This week on the Future Ear Radio podcast, I’m joined by Dr. Elaine Saunders and Kat Penno to discuss the past, present and future of telehealth and remote audiology. Elaine co-founded Blamey Saunders in 2011 and was one of the foremost trailblazers of telehealth solutions in the Audiology space. Kat now works at the Director of Hearing Health at Nuheara, and is deeply passionate about remote-based Audiology (which is what she studied in University).
So, the three of us sat down to really talk through the past decade of telehealth innovation and adoption, starting with Blamey Saunders and ending with where we see things moving into the future. Elaine shared her big takeaways as a telehealth entrepreneur and how she believes telehealth can be successfully implemented into the Audiology clinic of today and the future.
As Elaine tells it though, in order for practices to be successful with implementing telehealth services, they have to recognize that the way in which that care is facilitated varies considerably to in-person patient visits. She believes that telehealth and customer support are intimately linked, as well as suggesting that remote interactions do not necessarily need to be limited to being offered by the Audiologist.
Ultimately, my belief is that the idea of hearing health clinics incorporating remote patient interactions into their practice is only going to become more viable, logistically and financially, as times goes. It’s fascinating to hear Elaine’s story of how Blamey Saunders was able to not only able to make telehealth work in an era where the infrastructure facilitating telehealth was incredibly raw (relatively speaking), but be so successful that the company was eventually acquired by Sonova in 2019 (pretty fortuitous to acquire a telehealth company less than a year prior to a pandemic, eh?).
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
Hi, I’m your host Dave Kemp, and this is Future Ear Radio. Each episode we’re breaking down one new thing, one cool new finding that’s happening in the world of hearables, the world of voice technology. How are these worlds starting to intersect? How are these worlds starting to collide? What cool things are going to come from this intersection of technology? Without further ado, let’s get on with the show.
Dave Kemp:
Okay, so we are joined here today by two awesome guests. I’m so excited for this conversation. Kat Penno and Elaine Saunders. So before we jump into the conversation, why don’t we go one by one, tell the audience a little bit about who you are and what you do. We’ll start with you, Kat.
Kat Penno:
Hi, thanks for having me back on, Dave. I’m a big fan of your podcast, as you know, and I always love to come on and have a discussion with any parties that would like to join us. And today I feel really privileged to be here with Elaine Saunders. So I’m Kat Penno. I was previously the founder and owner of Hearing Collective, and now I have joined forces and am working with Nuheara. I am their Director of Hearing Health.
Dave Kemp:
Fantastic. And Elaine, welcome to the podcast. Tell everybody a little bit about who you are for those that aren’t familiar with the infamous Elaine Saunders.
Elaine Saunders:
Thank you so much. It’s really a pleasure to be here with you both. I’ve been really looking forward to it. So yeah, my name is Elaine Saunders. I’ve been in hearing literally since I was 16, when I was the most junior, junior assistant in a residential school for deaf children, which was one of those schools back in, this sounds like the 1800s. I’m not that old, but they were not allowed to sign. The hearing aids didn’t work very well. They had no communication. So I’ve been in hearing, and influenced by the need to really help people hear for a long time.
Elaine Saunders:
Most recently, I founded, or co-founded, Blamey Saunders, with my partner Peter Blamey. That was against a background of both of us having been in different aspects of the hearing industry. And I guess I should say I’m an audiologist, but I’m also a scientist and a biomedical engineer, and I’ve worked in academia. I’ve worked in most areas of clinical audiology, and all those things came together. There’s a backstory to Blamey Saunders, which I’ll tell in a bit when we get to that. So my background really is very much that of bringing multidisciplines, including business, into hearing health.
Dave Kemp:
That’s fantastic. So when I was thinking about what we were going to talk about today, I was listening back to the conversation that Kat and I had last time on the podcast. I think it was June of 2020, or even maybe June of this year, but we talked a lot about, it was mid-pandemic, and it became very apparent that tele-health was very, very needed. And we started to talk about Blamey and Saunders, and how pioneering your work was. You really were on the forefront. You were doing it before, I think, a lot of the technology had even matured in order for it to be facilitated in such a way, yet you still made it work.
