Interview with Brian Urban, Au.D., President, CounselEAR

Topic: If you are hand writing audiology reports, not writing reports or using Word as a report template, you need to read this!

Brian Urban, Au.D.

CAROLYN SMAKA: Today I have the pleasure of speaking with Dr. Brian Urban of CounselEAR. Brian, thanks for your time today. Tell me a little bit about yourself.

BRIAN URBAN: Thanks for having me. I'm the President of CounselEAR, and I own a private audiology practice, Advanced Hearing and Balance Center, in Evanston, Illinois. I'm also currently the treasurer of the ADA and was fortunate to participate in the Future Leaders in Audiology Conference (FLAC) hosted by AAA last fall. As far as my educational background, I have a master's degree in Audiology from the University of Minnesota, and an Au.D. from Salus University.

SMAKA: How did CounselEAR get started? How did the idea come about?



URBAN: At the time, I was working in a hospital. I came across an article by Dr. Bob Margolis on AudiologyOnline entitled In One Ear and Out the Other: What Patients Remember (Margolis, 2004). In this article, Dr. Margolis indicates that in an average informational counseling session, patients will forget 50 percent of the information we tell them as soon as they leave our office. Another 25 percent of the information will be remembered, but remembered wrong, which leaves, of course, only 25 percent that is remembered correctly. This really resonated with me and fit with my experiences with patients. So, I started looking at ways to help improve what my patients remembered and to try to increase the likelihood that they would follow through with my recommendations.

I began working with a computer programmer to develop an online system for myself and soon realized that we had something that might work for other audiologists as well. It started with the patient report, which is a single-page, customized counseling summary that the patient takes home. Since then, we've expanded significantly adding the ability to create professional reports, chart notes, fax cover sheets, cover letters, and medical clearance forms as well as the ability to fax and email reports directly from CounselEAR. We've continued to build from there. We're now compatible with NOAH, HearForm, Simply Hearing and Ear Works. We're also working with a fourth office management system to develop compatibility as well, which we hope to announce soon.



CounselEAR is HIPAA compliant, and compatible with NOAH, HearForm, Simply Hearing and Ear Works.

SMAKA: How does CounselEAR help with patients' retention of info and their follow through with recommendations?

URBAN: The CounselEAR Patient Report is designed to be a very efficient way for clinicians to create customized, single-page counseling summaries using the familiar sounds audiogram. As you know, the familiar sounds audiogram is an excellent tool to teach patients about their hearing loss. CounselEAR automatically takes the patient's thresholds, picks the closest degree, type, and configuration of hearing loss for those thresholds, and includes a layman's term description of that specific hearing loss. It also enables you to select the precise recommendations that you want the patient to remember and includes those on the report. The idea is that patients will take the summary home, perhaps look it over with their spouse and they'll have a chance to review the findings in relaxed, non-threatening environment where they will get a better understanding of what you want them to know. We're trying to help patients become better educated by eliminating the jargon and making the results and recommendations very easy to understand. This in turn, cuts down on our "tested, not sold" patients as well as those who don't return to our office, but we never find out the reason why.

Often times, patients may not understand that they indeed have a hearing loss;they could be going home with the wrong idea. Dr. Margolis' data show that only 25 percent of the information we tell patients is remembered correctly;we often do not know what information is going to be in that 25 percent. One of Dr. Margolis' recommendations to increase the likelihood of patients remembering important information was to provide them with customized information.

SMAKA: It reminds me of patients where I'd spend time counseling about their hearing loss, reviewing the audiogram, and recommending amplification, and they'd meet up with their spouse and say "She said I'm fine. Don't really need anything right now." The complete opposite of what I meant to accomplish.

URBAN: That was one of my experiences as well, and I think all audiologists have been there.

I remember one particular patient I had after I had been practicing for about ten months. I had done an audiological examination, diagnosed a mild sloping to severe high-frequency hearing loss and recommended hearing aids. I saw his name appear on my schedule a few weeks later. I thought, "This is great. He's coming back to order amplification." As it turned out, the appointment was basically an opportunity for his wife to talk to me, because he had gone home and told her that I said he had normal hearing. She was angry. She literally pointed a finger at me and shouted, "You told him he has normal hearing. He does not have normal hearing. You tell him that he does not have normal hearing!"

