer Accessory?
Couples who disagree about TV volume
Any end user who struggles to understand what is being said without closed caption activated on theirtelevision
Who Would Benefit from a Phone Accessory?
Any user with a Bluetooth enabled phone who has difficulty understanding speech on the phone when using other methods (unaided, acoustic phone program or telecoil)
Any user who would like to talk on the phone hands free
Who Would Benefit from a Remote Control?
Any end user wishing to make changes to the hearing instrument settings discreetly, without having to draw attention to the hearing instruments.
Any end user with manual dexterity issues limiting their range of motion for their arms or who have difficulty finding or feeling the hearing instrument controls with their fingers.
Any end user who has selected a micro hearing instrument model for cosmetic reasons and who wants to be able to make changes to the volume and program settings in the device
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Who would benefit from a Remote Microphone Accessory?
Anyone who wants to make listening easier in noisy situations or at a distance
Anyone who has one or more situations they struggle with despite hearing aids
The 2.4GHz Wireless Revolution Made for iPhone (Mfi)
- A direct connection to everything they love
” ”
GN ReSound, all rights reserved. Apple, the Apple logo, iPhone, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries.
Apps Offer…
Convenience
Internal locus of control
More personalized settingsVolume
Bass/treble
Favorites
Geo-tagging
Favorites
Three-dot menuMap view Detail viewList view
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Lab Test Results: Directionality, FM and Remote Microphone
Comparison
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
AdaptiveDirectionality
FM system +HA mic
Remote mic+ HA mic
SNR
(d
B)
Lab Test Results: Distance
-25.0
-20.0
-15.0
-10.0
-5.0
0.0
1.5 metersdistance
3.0 metersdistance
6.0 metersdistance
Adaptive Directional SNR
Wireless Remote Mic SNR
Wireless Remote Mic + HIMic SNR
Updated Proof of Benefit Testing
• Objective:
• To validate the speech intelligibility benefit obtained with a newer wireless remote microphone, as compared to directionality alone.
• To compare speech intelligibility benefit of a newer remote microphone with a newer FM system.
Methods
• Test material
• Dantale II test material (Wagener et al, 2003)
• Test setup
• The Dantale II material was presented from a Brüel & Kjær head and torso simulator (HATS).
• The external microphones were placed on the torso of the HATS
• The speech intelligibility tests were conducted with a fixed speech level of 55 dB SPL, while the noise level was adaptively varied to find the SRT.
Updated Proof of Benefit Results
• Wireless remote
microphone
provides 15dB
more SNR benefit
than directionality.
• No significant
differences in
speech
intelligibility
between updated
remote
microphone and
updated FM
system
technologies.
Remote
MicFM
System
Directional
Mics Alone
SR
T (
dB
SN
R)
Benefit of Remote Microphone and Bimodal
Wolfe, J. Cochlear Wireless Accessories for Bimodal Users. Presentation, San Antonio, TX, 2015.
09/15/17
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GN ReSound, all rights reserved. Apple, the Apple logo, iPhone, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries.
(Jespersen & Kirkwood, 2015)
Benefit of Phone Accessory vs. MFI Streaming of FaceTimeTest Condition 1: Acoustic Phone
Unilateral Audio
Test Conditions 2-3:
Phone Accessory, Audio Only
Unilateral Streaming Bilateral Streaming
Test Conditions 4-5:
Phone Accessory, Audiovisual
Unilateral Streaming Bilateral Streaming
Test Conditions 6-7:
MFi, Audio Only
Unilateral Streaming Bilateral Streaming
Test Conditions 8-9:
MFi, Audiovisual
Unilateral Streaming Bilateral Streaming
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Test Participants
15 individuals with severe-to-profound hearing loss (10 male & 5 female)
Median age: 77 years
Median years of experience with amplification: 32
(1st quartile: 25; 3rd quartile: 39)
Test Setup
Testing was done in a sound treated room with a loudspeaker setup as shown below:
45°
315
°
225
°
135
°
Test Material and Procedure
Test material
Dantale I speech material
Procedure
9 phone conditions completed over 2 sessions (counterbalanced test order).