Dave Kemp:
And so I thought I’d like to kick this conversation off after the introductions to kind of walk through how did that come to be. What was the big motivation behind it? And then what was that like in that period of time where the technology was a little bit raw, and then as it advanced to the point to where Sonova bought it, and then even how you see the world today with all these new tools in light of the pandemic as well? I’m curious to just get your thoughts from the start of it all into how you see everything today.
Elaine Saunders:
Well, at the start, Blamey Saunders was really actually another company that you may not have heard of called Dynamic Hearing, where I led a team of signal processing and software engineers to develop signal processing for hearing aids. And at the heart of that was a digital amplifier that my business partner had invented that was a strong alternative to compression. It focused really on keeping the audible zone, if you like, with hearing aids in the sweet spot of hearing, would be the best way to describe that. So that was one of the tools we had in the signal processing company where we worked with pretty much every hearing aid company from top tier to, let’s say the third tier, sort of mom and pop shops, around the world. And I have to say, you learn an immense amount loitering around the head offices of hearing aid companies around the world.
Elaine Saunders:
But one of the things we felt was that the customers, for most of these companies, was actually the audiologist or hearing aid dispenser. It wasn’t really the end user. So we thought that what we’d really like to do… This was a venture capital owned company. We didn’t own it. It belonged to the venture capital and the university. But what we thought we’d really like to do was try and remove the barriers to people getting hearing aids. And at the back end of that, we knew we could build the technologies to make it easy where your end user consumer has no expectation about particular software or anything like that, they just want it to sound good and be easy.
Elaine Saunders:
So we set out literally to remove the barriers to getting hearing aids, and they were effectively distance, or even just not being able to get out of your house for some reason. We didn’t anticipate COVID, but there are people with disabilities who can’t get out, dexterity issues, and the appearance. We didn’t hit them all at once. It took us several years before we got through the whole list. We set out with the distance and cost, I should say. So we set out trying to remove all those barriers. And so that was the story, but we had this knowledge behind us of really hard-to-build hearing aids, particularly the signal processing end, which was very, very, very helpful. It was a strong technology business, or still is, at the backend, but nobody needed to know that.
Kat Penno:
Elaine, it just blows my mind that you and Peter were so ahead of your time in regards to the business model side. I think it was inevitable that the technology was always going to catch up. And I think even now, I don’t know if you both would agree with this, but technology’s getting to the point where a lot of hearing technology will be able to be self-fit to a certain extent, not verified, but perhaps validated from a psychological ownership point of view with individuals. And I just think that the behavioral economics behind all the psychology still stands. So what I’m saying is you hit on points such as distance, so you’re selling convenience, not just to those in regional or remote areas, but in metro areas as well, and I’d be interested to know if you know what percentage of your clients came from a metropolitan post code, so big city versus out bush.
Kat Penno:
So you’re hitting on convenience, price, stigma. So barriers to access, convenience really, cost and stigma. I still think those factors will still stand. They still stand now, even though we’ve got an evolution of our services and our technology. So I guess my question really, in a roundabout way, is how were you so forward thinking then, and do you think much has really changed, now even with the pandemic having occurred?
Elaine Saunders:
I have to say, I think we’ve gone backwards a bit despite the pandemic.
Kat Penno:
Wow, okay.
Elaine Saunders:
[inaudible 00:08:37] the technologies in the hearing aids. I’ll be quite honest, I am disappointed that hearing aids have gone back to using audio compression. I can’t think that in, let’s say, in the music industry anyone would tolerate having audio compression and it’s difficult to fit. I loved [inaudible 00:08:59] book on the history of compression. It gives a really, I think, good story of how we are where we are with fitting predictions and so on. I also think if you go to verification, we have the speech perception test online. We strongly encourage people to do the test before and after getting hearing aids. And we looked at their results, and if they weren’t getting benefit, we were right onto it. So I think we really wanted them to do that to make sure that they were getting benefit. That to me is much more meaningful than looking at validation of a really a measurement or something like that, although you could do it if you wanted.
Elaine Saunders:
We also wanted to offer people choice, and this goes back to when you said we were far ahead. In 2011, when we actually launched, if you asked anyone, “How do you get a hearing aid?” They would say, “Well, I have to go to the doctor or the audiologist.” And so you’re kind of having to explain your business model. So that is something that perhaps would be different now, and that was a challenge in that we had to get to people direct and say, “No, actually, you don’t have to go to your doctor. You can do it all online. You can do the test online. We will support you online. But if you want to, you can come into the clinic.” So we gave them that choice. And in the clinic, I felt we had to have absolutely excellent audiologists who would really look at why people were not hearing well, and what their options were.