Thinking about that initial session, I had told him during the counseling session that he had normal hearing for low frequency tones. I told him that word recognition was essentially normal. I told him his ear canals were clear. I said audiograms were normal. I said the word normal probably seven, eight times, in describing his results. That's what he wanted to hear and it really shouldn't have been a surprise that that's what he went home and told his wife. I had spent so much time focusing on telling him all of his results that I completely ignored the core message that I wanted him to take home. Even if it was not the right time for him to pursue amplification, I at least needed him to understand that he had a hearing loss.

There are three universities right now currently looking at the CounselEAR Patient Report and its impact on making patients better educated and more likely to follow through with recommendations. We're very excited to see the data and expect it to be available in a matter of weeks. We will be giving a joint presentation with the researchers from the University of Oklahoma about the studies at the AudiologyNOW! convention in Chicago. I believe the talk is slated for Thursday, April 7th at 4:30PM.

SMAKA: That's great. I'd be interested in following up with you and hearing the outcome of those studies. Maybe I'm just not up on the research but it seems like we don't have a lot of data when it comes to counseling in our profession.

URBAN: I would agree. There's amazingly little data when it comes to counseling in Audiology. Any data we have is generally from other professions. Once these current studies are finished, we're looking to expand this and gather data on how the Patient and Professional Reports may affect different aspects of practice management including reducing the "test, not sold" rate and increasing physician referrals.

SMAKA: In terms of patient management, the recommendations may be very different from patient to patient and across practice settings. Is CounselEAR one-size-fits-all or can it be adapted by various practices?

URBAN: CounselEAR is a very flexible system designed to work across facilities and practice settings. CounselEAR can be modified to fit each clinic, so audiologists have the ability to provide specific recommendations for individual patients. For example, recommendations could be made for a particular manufacturer or style of hearing instrument, an ENT consultation with details on who to call and what to say, or tips on effective communication strategies. Or, if they prefer to have more general recommendations, they can do that as well. All of the templates and statements that are within CounselEAR can be changed easily by individual clinics, and we're happy to help clinics modify them if needed.

SMAKA: So far, it seems like we've been talking about the adult patient. What about for pediatrics?

URBAN: CounselEAR is designed to work with any patient population. So whether you see pediatrics, conduct auditory processing or tinnitus evaluations, perform vestibular testing, dispense hearing instruments, or work in other areas such as educational Audiology, you can configure the system to your needs. CounselEAR gives you the ability to store unlimited template phrases so that you can rapidly write reports for various types of patients and evaluations.

The idea is to do as little typing as possible. CounselEAR comes preset with a comprehensive list of phrases that are ready to use. When you're creating your case history, for example you no longer need to type everything out or edit a Word document. Instead, you can just click on individual statements, paragraphs, or full pages of text and create your report. All of templates can be changed, as well, to accommodate your needs.

SMAKA: It sounds like if you have a clinic where you have multiple audiologists and they have their own preferences or specialties, they can have their own templates, correct?

URBAN: That's right. You can set it up so that everyone can use their own customized templates. Clinics have a lot of flexibility to set up CounselEAR. They manage all their own users and decide on who has access to what features.

You bring up a good point about having multiple clinicians in an office, and that leads me to the subject of marketing. CounselEAR is a powerful tool for marketing a practice. When I do meet-and-greets with physicians, I'll take a sample Patient Report, which is a colorful, single-page summary and say, "Every patient you send to me is going to get a summary of their results, and it will look like this." It's important for the physicians to understand that while we are experts in amplification, our primary concern is the hearing healthcare of their patients. I try to instill confidence that we're not just about selling hearing aids. I'll then show them the Professional Report and say, "You're never going to get a handwritten report from my office. Regardless of which audiologist in my practice sees your patient, the report will always be typed, well organized, and easy to read." It speaks to the professionalism of your office, and we have had a great response from physicians. In addition, because CounselEAR helps speed up the report writing process, I assure physicians that they will receive their report in 24 - 48 hours after the patient visit. Although in most cases it is sent out before the patient even reaches their car.