Each session initiated with two training rounds; one being the audio only signal and one being the audiovisual signal.
Aim to obtain a percentage correct score for each test condition.
Speech and noise presented at constant SNR level of either 10/13/16/20 dB. The SNR level at which the participant had around 60% correct with the audio only signal was chosen.
Results:
Unilateral Audio Conditions (n=15)
6%
45% 45%
0%
20%
40%
60%
80%
100%
Acoustic Phone AudioUnilateral
Phone Accessory AudioUnilateral
MFi Audio Unilateral
Mean
Perc
en
t C
orr
ect
The Phone Accessory and MFi phone handling strategies provide a
significant benefit compared to acoustic phone, even in the unilateral
condition.
Results:
Benefit of Bilateral Streaming (n=15)
55%
65%
0%
20%
40%
60%
80%
100%
Unilateral Streaming Bilateral Streaming
Mean
Perc
en
t C
orr
ect
A bilateral phone handling strategy provides an average significant benefit
of 10% for both wireless connectivity solutions (Phone Accessory & MFi)
compared to a unilateral strategy.
Results:
Benefit of Visual Information (n=15)
48%
71%
0%
20%
40%
60%
80%
100%
Audio Audiovisual
Mean
Perc
en
t C
orr
ect
A visual phone handling strategy provides an average significant benefit of 23% for
both wireless connectivity solutions (Phone Accessory and MFi) and in both the
unilateral and bilateral condition.
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Results:
Benefit of bilateral- & visual information (n=15)
6%
78% 77%
0%
20%
40%
60%
80%
100%
Acoustic Phone AudioUnilateral
Phone AccessoryAudiovisual Bilateral
MFi Audiovisual Bilateral
Mean
Perc
en
t C
orr
ect
A bilateral, audiovisual phone handling strategy provides an large significant
benefit for both wireless connectivity solutions (Phone Accessory and MFi) as
compared to the traditional phone use solution.
What It Really Means
Pilot Study: Remote Control Apps as a Way of Helping Patients
Accept Prescriptive Targets?
• Why?
“What if it’s too loud?”
“I don’t want to have to
come right back to have
the volume changed
right afterwards!”
Why Was the Study Conducted?
Purpose: Evaluate the impact of clinician-directed versus patient-directed hearing aid gain settings, via real-ear insertion gain measurements.
Group A: Traditional fitting method, where the audiologist asked “How Does It Sound?” and made adjustments to the fitting through the fitting software based on patient’s initial reactions.
Group B: Patients were fitted with hearing aids pre-programmed to target settings, and then muted and the app volume set to the lowest level. They were then asked to increase the volume on the app to a comfortable level.
Differences in Patient Engagement were intrinsic to the design of Group A vs. Group B interactions.
How Does
it Sound?
Increase the volume so
that it’s comfortable and
helps you hear well
iPhone for
patient to
adjust volume
during fitting
Group A
Group B
Research Question: How do the Fitting Methods Influence the
Hearing Aid Gain Settings?
Null Hypothesis: No Difference in Final Gain Settings between Groups
Started at experienced target
settings.
Hypothesis: Will end visit with
decreased gain settings with
respect to target gains.
Started at experienced target
settings, but muted and with app
VC at lowest point. Unmuted
hearing aids and asked to adjust
to a comfortable yet beneficial
level.
Hypothesis: Will choose to
increase gain settings to about
the same level as Group A.
09/15/17
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Participants
• 14 participants completed the pilot study.
• Ages ranged from 50-81 with and mean of 67 years.
• All were experienced with amplification (a mix of manufacturers).
Results: Group A Subjects Wanted Less Gain than Targets
Results: Group B Subjects Increased Gain to Prescribed
Target Levels
Connectivity Between Hearing Aids
Connectivity and programming
Convenience features
Synchronized volume control and push button
Automatic telephone handling
Enhanced signal processing
Using wireless capability to make a feature work better/provide better benefit, e.g., Coordinated automatic directionality, coordinated tinnitus sound generator
“Binaural” processing
Using exchange of data for streaming or enhanced signal processing to do any or all of the following:
Maximize speech audibility
Maintain listening comfort
How is Wireless Used in Our Industry?