Elaine Saunders:
But if they did end up buying hearing aids, which most people did because actually, as you know, most people who have hearing difficulties actually need hearing aids. We tried to encourage them to go online so they wouldn’t have the inconvenience of having to come in and out for things. In the end of the day though, since it was self-programming, most people found that pretty easy, and were pretty self-sufficient.
Kat Penno:
Which I suppose leads me to my next question then, where do you see, in all honesty, let’s imagine that the big five didn’t exist, how would our profession actually look?
Elaine Saunders:
I think that’s a really good question because I think audiologists really need to decide professionally themselves what they want to be and do. And I know some who would embrace having people come into their clinic and do really good diagnostic audiology. I don’t just mean knock out an audiogram and perhaps do a Tymp. I mean doing good diagnostic audiology, which helps determine how they’re going to do with a hearing aid. And I’ll give an example of that, which is that people tweak hearing aids, which really thinking about the difference between hyperkeratosis and recruitment. We’re getting a bit tech out here, and all the logical techo. But I think that if audiologists want to really have a strong role and add value, they need to understand what value they bring. And a lot of that is in the knowledge base.
Elaine Saunders:
It’s about saying, well, we can help you understand why you have hearing problems. We can help you get on top of things. If it’s just to tweak software, then I don’t think that’s a future role for audiologists. If it’s just to be in a retail setting, that’s fine. It’s an individual choice, but it wouldn’t suit me.
Dave Kemp:
Yeah, that’s been a theme throughout the podcast, is this idea that if it’s really just tied to the widget, there’s not a bright future in that. I think that the value is in the provision of your expertise, and it’s finding ways to make that value more extensible. And that’s why I’ve always gravitated toward tele-health. I think it’s so interesting, is it seems to be a great way to take your value, yourself, and make it more extensible.
Elaine Saunders:
I think that’s absolutely right, and it’s a different skillset I did in my spare time, so to speak. We actually built a training course around teleology and telehealth, and I went about it very differently to a traditional audiology course. To me, it was all about good communication and understanding someone’s environment in the home. So we talked a lot more about auditory phenomena, if you like, than we did about anatomy and physiology.
Kat Penno:
And I think that’s what I love about the way you think, Elaine, is that you do think outside, like what I call the standard audiology courses or boxes. And so I remember when I saw your course in 2019, I was in Alice Springs, and Sophie Bryce was there, and I’m thinking, oh, this is really interesting that this tele-health course or tele-consulting course actually falls under, I think it was the digital health or innovation unit or department at Swinburne University, correct me if I’ve got the university wrong. And what I liked was that you took a very holistic approach that could be applied to many professions. And so I think what aggravates me a bit about our industries, that all the hearing aid brands have the capacity and functionality in their technology to offer these services. But we don’t freely offer, and by freely, I mean have access to almost an open-source platform for tele-health. And so where do you see, given what from your past what’s happened or happening at the moment with the pandemic, where do you see the future of tele-audiology going?
Elaine Saunders:
I think universities really need to embrace this with their students going out, actually understand that it works, and that people can fit their own hearing aids if it’s set up right, the technology is designed right. And not only that, but the research shows, and we did a lot of research, we kept our science and research going throughout. Research shows that when people set up their own hearing aids, they actually liked the settings better. And that’s not really surprising. I kind of make the analogy. I think that somebody’s coming into my house in the morning and setting my shower temperature up for me.
Kat Penno:
Really easy to understand analogy.
Elaine Saunders:
Well, I think the results that came out of the New Zealand study around it, that [Aaron Cage 00:15:55] did was that the settings were objectively similar of the audiologists, at the time, did their own setup, but the people prefer their own. They had greater ownership. And I certainly had debates over the email, or the fun with particularly, I have to say engineer clients, we all know engineer, or the hearing aid clients who absolutely insisted that I didn’t know what I was talking about, and they were going to set their hearing aid up the way they wanted. And intuitively, from an audiological point of view, think that’s terrible. They thought with one guy, I said, “Look, that’s never going to work, send them back.” And he just said, “It will work and then send it back.” And he said, “It does work and I’m not sending them back.”
