Interview with Jan Gilden, Director, Houston Ear Research Foundation

Paul Dybala: Hello everyone. This is Dr. Paul Dybala with Audiology Online, and today I am talking to the Director of the Houston Ear Research Foundation, Jan Gilden. Jan's visiting with me this morning to talk about the Sound Partnership's Hear Always Program through Cochlear Americas (www.cochlear.com). It is a very interesting concept that I know a lot of you are going to want to read about because it is pretty innovative. But before I jump into that, Jan, I want to give you a chance to introduce yourself and tell a little about what you do and maybe even something about the Houston Ear Research Foundation.

Jan Gilden: Oh I would love that. I have been associated with Houston Ear Research Foundation for over 21 years. I started here as a part-time clinical audiologist doing cochlear implant evaluations, programming, and counseling. About 13 years ago, I became the Director, and I am passionate about the work that I do.

The Houston Ear
Research Foundation

The Houston Ear Research Foundation

The Houston Ear Research Foundation was founded back in 1983 as a non-profit organization to assist patients and their families who were interested in cochlear implants. We performed all stages of the cochlear implant process, and still do! We begin with the evaluation, which includes families and the recipients themselves. We do the programming of the cochlear implant device, the troubleshooting, maintenance follow-up testing, therapy for both children and adults, and we just keep getting busier every year.

Dybala: It sounds like a pretty extensive program, children to adults. About how many cochlear implant patients do you see each year?

Gilden: We have approximately 60-70 new surgeries every year, plus we work with patients who have been previously implanted through our center or other centers. Anybody who works in the field of cochlear implants knows that basically when you implant someone, you're their friend for life. They continue to return for services for years to come. Over the years that we have been in existence, we have implanted close to 1,000 individuals, both children and adults, and it is split pretty evenly between the two groups. We do continue to follow a large percentage of those individuals.

Dybala: Well this leads right into Cochlear's Sound Partnership program (www.soundpartnership.com). Can you give us a quick overview and then progress into the Hear Always component of the partnership?

Cochlear America's Sound Partnership Program

Gilden: Sure! The Cochlear Sound Partnership program is really a comprehensive suite of initiatives to assist clinics in becoming more efficient through the entire continuum of care. The four main components of the program include reimbursement services, business solutions, Hear Always and educational outreach.

Dybala: A pretty broad group of initiatives! Give us an overview of why the Hear Always component is important to you when working with cochlear implant patients.

Gilden: When working with cochlear implant patients, especially with children, there is a large amount of interaction with not just the patient, but the entire family. This not only involves the programming the device and maintaining the equipment, but many times you receive phone calls from the patient or parents for troubleshooting. "How do I do this? I forgot. I know you told me how to change my volume, but remind me again."

There is a lot of non-contact time involved. All of us in the field of Audiology know how important reimbursement schedules have become, and I think it has become especially critical for cochlear implant programs. All of this non-contact time is critical to the success of the cochlear implant recipients, because you need a device that is up and working, and in order to do that you have to spend quite a bit of non-billable time. That's where the Hear Always program has entered the field.

About a year-and-a-half, almost two years ago, Cochlear Americas gathered a group of individuals who were involved with cochlear implants and basically asked, "What can we do to help?" and unanimously all of us said, "We need some help with the non-contact time we are spending on our patients."

The Hear Always program stepped in and said, "Okay, we can field some of those phone calls for troubleshooting." Now it does not have to be the audiologist at the center who is helping the patient who forgot how to change the batteries or maybe has a cracked case or a cable that needs replacing and wants assistance with it.

With Hear Always, we can direct our patients directly to Cochlear who has a staff of specially trained individuals to work in this area. They can walk patients through a troubleshooting guide to help them determine if their sound processor is not functioning correctly and identify where the problem lies. If they find an equipment or hardware problem, they can assist the patient in getting replacement parts either under warranty or purchased directly through the company, rather than having to go through the cochlear implant centers. So it frees us up more time for us to spend on direct patient contact for programming issues versus hardware issues. This process also reduces the time the recipients are off-the-air.

Dybala: Can you give us some additional specifics on how this changed your workflow?

Gilden: Because we are dealing with mechanical equipment and hardware parts do break, sometimes you do need to have replacement equipment. The cochlear implant processors are downloaded with unique programs or MAPs for the individual patient. So in the past if we replaced the processor, the new processor would have to come to our center where we would connect it to the computer, download that individual's MAP and then either have that individual come in to pick it up and leave the broken part to be returned to the company, or we would have to send it to the patient.

With Hear Always, we "bypassed the middleman", so replacement equipment can go directly to the patient. We are able to send the patients' programs to Cochlear via e-mail so that they have the ability to download those unique programs back into the sound processor and send it ready for the recipient directly back into their hands.

Not only is this helpful to the clinics because now we don't have to go through the process of unpacking the boxes, hooking up the device, downloading it, and repacking it for the patient, it has also been very beneficial to our patients because they tend to get replacement equipment faster because it is sent directly to them.