4 Goals of Wireless Technology in Hearing Aids Today:
Re
qu
ire
s e
ar-
to-e
ar
wir
ele
ss
tra
ns
mis
sio
n
Speed of Ear-to-Ear Transmission
• How fast is it?
• Actual transmission of the signal is 108 m/sec (the speed of light)
• How long does it take for the signal to be transmitted?
• There is a delay that involves processing of the action to initiate the transmission.
• For exchanging data about the environment, this involves the time for each hearing aid to update the analysis of the environment, and then for the hearing aid to initiate the transmission. Therefore, about 1-2 seconds.
• For user actions like VC and program changes, some processing also has to occur in the hearing aid for it to initiate the transmission.
• Plus, for this VC and program changes, there is commonly an added delay of about 400 ms to avoid the beeps being on top of each other on the two ears.
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Speed of 2.4 GHz Ear-to-Ear Transmission
• How long does it actually take between the time a signal is initiated on one ear and received on the other?
• This is variable and depends on the individual and the environment.
• The device initiating the action will continue to send the data packages of info to the other ear until the other ear says it got the info.
• There is a time out on the order of up to 120 seconds.
• After this limit is reached, the HI will stop trying to send the info (until a new action is initiated).
• For user operations like VC and program change, the shortest possible time would be around 400-500ms because of the built-in delay.
• If there is no acknowledgement from the receiver ear by the end of the time-out period, the transmission is cancelled.
Why the Redundancy in 2.4 GHz Ear-to-Ear Transmission?
1. 2.4 GHz does not travel through or around objects easily.
• The antennae are designed in such a way that they point the signal to refract around a surface rather than just directing into free space.
• This means it works well for most people, less great on others.
Why the Redundancy in 2.4 GHz Ear-to-Ear Transmission?
2. Environments that provide no surfaces for reflection of the transmission can degrade performance, so there can be more variation depending on where you are.
• Easier to get reliable e2e performance in a building than in an open park!
3 Tactics to Achieve These Ear-to-Ear Goals:
Mirror operation from one side to other
Synchronized volume control
Steering of other algorithmsAutomatic directional steering
Binaural compression
Streaming of soundSound is streamed for other ear for audibility, or is used for enhanced signal processing
• CROS
• Coordinated automatic directionality
Connectivity to Professional Services
What are the Demands of Hearing Healthcare Consumers?
• Growing body of research
• Information searching on a topic of interest: Top online activity for Baby Boomer or seniors via smart phone or tablet (IPSOS and Google, 2013)
• Significant number of study participants willing to use telemedicine for audiological care (Eikelboom and Atlas, 2005)
• Reasons?
• Reduction of waiting time for appointments
• Reduced costs
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What are the Demands of Hearing Healthcare Consumers?
•Perceptions of internet-based hearing instrument acquisition
• 18 experienced HA users
• Results:
• Participants noted greater convenience for fitting and follow-up needs
• E.g., fine tuning in real-world listening environments with professional guidance
• HOWEVER…
• Patients preferred audiologist expertise to pure online solutions
• Patients expressed trust in audiologists over online retailers
Chandra N, Searchfield GD. (2016). Perceptions toward internet-based delivery of hearing aids among
older hearing-impaired adults. J Am Acad Audiol 27:441-457.
Our Patients Need and Want Us!
Humes L, Rogers S, Quigley T, Main A, Kinney D, Herring C. The effects of service delivery model and purchase price on hearing aid outcomes in older adults: a randomized double-blind placebo-controlled clinical trial. American Journal of Audiology. 2017; Accessed online on March 10, 2017 at: http://aja.pubs.asha.org/ epdf.aspx?doi=10.1044/2017_aja-16-0111.
Reprinted version in ASHA Leader
Paradigm Shifting: Patients as Consumers
• Examples:
• Ratings and surveys of medical professionals and facilities
• “How long was your wait time before seeing the doctor?”