SMAKA: I'm sure there is a lot of variability out there, but what are most audiologists doing today in terms of reports?

URBAN: The most consistent practices I'd say are handwritten audiograms with a handwritten note at the bottom of the audiogram page, or no report at all, just an audiogram. This latter practice is particularly alarming when you consider Medicare/Medicaid/FDA guidelines. As audiologists, we're now billing under our own NPI numbers even when we're working with a physician, and we are required to fully document each patient visit. Some will use Word document templates, and I did this for years prior to creating CounselEAR. Word doc templates can be problematic, because you're basically copying and pasting. Information from one report can inadvertently carry over to another. On a couple of occasions I had physicians tell me that I inadvertently used two different patient names throughout the Word document report. Other times I later discovered that I had not changed the birth date or had he/she errors throughout the text. The way we've designed CounselEAR is that every report is distinct for that patient, so you will never see these types of errors. Due to the fact that all the template phrases are vetted, you can create your report quickly with the confidence that you are not missing embarrassing errors. This drastically reduces your editing time and helps you get the reports out right away.

SMAKA: I've had that problem with Word templates as well, both with patient reports and in other communications. When you cut, paste, copy and delete it doesn't really lead to 100 percent accuracy, especially in a busy clinic when you're trying to get your reports done at the end of the day.

How long has CounselEAR been available?

URBAN: We started working on CounselEAR in 2005. As I mentioned we were initially focused on the patient counseling summary, because we felt that it is not only unique to Audiology, but unique to healthcare in general. Even with physicians, physical therapists or other healthcare professionals where you may get a summary of your visit, it's typically an off-the-shelf type of handout. We designed CounselEAR to be very specific for each patient, so even if they're not ready to pursue amplification right then, for example, they will be able to look at the Patient Report months or years later and know what you wanted them to remember. The goal is obviously to demonstrate a high level of care to the patient so that they are sure to return to your clinic when they are prepared to move forward with amplification. As we continued to develop other features and compatibility with NOAH and several OMSs, practices came on board with CounselEAR. Clinics, hospitals, and school districts have been using CounselEAR on a daily basis for about the last three and a half years, and we continue to enhance our features and offerings.

SMAKA: How does pricing work? What are the upfront costs to get started?



CounselEAR provides a no obligation, free 30 day trial. Visit https://www.counselear.com/AudiologyOnline for more information or to sign up.

URBAN: That's a very common question. CounselEAR is an online system, so you can access your patient data wherever you are, as long as you have Internet access. CounselEAR is based on a monthly subscription of $39.95 per clinic. There is no cost up front, and there is no contract to sign.

With CounselEAR, the first month is free so you have a chance to test out the full system without risk. If you go to www.CounselEAR.com, there is a free 30-day trial icon on our homepage. You fill out just some very basic information - no credit card information required - and you are able to use the system. It's the full working system, not a dumbed-down demo version. We typically will provide a half-hour webinar training during the testing period just to get you going, although we work very hard to make CounselEAR intuitive to use. A lot of clinicians sign on and start using it from Day 1 without ever actually accessing the training.

We're also happy to work with practices on an ongoing basis. A few things that we can help with are uploading a clinic's referral database, signatures, and logo. This allows the audiologists to just click on the physician's name, and then select whether they would like to create a fax cover sheet, cover letter and the medical clearance form without having to pull those extra sheets, fill them in and fax them. Once those are created, the reports can be faxed or e-mailed directly from CounselEAR with your signature and clinic logo included. It makes the reporting writing process much more efficient, and if your intention is to move toward a more paperless office, we are right in line with that goal.

SMAKA: You mentioned email. Are physicians accepting e-mail reports these days?

URBAN: Some are. In fact, I was just talking to a clinic yesterday that has started contacting all their referral sources to ask if they accept emailed reports. Many of them are, and so the clinic has started to simply email their Professional Reports directly from CounselEAR.

SMAKA: What about a clinic with various satellite offices and multiple audiologists? How does the pricing work?

URBAN: With CounselEAR, the pricing is based per clinic, so it's $39.95 per month per clinic. Half-time clinics are half price, and satellite clinics or one-day-a-week clinics are no charge. Our goal is to help you integrate your clinics simply, instantly.