Kat Penno:
I love that. And what we’re talking about there is this, it’s called psychological ownership, and there’s a lot of studies, not just with hearing aids, all the devices. I know there was a study, I want to say with cochlear, where they found that the audiologist might have done the first fit, but then they gave control to those clients via an app. And then the clients went off and made vastly different adjustments, and they surveyed them with an EMA, an ecological momentary assessment, and they found that participants preferred their fit over the audiologists’ fit. And so for me, that bridge or that gap really comes down to perhaps some counseling in understanding how the technology will benefit them and auditory training. And I can see that across all hearing technologies now, hearables, hearing aids and implants. T [inaudible 00:17:41] the field’s going.
Elaine Saunders:
Yes, I think you’re right, but I think actually, it goes deeper than that. I think it’s not all psychological. And if you look at the science around, let’s say fitting formula and fitting predictions, it’s all about the mean and the standard deviation. And we all know that we’re individuals, and actually, I’ve never met Mr. Average because actually, it’s the scatter and the individual data. I was very influenced by [Giles’ 00:18:15] believe not presenting at a design conference where I felt somewhat out of my normal comfort zone. And the key speaker designed chairs for people with arthritis. And he said, “You can’t have an average person and an average chair. It just won’t suit anyone.” You’ve got to have individual chairs. And I think it’s the same with hearing. I think for a long, long time, we thought, “Oh, well, if you can do in measurements, your client will be happy because we all know they’re getting sound, but they actually might not like it.”
Kat Penno:
Oh, insert mind blown emoji. Now what you’re saying is very controversial, and I love [inaudible 00:19:03] out hard on you, Elaine. Yeah, I think what you’ve just said, we can apply to a lot of major, well recognizable brands out there, that there’s an average, and if we design for the average, it’s really a certain population. And I agree, we’ve never met Mr. or Mrs. Average. So how can we expect people to feel confident and satisfied with our services if we’re going to hit these average targets? That’s huge.
Elaine Saunders:
Yeah, I know it’s controversial. I’m kind of used to that. When we first started Blamey Saunders, I wanted to involve audiologists in the evolution, if you like, of the journey with Blamey Saunders. Not specifically commercially, but I felt very strongly this was the future, and I wanted audiologists to come along. And we did a seminar, I actually held it at our MIT university, very eclectic. And we called it Audiology in the Connected Century. And I submit it to the professional association for them to disseminate it. And the response I got back from the professional association in Australia at that point was, This is not in the interest of audiologists. We will not support it.” So I had a good audience, but there wasn’t a single audiologist there. They were people from the general public, scientists, everybody except audiologists
Kat Penno:
That is absolutely nuts. Absolutely nuts.
Dave Kemp:
You’re striking a chord there.
Kat Penno:
And I suppose, what is the professional feeling towards your model? Has it flipped? Because it sounds like it was met originally with a lot of animosity and now-
Elaine Saunders:
Now it certainly has flipped. So I’m not really closely in touch anymore, but Sonoma found themselves owning a tele-audiology company as we went into a pandemic. So I think they probably got more value out of it than they actually expect to do so because they had a already built tele-audiology team. I’m just going to take a quick diversion there because one of the things people forget about tele-health, and particularly in audiology, is that you can actually respond to immediate situations as any consumer company would. So health in general is, we do tele-health. We do it just the same as we used to. We’d have appointments, and then they still might be two or three weeks ahead. Whereas if you set up a tele-health team in the right way, and clearly you’ve got to work out the costs and everything, then you can respond immediately.
Elaine Saunders:
And there’s so much value in that in not letting a problem fester. So someone contacts you, and dealing with it just like a consumer company, I don’t know, you probably do this in your hear. You have a support ticket, a help ticket, and you help them that day. And then you haven’t got this festering audiological problem whereby they go off their devices, and it doesn’t work in these scenarios because you’ve fixed it when it happened. So we had a team, and one of the comments I have made in tele-audiology when people said, “Oh, we can do it in our practice. We’ll just schedule appointments.” And I said, what are you going to do when you get 200 calls a day? So you’ve got to think about scale in tele-health. And that may mean that you’re not hiring people who have very high post-doc qualifications, or they have to work out how you’re doing it. But I think tele-health and customer service are frankly synonymous.
