An End To End System For Remote Hearing Care
Signia just announced the introduction of a completely new end to end remote care system that includes everything from a hearing assessment, through hearing aid choice to aftercare, all virtually. They said"As social distancing and self-quarantines have become the norm in the face of COVID-19, individuals with hearing loss may find it difficult to get the help they need. Responding to this reality, hearing aid innovation leader Signia announces the introduction of Remote Care, a new program enabling hearing care professionals (HCPs) to prescribe, fit and fine-tune hearing aids remotely." Let's take a look at the system, what it can do for you right now, and maybe what it means for the future
How Does it Work?
If you have a recent hearing test, it can be used as the start point for a virtual hearing aid evaluation. Interestingly, if you don't, you can undertake an online hearing assessment that can be used as a start point, I will discuss more on this later. When you attend your online hearing aid evaluation, the professional will discuss your needs and the hearing aids that are right for you. You decide on the hearing aids, the professional orders them with the relevant information.
The hearing aids can then be delivered straight to you or alternatively to your professional who can give them to you at a curbside appointment. The professional can organise a virtual follow up meeting to customise the programming to your loss. Your ongoing care can be undertaken in this manner as well. It means that you may rarely have to visit the clinic.
A New Assistant
Signia has also introduced a new powerful virtual assistant to its app which will help to deliver changes to the way your hearing aids work on the go. This is pretty big news, even though it might not sound it. The system is similar to the SoundSense system from Widex which is a machine learning system that allows you to make in-depth changes to how your hearing aids work in a very simple manner. While the Widex system works a little differently, this system from Signia should deliver similar benefits.
This type of machine learning technology is a true game-changer for hearing aids. I know you probably hear that a lot if you look at hearing aid brand websites, but this system has far-reaching benefits for hearing aid users. Signia say "Based on highly advanced machine learning algorithms, the Assistant gains more knowledge and further improves its support every time it is used by hearing aid wearers around the world. It also learns the preferences of each individual wearer to create the optimal tailored solution for every person."
Like the Widex system, the hearing aids will just get better as you wear and interact with them. These systems will lead to fewer fine-tuning appointments moving forward. The professional is able to see all the adjustments that the Signia Assistant has made since your last session. Signia says that soon the system will be upgraded to include details about each specific interaction: the situation you were in at a particular date and time, the issue that required assistance, and the solution implemented by the Assistant. That's a lot of information for them to base any further decisions about fine-tuning.
That's The Good, What's The Bad News?
While this technology should be celebrated and it is ideal for use during the current crisis. It does lack certain elements of best practice hearing care. For starters, the online hearing assessment is not anyway near a full hearing test. The problems for me are in the testing, the fitting and the follow-up stage. I am going to outline what I see as an issue and also play devil's advocate with why it may not be the huge issue I am worried about. We got to be fair right? Anyway, the first thing is the test, these are the issues I see:
- No one looks in your ear
- We only have vague air-conduction results which mean we don't know you have a conductive element to your loss
- There is no speech testing that we can use for the best recommendation of devices
While we can get a better reading on your hearing thresholds with in-situ audiometry through the hearing aids when they are in your ears, we still don't know if your ear canals are blocked, and we still don't know if you have a conductive element to your hearing loss. While the delivery system is an excellent tool if you have had a recent hearing test and you have the full results, if you haven't, it's not ideal.
The counter-argument is that if you are an existing user and want an upgrade, well then a comparative study of your in-situ results and an old audiogram would help us understand how things stand, what changes may have occurred and whether it points towards an ear canal blockage. In all, as I said, a good solution for the current situation, but it could be better.
What about fitting? My main issue is that I can't perform Real Ear Measurements (REMs) on the hearing aids in your ears. That is a big issue for me, I believe that Real Ear Measurements are the single best process to ensure that hearing aid users are satisfied with their hearing aids. I don't just do them at the fitting either, I undertake REMs every time I make changes to a Patient's hearing aids and I do them at least once a year to ensure that the aids are still functioning in the ear correctly.
I think there may be some weight in the counter-argument that the new machine learning system on the app could act to ensure that the hearing aids were functioning in your ear in the manner that they should. In fact, I would say over time that it would certainly move toward that. How are we to know for sure though? How are you to know for sure?
Those are my underlying issues with this provision model, while it scratches many itches, it just doesn't scratch them all. Right now, a face to face appointment for an in-depth hearing test including speech and speech in noise, and a fitting that involves REMs is the gold standard. That could change though, and I think it could change based on what you the consumer wants. Let's talk about a new model.
A New Model
This technology represents a completely new model for the provision of hearing aids. While at the minute, every hearing aid brand is delivering some sort of end to end solution tied to the traditional channel (professionals). This type of system could easily be used in a direct to consumer model by any of the hearing aid brands. As I said this model isn't ideal, not even close, however, changing technology could meet the problems I have raised. Who is to say that some smart company won't introduce some sort of reliable, validated remote test protocol that provides the results that we get from an in-depth hearing test?
Who is to say that the hearing aid brands can't introduce a tech feature which allows them to undertake some sort of REM with through the hearing aids? Who is to say that the artificial intelligence used in the accompanying apps won't advance so much that programming and fine-tuning hearing aids won't be a thing of the past? I know that many people within my profession would be aghast at those thoughts, and would see it as a failure on the hearing aid brands part to support them.
I wouldn't, I would see it as a failure on my part to make myself relevant to you in your journey to hear better. I think for you to want me to be a part of your journey, you need to believe I am relevant to the best outcomes for you. That means I need to work and act in such a way that you do.
The Consumer's Choice
The future will be decided by the consumer, that's you. I can make a case for why I can be a helpful companion along the journey. However, in the final analysis, it is you who will decide whether I am or not. I have spoken quite clearly before about my attitude to online sales of traditional hearing aids. Back then I said that I couldn't feel comfortable selling traditional manufacturer's hearing aids online because they weren't designed with that in mind. That is changing rapidly, I have laid out why I don't think we are there yet, however, I believe that technology can overtake my objections.
I would certainly consider selling hearing aids in this manner, however, I would want to see you physically at some stage. Above all, I am committed to doing the best thing for you and your ability to hear. If you feel that knowing all of the information, that a different provision model, a direct to consumer model is for you, I won't fall out with you. I believe that consumer choice, once it is an educated choice, needs to be respected. As I said, it's my job to make myself relevant to you, no one else's. If in the future you don't feel I am relevant, well then I have failed badly.
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