Because CounselEAR is online, there's no setup. You can just log in wherever you are. Recently, an audiologist relayed this scenario to me. She was working on a report in the office, and received a phone call that her child was sick at school and she needed to pick him up right away. After she got home, she realized that the report she was working on in the office needed to get out that same day.

She was able to log in to CounselEAR, complete the report and then fax it straight from her laptop while sitting at her kitchen table. It ended up on the physician's fax machine as if she had done it from her office.

SMAKA: There is nothing like trying to finish a stack of charts at the end of the day.

URBAN: Because CounselEAR makes report writing more efficient, hopefully those reports are getting done the same day.

If we can cut that report writing time down to several minutes instead of 10 or 15 minutes, they are more likely to get done right after the patient leaves, rather than waiting until the end of the day or the end of the week. When they're completed closer to the actual patient visit, they're likely to be more accurate as well.

Your referral sources will also appreciate getting the report 24 to 48 hours after the patient visit instead of a week later.

SMAKA: Electronic Medical Record (EMR) systems are becoming more prevalent. Can CounselEAR be used with an EMR system?

URBAN: All the reports in CounselEAR are created as .pdf files. With an EMR system, instead of having to sign the reports, scan them as .pdf files, and then upload them to the EMR system, you can simply take the .pdf from CounselEAR and load it into that system. This streamlines the process by removing several cumbersome steps.

SMAKA: How does CounselEAR differ from other systems out there?

URBAN: There really is nothing out there like CounselEAR. There are reporting systems within a couple of the office management systems and within some of the audiometric equipment packages, but our system is very dynamic in that we offer a wide range of features within our system. Also, since we're online, the system can be accessed from anywhere at any time.

In addition, we are a company that came from audiology, so we are continually responding to what our users need. Oftentimes when people request new features or functionality, we review the request, and if we think it will work for the majority of our users, we can make it available in a matter of weeks. You log on, and the feature is available. There's no change in the price. We also continually look to work with other office management systems to reduce the time required for audiologists and for office staff to enter patient information, so that information is transferred seamlessly. Our development is an ongoing process and our users are able to reap the benefits of our continual enhancements.

SMAKA: Is CounselEAR HIPAA compliant?

URBAN: Yes. CounselEAR is fully HIPAA compliant. All of the data is encrypted from the moment it leaves your computer by the time it gets to our servers. Of course, all of our systems are backed up and have a very high-level security. The data is then encrypted when it returns back to your computer. We also provide an audit trail for all report activity and comply with the guidelines regarding official signatures on reports.

SMAKA: What kinds of comments do you hear from audiologists who start using CounselEAR?

URBAN: One of the most flattering things we've heard about CounselEAR is that it's made report writing much faster and more consistent. Audiologists have also told us that they enjoy being able to provide their patients with a unique, professional and easy to understand summary, and that patients really appreciate having their results in that format. Some clinics have told us that they use the Patient Report immediately in counseling whereas others like to send it out the day after the patient visit as a good way to keep in contact with patients who are not comfortable making a decision about hearing instruments in their first visit. Another benefit we've heard from practice owners is that CounselEAR assures them of quality counseling and consistent report writing regardless of who worked with the patient or which office they were was seen. The ability to access the system from wherever they go is also seen as a major benefit.

More and more audiologists are working with online systems, so they're getting accustomed to having access to their schedule when they're on the road. They can look on their tablet computer or smart phone to see what their schedule is for the next day. CounselEAR supports that model of increased mobility and flexibility that's important for today's professionals.

SMAKA: Thanks for giving us an overview of CounselEAR today. Looking forward to catching up with you at AudiologyNOW!

URBAN: Thanks much, Carolyn.

References

Margolis, R.H. (2004, Feb 23) In one ear and out the other - What patients remember. AudiologyOnline Article 548. Retrieved February 21, 2011 from the Articles archive on www.audiologyonline.com

Margolis, R.H (2004, January 24). Informational counseling in health professions: What do patients remember? Retrieved February 24, 2011 from www.audiologyincorporated.com

For more information about Counselear, visit www.CounselEAR.com or the CounselEAR web channel on AudiologyOnline