Dybala: That makes sense. If patients have to drop something off through you, it creates an extra step, probably adding a day or more each way. I can see a huge benefit to the patient by introducing this. That's great.

Gilden: Absolutely. It has been wonderful. The Houston Ear Research Foundation has always been very service oriented. I have to confess this was a little bit uncomfortable for all of us initially because we were letting go of a key component of taking care of our cochlear implant patients. What we have done, and continue to do, is tell our patients, "We are always here for you. We want you to utilize this partnership program because it's going to help you get service faster. And if you have a problem, if this doesn't work, call us back." We have been very pleased with the response from our patients. They have called, not because they are not getting the service, but to tell us how thankful they are for it and how wonderful it has been.

Dybala: Each time a patient of yours calls into the Hear Always system, are you notified?

Gilden: Absolutely, but each center can handle it differently with Cochlear. Because we work so closely with our patients, if we have a patient contacting Cochlear directly every week we want to know. We want to know if there is another problem besides hardware. Maybe they need to come back in and be reprogrammed. Hear Always through the Cochlear Americas Sound Partnership program has in every sense of the word been a partnership because we have been kept in the loop.

When replacement equipment is sent to the patient, the audiologist who works with that patient gets an e-mail letting them know what was replaced. They also receive new serial number information, if that's applicable, or a notification if they feel like perhaps the individual patient needs to contact the center to be seen. We are notified of all these things so that we can follow what equipment is being replaced and what steps have been taken directly between Cochlear and the patient.

Dybala: Do you use the Hear Always program with all of your cochlear implant patients?

Gilden: The wonderful thing about Hear Always is that you don't have to use it for every single patient. We are encouraging the vast majority of our patients to use it because we do feel it benefits not only them, but us also because it frees up time in the office so we can actually spend quality time when patients do come in.

Dybala: Right.

Gilden: On the other hand, if we have a patient who we think would have difficulty transitioning to the Hear Always program and if we think they are going to be uncomfortable, we don't have to send them on. That's the beauty of it. We can tailor it for that individual patient based on we think their needs may be, and that's been wonderful.

Dybala: Sure. This is a really interesting and innovative program. I am glad we have had the chance to talk about it today as I know many clinicians might feel uneasy about turning patients over like that. This was my first reaction, too, when I read about the Hear Always program, thinking back to my days in the clinic. Those were my patients.

Gilden: [laughter] Right! It is a tool. As with any tool, you use it when you need it. You use it when it helps. If it doesn't work for you in a particular instance you don't have to take advantage of it. Sorry, but I had to laugh a little bit when you mentioned that. The people who were involved in the initial stages of this know that I was the one sitting in the room saying exactly what you said. "Those are my patients. How can I let you take care of them?" And what has happened? It has been better service for our patients. I think overall it has been overwhelmingly accepted and very much appreciated.

Dybala: That's great. Well Jan, thanks again. I know you have a busy clinic schedule today so I appreciate you coming and talking with me today. If anyone is interested in more information on this, you can visit the Cochlear Web Channel on audiologyonline.com, and also as we mentioned before you can go to mycochlear.com or (www.soundpartnership.com) to register and find out more information.

Jan, thanks, and I wish you continued success in your work in Houston.

Gilden: Thank you very much, Paul. I enjoyed talking with you today and appreciate the opportunity.

About Cochlear™ Americas

Since launching the world's first cochlear implant system more than 20 years ago, Cochlear Limited and its US headquarters, Cochlear Americas, have brought the miracle of sound to more than 75,000 hearing-impaired individuals across the globe. Cochlear's state-of-the-art technologies, based on extensive research and development at preeminent academic institutions, restore the ability to hear sound and understand speech—enhancing both learning capabilities and quality of life for those with severe to profound hearing loss. Cochlear has remained the market leader in its field thanks to an unwavering commitment to innovation, reliability and customer support. Numerous awards, as well as published scientific data, attest to Cochlear's outstanding product line and unsurpassed performance. Cochlear's promise "Hear now. And always" reflects its dedication to durability and service.

Call the Cochlear Nucleus Hotline at 800/458-4999 (Voice) or 800/483-3123 (TTY) or visit www.cochlear.com for more information or the Cochlear Americas Web Channel on Audiology Online at www.audiologyonline.com/channels/cochlear_americas.asp

About Houston Ear Research Foundation

Houston Ear Research Foundation was incorporated in August, 1983 as a center to provide excellence in service dedicated to the cochlear implant. Sometimes referred to as an "electronic ear", a cochlear implant enables a deaf or severely-to- profoundly hearing impaired individual to hear sound. The cochlear implant is a surgical procedure to help those hearing impaired individuals who are not able to benefit from hearing aids, due to the severity of their hearing losses. It helps to restore some auditory sensation. This stimulation provides a wide range of benefit and auditory information necessary for recognizing and understanding environmental and speech sounds. Performance with the cochlear implant varies among individuals, but benefits include increased awareness of environmental sounds, improved speech recognition and production (to varying degrees), and enhanced lip reading abilities, which improve communication skills. The level of benefit with the cochlear implant is most successful with consistent auditory stimulation and input.