There are 36 million Americans with hearing loss. Nearly 15 percent of children ages 6 to 19 have some level of hearing problems, according to the CDC, and the elderly population’s need for audiologic services is growing. Yet the number of audiologists is predicted to decrease in the coming years, increasing the need to make audiology practices more efficient.
For the past seven years, audiologists at Boston Children’s Hospital’s Department of Otolaryngology and Communication Enhancement have recorded hearing test results using an audiogram software application called Mi-Forms. The software was developed in 2007 to help with documentation. At the time, most audiology clinics used (and most still use) pen and paper, so Mi-Forms was a big advance. It’s been used by more than 90,000 Boston Children’s patients, reducing the clinic’s administrative burden by an estimated 11 percent.
However, over time, limitations became apparent. The data generated were disconnected from the patient’s electronic medical record (EMR) and at times were difficult to access. Generally, the forms took up to 40 minutes to fill out, and a mistake required starting over from scratch. With 25,000 patients seen a year in the clinic, that can represent a great deal of lost time.
“I started at Boston Children’s in September 2014 and used Mi-Forms for one month,” says Diagnostic Audiology director Derek Stiles, PhD, CCC-A, FAAA. “That was long enough to realize they needed to be improved.”
Fortunately, Mi-Forms was about to enter the modern age. In 2012, clinicians led by Howard C. Shane, PhD, director of the Center for Communication Enhancement (CCE) and Joe Resendes, IT project manager for the department, set out to create a more comprehensive clinical audiology app that would integrate with Boston Children’s IT infrastructure.
An audiology clinic on an iPad
With support from Boston Children’s Hospital’s Technology Development Fund and a match from the Otolaryngology Foundation, Resendes and Shane engaged BWorks LLC as a development partner. By Christmas of 2013, the team had a working prototype. Their app, currently called “AudioHub”, runs on the iPad platform and covers every aspect of an in-depth audiological assessment, providing fast, portable and highly accurate documentation that eliminates lengthy data entry and saves clinicians valuable time.
Equipped with Audiohub, audiologists now have a standardized documenting system for findings that formerly were only captured as a narrative in the patient record. An example is the auditory brainstem response (ABR) test, which can detect the ability to hear in children as early as 6 months of age by measuring nerve responses to different sounds. AudioHub records and displays the child’s response to frequencies at different volumes, allowing audiologists to quickly analyze results, rather than rely on subjective narratives. The audiologist can capture a photograph of the computer’s visual wavelength and save it in the patient record for clinical interpretation and later review. “Many other audiology apps on the market only include a core of basic tests,” said Boston Children’s audiologist Tamar M. Gomes, AuD.“We expanded beyond those tests and broke into a new realm of documentation.”
AudioHub also makes improvements in patient record search, documentation and analysis of tympanometry, and documentation for hearing technology testing, including capturing diagnostic test results and images of hearing instruments. The app also includes patient history and related clinical recommendations.
AudioHub was developed using the agile software development method; numerous enhancements and adjustments based on user feedback led to 33 successive versions of the app. Gomes rigorously tested each version to ensure that the app was usable and applicable for everyday clinical use.
The AudioHub app was connected to the EMR system and provided with tools allowing it to retrieve and visually display patient data and integrate with both PowerChart and Children’s360, a data warehouse that pulls information from various hospital systems such as EPIC. Because of this integration, mistakes on a record are easily corrected, saving up to 20 to 40 minutes of documentation time. None of this would have been possible without close teamwork and cooperation with a group from Boston Children’s Information Systems Department that included Paul O’Byrne, Dan Nigrin, Scott Ogawa, Ryan Callahan, Steve Mullen and Kevin Murray.
When Stiles came on board in fall 2014, he helped launch pilot testing of AudioHub with seven Boston Children’s audiologists. AudioHub went clinic-wide in December 2014.
The power of data
AudioHub generates an electronic audiogram with a “drag and drop” feature that allows the audiologist to easily place symbols on the audiogram graph and record the patient’s hearing thresholds during testing. Collectively, audiologists can view trends over time and lay audiogram charts over the data to look for correlations. This feature has both clinical and research implications.
Data from AudioHub’s 537 data fields are stored in Children’s360. Since the launch, the audiology group has already collected 2,000 records and anticipates collecting 25,000 records per year. Clinicians are highly satisfied: they can now track changes in a child’s hearing, study the efficacy of new therapies and document changes in hearing thresholds as kids take cancer drugs that affect hearing, so their oncologists can adjust medicine dosages.
In the future, the development team hopes to spread this timesaving app to medical centers and private practices around the globe, and is seeking a licensing or development partner (email Alan Yen).
“AudioHub is an app that could be used in a wide variety of settings,” says Gomes. “It was built with the intent of use in other clinics, and the platform is flexible and can be customized to each clinic’s needs.”
David Altman is manager of marketing and communications in Boston Children’s Hospital’s Technology and Innovation Development Office.