Dave Kemp:
Because this is something I’ve thought a lot about too, is this model is you have to rethink way in which that care is facilitated. I liken it to, I use the analogy all the time of the dentist. So you go in, and you’re getting your teeth cleaned. You spend 5% of your time maybe with the dentist, and you spend 95% of your time with the hygienist. It doesn’t necessarily devalue that time that you spend with the audiologist. It’s just that you don’t necessarily warrant their care. And so I think it allows for them to have a level of oversight into all of the patients, but having, like you said, whether it’s audiology assistants or some type of front office technician, something like that, I just can’t shake this feeling that what this ultimately might look like is the private practice of the future.
Dave Kemp:
And I come from the states, so I have that perspective, but the private practice of the future might very well be you have the brick and mortar presence, you have your current flow of patients that come through your doors, but then you augment it with click-to-chat tele-health. And one of those patients might actually come and see you, and so it might transfer transfer between the two. Sometimes you might meet with them through follow-up visits online. Other times it might be that you’re only visiting with them in person, but it seems to me like the two compliment each other so well, however, you can’t assume that the way in which you deliver care in the in-person model is synonymous with the tele-health model.
Elaine Saunders:
You’re totally right. In fact, what our team found was that you learn so much on the tele-health side because people tell you everything on the phone, or they are very responsive. [crosstalk 00:25:05] this experience. And I don’t know whether they do this now or not, but we at one point, we would put our new audiologists into the tele-health team for training because they would just learn so much. The tele-health team are not inferior to the audiologists. They’re different. They are very interactive, very strongly customer service. They have to find a solution. They have to do it fairly quickly because there are business economics. But if someone has a really bad problem or a difficult problem, maybe one that has to be solved face-to-face, then they spend the time with an audiologist. It’s different.
Kat Penno:
Totally agree. And this makes me think of a lot of other conversations you’ve been having on your podcast, Dave, especially one circling back to one with Andy and Mark Truong, maybe a year or so ago when he mentioned, and you guys were discussing the Genius Bars at apple. And so what I’m thinking of and pulling together here, as you both speak, is that the future clinic will have the bricks and mortar Genius Bar out the front, and at that Genius Bar will have exactly what you say, Elaine, these customer service representatives, face-to-face and virtually. And I love the idea that we solve problems rather than letting them manifest, because isn’t this healthcare in general, we’ve built reactive models where if you wait and wait to see the professional, your perception of this annoyance blows out by the time you actually see them.
Kat Penno:
Your hearing aids are in the drawer. You’re angry at the professional. You’re angry at the technology. You haven’t solved my hearing loss issue. I’ve paid thousands of dollars. We’ve built this negative cycle where the experience [inaudible 00:26:58] expectations in the 21st century. It’s so systemic as well. And I know it’s the same in the states, so it’d be very interesting to hear anyone listening out there, has anyone designed this future clinic? Please tell us so we can talk to you. And if you’re thinking about it, please reach out because we’d also like to talk to you, I believe.
Elaine Saunders:
Excellent points. And I think what you’re saying there, and this was absolutely central to Blamey Saunders, you have to build trust and building trust is about your interaction with the public. Whoever’s doing it, you’ve got to have rock solid trust, and we actually ended up with three Eastern seaboard clinics, because initially, we found that people, they might never visit those clinics, but they felt slightly comforted that there was actually a physical presence within their state. So they function very well as clinics, and I did some tele-health. The tele-health itself was predominantly centralized. Once you’re on telehealth, as we know from the COVID scenario, it doesn’t actually matter where you’re telling audiologists sit. They could be St. Louis, they might have to get up in the middle of night.
Dave Kemp:
I love this idea though, because if I were an audiologist, I would be so magnetized to this idea of, I can get back to just providing care. I can get back to tackling all these different solutions. It inverts the value proposition in such a way where I think it’s like, it then goes more toward, this is my healthcare provider, and not my hearing aid salesperson. And again, I don’t mean to disparage the current model, because it is what it is, and I know that a lot of providers out there today, they do this on top of their current revenue generation model of selling hearing aids. But I think that the reason that there isn’t a truly compelling alternative is because it just hasn’t arisen yet, and then there’s not a viable way to do it yet.
