HEY! WAKE UP, Audiologists! The Future is Here – guest post by Jerry L. Northern

I thoroughly enjoyed the AudiologyNOW! 2013 presentation from futurist, Jack Uldrich. His presentation has given me considerable cause during the past month to think about the future of audiology in light of his intriguing comments. Many of the health specialties that surround audiologists are in the midst of exponential (and exponential is the key word here) change and progress. In contrast, audiology is stuck in our conventional tests and procedures which, frankly, have not changed much over the past two decades. We still test hearing in the same old way and we still manage persons with hearing impairments in the same old antiquated way. I’m thinking that we need to be developing and creating new ways to become more effective and efficient in the delivery of our hearing services.

I have always been an avid reader, and lately I guess I have almost inadvertently been focused on books dealing with new advanced technologies – but I had honestly not related them to the field of audiology until I heard Jack Uldrich’s speech. Following AudiologyNOW 2013, I purchased Uldrich’s  2008 book, Jump the Curve.  His themes of “…staying ahead of emerging technologies”, and “…keeping up simply isn’t good enough anymore” could certainly be the bell-ringer for audiologists. It seems to me that during the nearly 50 years of my career, audiologists have always followed the lead of technology – rather than being the leaders.  We have simply always been behind the curve – not ahead of it. In most of our specialty areas of hearing, for pediatrics and adults, our diagnostic and rehabilitative procedures have been developed or altered to implement some new technology that suddenly became available (e.g., otoacoustic emissions) – developed by some industry or commercial enterprise – and we found ways to incorporate these new schemes into our daily practice. Sure, we have seen some improvements in our clinical protocols over the years, (e.g., evidence-based practices) but nothing has really changed our approach to testing. And an embarrassingly large percentage of audiologists fail to take advantage of new technology or proven evidence-based practice to change their routine behaviors. Perhaps, the major exception to these remarks has been the exceptional development, acceptance and application of cochlear implants.

Uldrich identifies the nine technological areas that are undergoing exponential change, and offers a new and intriguing perspective on how the intersection of medicine and technology can transform the future and delivery of healthcare. It is easy to see that audiology is inherent in each of these nine areas which include:

1. computers/semiconductors;
2. data storage;
3. Internet bandwidth;
4. screening of the human genome;
5. brain scanning;
6. artificial intelligence;
7. nanotechnology;
8. robotics;
9. and advancement of knowledge itself.

As I wandered through the extensive exhibit area at AudiologyNOW 2013, I saw multiple examples of new technology being applied in various audiology-related enterprises – imploring audiologists to step up and utilize them in their daily practices. And yet, year after year has gone by without much changes in our field in spite of many opportunities. By the way, Jump the Curve is a quick and easy read with numerous fun and fascinating examples of exponential growth that you can toss out as conversation pieces during your next staff meeting, family gathering or cocktail party!

This concept of exponential growth is shocking. A common example often cited is known as Moore’s Law, named for Gordon Moore, co-founder and former CEO of Intel Corporation. In 1965, Moore accurately predicted that the number of transistors that could be placed on a computer chip would double every 18 months. By the year 2007, Intel had successfully squeezed more than 500 million (yes, that’s with an M!) transistors on a single chip! The economic impact dropped the cost of 1 megahertz of computer processing power from $7,000 in 1965 to only pennies today. And, of course, our daily lives now have been “exponentially changed” by the ubiquitous utilization of these inexpensive computer chips.

Another fascinating book is The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, by Eric Topol, M.D. I first saw Dr. Topol interviewed on 60 Minutes a few months ago and then quickly downloaded his book to my iPad. This book offers …“a new and intriguing perspective on how the intersection of medicine and technology will transform the future delivery of healthcare.” Basically, along with other technological developments based on the sequencing of the human genome, he predicts that the future of health sciences will be conducted through a mobile technology platform, remote sensing devices and social networking (ya, like processing everything through your smart phone!).

Topol points out how your cell phone, which he calls the “hub of telecommunication convergence” has become a remarkable collection of devices rolled into one simple, portable gadget that we carry at all times on our person. Although it started as a telephone, it is now our personal assistant that likely includes a camera, a video recorder, a GPS, a calculator, a music player, a voice recorder, a watch, an alarm clock and timer, a personal scheduler, a photo album, and a library of books. And, if it is connected to a wireless network, it becomes a ‘smart phone’ which can be used as a web surfer, word processor, video player, translator, dictionary, encyclopedia, and a gateway to the world’s knowledge base with some simple strokes and finger presses. With more than 800,000 apps available now, there seems to be no end to how your cell phone can influence and become an integral part of every activity in your daily life.

Topol offers a plan to use the mobile platform device as our personal and individualized health monitor and data file. He points out that all the applications are now available to put your entire medical history in your hands available to any physician or emergency room, as need be, through your cell phone. Your mobile device can perform routine measures such as blood pressure, weight, body temperature, electrocardiology measures, ultra sound and EKGs as necessary without you ever going into a medical office. By downloading your personal human genome sequencing, disease entities can be identified or predicted and treated with appropriate pharmaceuticals. Although this technology is now available, Dr. Topol points out that medicine in general, and physicians in particular, seem absolutely unable or unwilling to change.

We do have a bit of a jump in audiology because apps are available to perform hearing screening and testing, environmental sound level noise measures, and at least one hearing aid company has developed technology to program their hearing instruments via the cell phone. But, I’m thinking there must be myriads of other applications whereby the audiologist armed with a smart phone could provide hearing services? As audiologists, we should right now be asking ourselves how additional audiology services can fit into this mobile platform model? How about educational activities, rehabilitative protocols for use by patients, simulated patient responses for practice by students, etc.? A natural platform for tele-audiology, further development of smart phone apps could do much to extend our hearing services across vast distances to save time and increase our efficiency.

