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NCHAM: National Center for Hearing Assessment and Management, Utah State University

Last Modified: 03/04/2014

VI. Tele-audiology Technology and HIPAA Compliance

A mother holds her infant during tele-audiology testing with assistants in the room watching the computer

Today, the Internet is more accessible than ever before, and Internet service providers (ISPs) continue to develop faster and more reliable services at lower costs as time goes by. This section provides information about technologies used by learning community members as well as general considerations.

HIPAA-Compliant Strategies for Tele-Audiology

One constant in the ever-changing arena of technology is the requirement to adhere to privacy and security requirements under the Health Insurance Portability and Protection Act (HIPAA). An overview of HIPAA requirements that pertain to telehealth is provided in this section of the Tele-intervention Resource Guide, also on the NCHAM website. Those interested in implementing tele-audiology are strongly encouraged to review this chapter.

Audiological Equipment

Vivosonic equipment with the program displayed on the computer OAE Screener inside traveling case ABR attached to infant

The use of standard equipment for diagnostic assessment is recommended to support ease of training and familiar operations at both the specialist site and the patient site. Any audiology equipment that is PC based can be utilized. The audiology equipment is placed at the patient site with a personal computer that contains the software necessary for the various tests/procedures - ABR, ASSR, OAE, Immittance and video otoscopy. This equipment is likely no different than that which would be found during a traditional face to face evaluation. At the specialist site there is a second personal computer with desktop sharing software. With this software the audiologist will connect to the computer at the patient site, access the software for each test/procedure as needed, and personally perform the evaluation in real time. Audiologic data will be stored in the computer at the patient site while reports/tracings can be printed at the specialist site, if desired. Current desktop sharing or application sharing software packages, such as PC Anywhere, Real VNC, Microsoft Shared View, Remote Desktop and others are widely used.

Telemedicine Equipment and Connectivity Methods

Monitor showing Tele-Audiology patient room Audiologist in Tele-Audiology session

Each site requires teleconferencing capability in order for those at one site to see and hear those at the second site. This teleconferencing equipment could include a personal computer with software based videoconferencing, a web camera that can be focused on any member of the group depending on the activity and a microphone. Another option is a turn key unit. This unit will include a dedicated video codec (compressor/decompressor), pan-tilt-zoom capable camera, and video display integrated as one unit. With this option the teleconference call is placed directly with the unit. A turn key unit could accept peripheral equipment, such as a camcorder or video otoscope, as needed.

Intranets:

While the internet is available to the public and allows individuals or organizations to view a multitude of webpages, intranets are setup as an internal network of webpages for designated individuals of an organization. In general intanets are protected by firewalls or other security systems that protect from unauthorized access. Intranets could be used in health care settings that have multiple satellite sites that are part of the same health care system.

“Intranet is a type of network” (DifferenceBetween.net)

Use a Virtual private network (VPN):

VPN’s is a secure ways to allow individuals remote access to a private network or Intranet. The data will be encrypted while it is being uploaded, viewed, downloaded to the computer accessing the information. VPN’s are typically available via universities, health care centers, and businesses.

“VPN is a method of connecting distant computers” (DifferenceBetween.net)

Secure VoIP programs:

“VOIP for Telerehabilitation: A Risk Analysis for Privacy, Security, and HIPAA Compliance” Part 1 [PDF] and Part 2 [PDF] by Watzlaf et al provide criteria for selecting a secure Voice over Internet Program (VoIP). Software must have standards to support compliance with The Health Insurance Portability and Accountability Act (HIPAA). Some programs that are considered to have stronger security than systems such as Skype, and that have other useful features to facilitate live telehealth interactions:

  • VSee: Provides a good summary of HIPAA and how it pertains to telehealth.
  • Vidyo: Transmits secure video and audio; HTTPS with certification login for security. Encrypted technology
  • VISYTER (Versatile and Integrated System for Telehebilitation): software platform that supports high quality TR video-conferencing. Users must login to a private server and enter a room that is restricted to the users with privilege for that room. All traffic data are encrypted; no public ID or personal information is accessible.

Recommended Upload and Download Speeds

A hard-wired internet connection with an upload and download speed of at least 12 megabits per second (Mbs) actual download speed and 5 Mbs actual upload speed is recommended. Additionally, a VoIP) software program is requires on both computers.

Learning community examples:

  • Iowa: Used CrossLoop application for desktop sharing; Polycom for audio and video communication]
  • Canada: Used an established telemedicine network. Use RealVNC as an application sharing software to control ABR equipment; video conference software is propriety to the Ontario Telemedicine Network, and they’re using Tandberg video equipment.
  • Colorado: Used Netop remote control software on a standard desktop PC to take control of ABR equipment. Using Nefsis security videoconferencing software.
  • Wisconsin: Used Broadband 10 meg, OC3, OC10 proprietary fiber network, running at 100 megs, for intranet and internet connectivity between patient and audiologist sites. Audiologist accesses the patient site computer via a pc connectivity software called VNC. Polycom software used for communication. They use Polycom 70000s video codec, HDTV, microphone; Logitech 9000s video camera.
  • California: Used a dedicated T1 connection that exists as part of their telehealth program; it also can work over a public broadband connection once a secure, encrypted connection is created. Use PC Anywhere software to control the equipment from UC Davis. Use Polycom/Tandberg high definition video conferencing system and desktop PC’s.