Dave Kemp:
And I think that as soon as that happens, I find this to be inevitable, basically, that you will restore the value of the provider so dramatically. And I think it will be totally viable because there’s so much value there. There’s so much value in, like what Kat said of being more proactive with this. There’s so little conversation today, even around hearing conservation and preserving your hearing, it’s all about treating your hearing loss. So it just feels like there’s so much potential out there with what providers can ultimately do if they’re not completely limited to basically the current model.
Elaine Saunders:
I think that’s absolutely right. And I think for audiologists of the future, and they potentially have much more exciting careers, I did a study some years ago, looking at the mismatch between audiology training and where most people ended up in jobs in that most audiologists actually ended up selling hearing aids. The training doesn’t focus on that. And probably if it did, no one would go into it. Selling, hearing aids is okay, but it’s a very small part of quite a broad skillset.
Dave Kemp:
Could not agree more. So I know we have a hard stop coming up here. Kat, did you want to say something?
Kat Penno:
What I’m hearing is that really we’re just at the beginning of the tele-health journey, I sort of cringe at the word tele-audiology because [inaudible 00:30:54] the end user or the consumer doesn’t understand that. And then it also implies certain things. And I think if we’re a bit more general about it, I’m hearing that we as a profession are at the beginning of a digital experience. And I think there is a lot of opportunity here. My brain’s racing. As you talk, Elaine, it’s racing.
Elaine Saunders:
We actually use the word tele-audiology almost to give it some respectability, but I don’t know how they hire now. So anything I say is historic, but for the tele-audiology team, I taught people who’ve got at least a degree equivalent in health sciences. So broad health science, which I think is very important because people do tell you about their sore thumb when they’re on the phone about their hearing aids.
Kat Penno:
They do.
Elaine Saunders:
And I didn’t want to have to explain, I have to teach them basic anatomy and all that kind of thing. So we had people who got degree equivalent of health sciences, and some customer retail experience, preferably in an area where it was required specialist knowledge. So I didn’t typically care what that was. So if it happened to be a high thigh business, that was probably good, but where they had demonstrated they really could learn about a specialist topic. And then we taught them the rest, and we ran an internal, we called it Blamey Saunders College, an internal training scheme to really bring them up to audiology levels, or we put them through audiometry calls remotely. But we taught them the audiology on top of the basic skillset.
Dave Kemp:
Yeah, that’s fascinating. I just find this whole thing, you were so ahead of your time. I guess, as we close here, I would just be curious, so if you were to start Blamey and Saunders in 2021, I know this is a loaded question, but I’m just curious, like what would be going through your head right now, knowing everything that you now know, what currently exists, the current appetite for something like this. I guess what would be top of mind for you right now, if you were to start this right now?
Elaine Saunders:
I think I would be really trying to differentiate because the market is more crowded, and a lot of things I’d keep the same. I’d really want absolutely top customer service as, I don’t know whether you know or not, but we made our own hearing aids. I’m not sure I’d do that again, but I would do a lot the same, but I’d have to expend less energy in if you like protecting the backside from … We complied, possibly over complied with anything you’ve had to comply with, because we didn’t want any of our, we’d upset a few people in the audiology professional. We didn’t want them to be able to pull us down, but our focus was the customer, the end user. And that would still be exactly the same.
Dave Kemp:
Fantastic. This has been such a great chat. Kat, any closing thoughts?
Kat Penno:
So many that we don’t have enough time [crosstalk 00:34:21] here. I really look forward to when we one day do meet again, face-to-face. We’ve had some chats already virtually, and I’ve always appreciated your time. So thank you for being controversial, even though you might not see it as that. And I think it’s really important to have these conversations in our profession so that we keep evolving and being better than we were yesterday for our clients. Thanks, Dave. Thanks, Elaine.
Dave Kemp:
Could not agree more. Well, thank you so much, Elaine. Thank you, Kat. And thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers.
Dave Kemp:
Thanks for tuning in today. I hope you enjoyed this episode of Future Ear Radio for more content like this, just head over to futureear.co, where you can read all the articles that I’ve been writing these past few years on the worlds of voice technology and hearables, and how the two are beginning to intersect. Thanks for tuning in, and I’ll chat with you next time.