To amaze you with more facts, Time Magazine recently reviewed a new book by Al Gore, titled The Future. I’m probably not going to read this one, but none-the-less Gore states that “The number of mobile-only Internet users is expected to increase 56-fold over the next five years.” Gore also cites the many uses of smart phones including the interesting trivial fact that Swiss dairy farmers are now attaching wireless thermostats to the genitals of their cows so they can track hormone changes to identify the onset of breeding periods. And, the article points out that it should come of no surprise that there are now more mobile phones in the world than toilets!

My final book recommendation (and I give this one my absolute highest recommendation) for your summer reading is The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, 2011 (Amazon.com, $13.90 paperback, 9.99 Kindle version). The Emperor of All Maladies is a very readable, educational, fascinating and magnificent history about cancer and its treatments. The book begins with the earliest documented appearances of cancer thousands of years ago and continues through the twenty-first century, describing the various attitudes and attempts to cure, control, and conquer cancer right up to our newest understanding of its essence. From the audiologist’s point of view, although we don’t necessarily deal with cancer patients routinely in our work, this book will give you a new understanding of the individualization of cancer treatments, and it might provide you with some new insights to break out of the time-locked hearing service molds that currently curtail us as we seem locked-in to the management of our patients with a one-style-fits-all approach. We recognize that every hearing loss is not exactly the same regardless of similar audiograms? Does every patient with hearing loss benefit from the exactly the counseling story which results in the same hearing aid fitting?

And while we are talking about the future for audiology, let me digress and mention the amazing contributions of Richard J.H. Smith, M.D. and his prolific research team. Dr. Smith is the Founder and Director of the Molecular Otolaryngology and Renal Research Labs (MORE), and the Director of the Iowa Institute of Human Genetics at the University of Iowa. He lists more than 400 peer-reviewed publications in his vitae. I have listened to Dr. Smith’s presentations a couple of times during the past year or two, and most recently when he was featured as the 2013 Carhart Memorial Speaker at the American Auditory Society meeting in Scottsdale during March of this year. His work will have an extraordinary impact on the diagnosis, and ultimately the treatment, of patients with sensorineural hearing loss. An outrageously good speaker, his current body of research, involving the genetic testing of deafness, leaves me in awe. If you ever see his name on a program, or have the chance to hear him speak, run – do not walk – to get a good seat and be ready to be blown away as he discusses his research projects and you can decide for yourself how big an influence his works will have on your practice of audiology.

In brief, they have developed an accurate, comprehensive, and cost-effective genetic testing (OtoSCOPE) to establish “population-level frequencies of reported deafness-causing variants in 1,000 controls from six ethnic populations. These data have been used to determine the cause of deafness in 100 patients with presumed genetic hearing loss.” This approach to determining the etiologies of deafness will facilitate genetic counseling and provide valuable prognostic information for affected individuals.  Dr. Smith’s group has used these data since 2008 to formulate a bioinformatics platform known as AudioGene.  AudioGene is a software system that employs machine-learning techniques utilizing phenotypic information derived from audiograms to predict the genetic cause of hearing loss in persons with autosomal dominant non-syndromic hearing loss. These researchers have found that certain easily recognizable audiogram configurations, (termed “audioprofiles’) provide a powerful tool (accuracy is reported at 68% and no doubt will increase as more data is collected) for predicting hearing loss genotypes. Their data set, at this time, is based on 3,312 audiograms from 1,445 patients. Currently, the potential benefits of uncovering the human genome and its relation to deafness and hearing loss are focused more on identifying the causes and less on treatment, although in the future we can anticipate improved diagnostic methods, earlier detection of a predisposing genetic variation, advances in pharmacogenomics and, possible gene therapy to reverse or eliminate deafness disorders. As example, since we know that early intervention is crucial to prevent developmental delays in children with hearing loss, the ability to identify the specific etiology in young children would be beneficial in prognosis and in developing lifelong treatment plans. Now that should get the attention of every audiologist!

In summary, we continue to see new breakthroughs in technology and social media that I wish we could apply in some form or another to audiology. New innovations will soon change overall healthcare into an individualized approach – where diagnosis and treatment will be customized for each individual based on genomic information and real-time data obtained through embedded nanosensors and wireless technologies. We need to be thinking about how audiology will fit into this futuristic approach to healthcare services. Can some form of social media be used to spread the ‘good word’ about audiology that will result in better student recruitment, more patients looking for better hearing, younger hearing-aid seeking individuals, and improved referrals from our medial and allied health partners? Perhaps one of our “digital natives,” (a term used to describe “under 30 year olds” who have only known the “digital world”), might come up with a new and intriguing perspective on how the intersection of audiology and technology can transform the future and delivery of hearing healthcare. We need something significant to break us out of our complacency and antique clinical protocols; otherwise, these futuristic technologies are going proceed without us and  leave us wondering whatever happened to audiology as a profession.

Photo of Jerry Northern courtesy of EarTunes.com @
http://eartunes.com/if/audiology-inf-109.shtml

Jerry L. Northern, PhD is Professor Emeritus at the University of Colorado School of Medicine and President of the Colorado Hearing Foundation.  As a native of Denver, Colorado, he received a BA degree in Experimental Psychology from Colorado College in 1962, holds Masters degrees from Gallaudet University and the University of Denver, and earned his PhD in Audiology at the University of Colorado (Boulder). Dr. Northern is amongst the most recognized members of the Audiology profession in the world.  He is a prolific writer including his textbook Hearing in Children (5th Edition, 2003) and also served as editor for Seminars in Hearing and Audiology Today. As a Founder of the American Academy of Audiology, Dr. Northern served as the organization’s third President.