• HealthGrades and other online ratings for providers
• Price-shopping
Paradigm Shifting: Patients as Consumers
• Examples:
• Ratings and surveys of medical professionals and facilities
• “How long was your wait time before seeing the doctor?”
• HealthGrades and other online ratings for providers
• Price-shopping
Greater Patient Engagement
How Can We as Hearing and Health Professionals Meet These Changing Needs?
• Greater patient engagement
• Better goal achievement and functional outcomes have been attributed to patients and their families becoming more actively involved in the process
Turner-Stokes L, Rose H, Ashford S, Singer S. (2015). Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation. International Journal of Therapy and Rehabilitation 22(5). Accessed online on July 6, 2016 at: http://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2015.22.5.210.
• Engaged health care recipients are proactive
• Tend to achieve better outcomes than those less engaged in their care
Hibbard JH, Greene J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2):207-214.
Financial Link to Patient Empowerment
• 33,000-patient study on patient empowerment
• Patients with lowest “activation” or engagement score on a survey had significantly higher costs
• Why?
• Increased need for multiple follow-up visits
Hibbard JH, Greene J, Overton V. (2013). Patients with lower activation associated with higher costs; delivery systems. Health Affairs 32(2):216-222.
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Professional Guidance
• Of course, not EVERY individual is the best candidate for self-engagement
• Professional responsibility to consider the individual patient when determining how best and how much to promote self-engagement
• BUT, professional support to encourage greater engagement and understanding can actually increase a patient’s activation level
(Hibbard JH, Greene J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2):207-214.)
• Since many patients are already online and making active choices about providers and services, it may make sense to promote higher levels of engagement
Audiological Touchpoints that Currently Promote Patient Engagement and Satisfaction
• Increased satisfaction and reduced return rates due to
• Verification measures
• Outcome measures (questionnaires, sound field SNR testing)
Valente M, Potts LG, Valente M. (1995). Signal testing approaches; clinical procedures to improve user satisfaction with hearing aids. In: Tobin H, ed. Practical Hearing Aid Selection and Fitting. Baltimore: Department of Veterans Affairs: Chapter 6.
• Patients’ self-perception of benefit and satisfaction
• Counseling
• General communication between patient and professional
Street RL, Makoul G, Arora NK, Epstein, RM. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling 74(3):295-301.
Strom KE. (2005). HR interviews Sergei Kochkin, PhD. Hearing Review, 12(11):24-32, 82.
Even When Programming and Fine-Tuning the Hearing Aid?
• Survey of 100 hearing aid users
• 90% said they wanted to be more actively involved in the HA fitting process!
Schweitzer C, Mortz M, Vaughan N. (1999). Perhaps not by prescription—but by perception. High Perform Hear Solutions 3:58–62.
More Personalization = More Engagement!
• Greater value shown to be perceived for products or processes in which the user had a role in creating
Norton MI, Mochon D, Ariely D. (2012). The “Ikea Effect”: When labor leads to love. Journal of Consumer Psychology 22(3): 453-60.
• In the realm of hearing aids, user-controlled apps and “favorite” settings can achieve the same effect
STRICTLY CONFIDENTIAL / FOR INTERNAL USE ONLY
Patient Hearing care
professional
Fitting
software or
web portal
User app
Cloud
Hearing care
professionals’
benefits:
• Higher user
satisfaction
• More efficient clinic
management – with
more time for
valuable counselling
• Reduced return
rates
Users’ benefits:
• More efficient fitting
process – with
intuitive, on-the-go
fine-tuning
capabilities
• Better fit and
consequently better
sound quality
Online Services
Personalization + Convenience + Professional Care
Connectivity to the Audiologist Adds Up
Better hearing
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Connectivity to the Audiologist Adds Up
Better hearing
Better hearingGreater satisfactionMore likely to purchase
Connectivity to the Audiologist Adds Up
Better hearing
Better hearingGreater satisfactionMore likely to purchase
Better hearingGreater satisfactionMore likely to purchaseBetter relationshipsGreater convenience
Game Changers in Hearing Aids
CONNECTIVITY