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Managing Occupational Hearing Conservation Data

By: George Cook, Au.D., CCC-A

Most of us over 50 just do not realize how much electronic data management and computer technology have permeated our society and affected our lives. We say we do, but in truth the change is so all-pervasive, we haven’t the proverbial clue. And why should we, when we are a generation that feel we could easily live without computers, followed by a generation that openly speaks affectionately about their lap tops and the Internet and testify that they could not live without them.

Computers and hearing conservation software are absolutely necessary in managing an occupational hearing conservation program in both large and small plants. Companies simply could not keep up with the testing, notification, record keeping and professional review requirements without the efficiencies of the computer. Federal and state OSHA inspectors would have a difficult time finding out what they need to know if all records were kept manually.  The OSHA Noise Standard could not be adequately implemented by companies and could not be adequately enforced by regulatory agencies. It would be legislation for legislation sake, not the international model legislation for conserving worker’s hearing that it has become.

The best demonstration of the need for computerization in hearing conservation is the comparison of individual test data to a baseline or revised baseline. Most hearing conservation software will track each ear separately. The changes which are important to track are Standard Threshold Shifts (defined by Noise Standard) and 25 dB Average Changes for entering on the OSHA 200 Log. Therefore, with two different baselines for each ear, there are a total of four baselines to be tracked. That may not be a problem in the first year or two, but with 20 years of tests, it would be extremely difficult to manually review any significant number of employees.

The technology onslaught has affected occupational hearing conservation just as it has every profession. It has given the field depth by creating a new jargon, tools for greater efficiency, and innovative logic for solving problems. Today, many plants do hearing testing on new hires at the plant during the year. Annually, a mobile testing provider visits the plant to test the majority of employees. The testing unit secures computer files from the plant and loads that data onto the computer on the mobile unit. Following testing on the mobile unit, employees are given a Notification Report about hearing status and any change. Notifications are signed and training is provided at the time of the test. The database is left with the client on their computer network and test results are electronically forwarded to the mobile unit computer center for additional screening and audiological review. Results of the reviews can be e-mailed to the plant computer to update files with revised baselines, medical referrals and instructions for follow-up.

In clinics or plants where the hearing testing is done by a plant Occupational Hearing Conservationist (OHC), the employee enters the hearing testing area and the OHC accessed the employee’s demographic information from the computer network. The demographics and audiological history are updated. The employee is seated in the booth, instructions are given, earphones are placed and testing is performed by a computer chip audiometer (microprocessors). The results are reviewed by the OHC and if not acceptable, select frequencies are manually re-tested. When the test is acceptable, it is sent to the audiometer. There is some front end editing of the hearing test data. For example, a hearing test with all zeros would be suspect and therefore the program would alert the user with a notice saying, “This test is all zero’s. Are you sure you wish to save? Yes, No.” A test with poor test/retest agreement at 1,000 Hz would be invalid and the user would be flagged with a similar message. Once the computer has accepted the data, it becomes part of the employee’s database. A visual review can be made of the test results compared by the computer to previous tests. Tests are compared to the baseline test and when certain conditions are met the computer software may actually be empowered to revise a baseline hearing test to an annual audiogram. The computer could make a mistake; therefore, all revised baselines need to be reviewed by an audiologist, otolaryngologist or other physician. This needs to be a feature of the software program. Some programs do not revise a baseline automatically but require the professional to manually indicate the comparison test within the employee’s data file. Anytime future tests are performed, they will be compared to the revised baseline.

A Notification Report is produced for the employee at the time of the test. The results can be displayed by graph or serially or both. There is a place for the employee to sign and date that they have been notified and since this report is produced for every employee, it is common to find that there are also areas for employees to document that they have received additional required training such as hearing protection fitting and/or annual education.

Testing by computer, comparison of hearing test data at the time of the test with previous tests, and on-the-spot notification to the employee of test results is just the beginning. Scheduling, summary reports, and audiologist and/or physician review are also now high technology. Imagine compiling list upon list of employee information to schedule hearing test by plant, department and job.  This task is simple when done by computer. The company file server downloads demographic information which is imported into the hearing conservation software and a scheduling program prints a list of employees due a hearing test by department. In some software, even an individual notification with a customized message can be printed.

Before the Personal Computer, information was kept on hard copy in file cabinets in duplicate files, one file in alphabetical order to locate employees by name, and a second file by test date to schedule testing. To find out how many employees were tested and how many Standard Threshold Shifts have occurred in a year, it literally took a nurse or other personnel days to search through the files. Not so anymore. In seconds, management can view statistical summary reports that will count and list by name all significant changes in hearing. STS reports and possible OSHA 200 Log entries are available and are state specific. Graphs comparing plants or departments and statistical trending are standard features in most software. Even the professional review process has electronic data management (EDM). Program files can be e-mailed across the internet making a distant reviewer appear as if they were in the next office.

If you’re an independent hearing conservation service provider, or a provider doing a little hearing conservation and a lot of something else, where do you stand in this technology maze. First of all, if you are an audiologist in private practice, don’t look for a combination software package for your clinic and hearing conservation programs. To my knowledge, there are no major developers that have put the two activitiestogether. Now that is not true for occupational clinics. There are programs specifically written for occupational clinics providing hearing testing and there are other programs available that are adaptable to occupational health clinic use.

What are 9 things to look for in a PC package of occupational hearing conservation software?

1. Ability to set-up multiple directories.
If you are a service provider, you will have different companies to service.
The software may have entry for multiple companies but you must be sure each company can be in a different directory. If all companies are in the same directory, an employee leaving a company and going to another of your client’s plants will be pulled up when his baseline test for the new employer is to be performed. The past test will be a part of the new employer’s files. This makes for an unhappy client when the employee is notified of an STS or has an OSHA 200 recordable and has just begun work.

2.  Communication capabilities for peripheral equipment.
This is a given now days. However, you should check to be sure the software will communicate with your audiometer and other testing equipment such as a spirometer, vision tester or blood pressure measuring equipment (sphygmometer). It would be irritating to purchase software and then to have to purchase new testing equipment. All testing equipment is not able to communicate or sometimes is not worth the time and expense to retro-fit for communications.

3. Audiometer vs. software
Some software is very powerful and contains most of the fields needed. The printer is also driven by the computer. Therefore, an expensive audiometer with data entry pad and printer may be an unnecessary expense. All that is required is a simple microprocessor audiometer that is capable of securing a good test and communicating with a computer. These are available for around $2,000 or less. 

4. Help desk
Does the developer have a decent help desk? The help desk is telephone access to a person versed in computer technology and the software product you are using. The help desk is there to assist with problems users have with the product. To take the side of the manufacture of the software, customer expectation for help desk services are unreasonably high. They end up providing computer basics, trouble-shooting equipment, network administration, etc. No wonder we hear about the help desk position fast becoming America’s most stressful occupation. However, the consumer should reasonably expect to talk to someone about a user problem and expect intelligent answers and timely follow-up. A manufacturer may have all the lights and whistles in a software package but lose the advantage by having an inadequate help desk.

5. Developers
Who wrote the software? Was it an audiometer manufacturer promoting audiometers? Was it a consulting group providing support services? Was it a software developer providing a lead-in package?

We go to all the trouble to inspect every aspect of software features but do not take the time to find out the orientation of those who wrote it.

6.  Software features
There are many desirable software features but here are a few special ones to look for;

OSHA record keeping documentation. For example, the Notification Report should have a place for documentation of multiple requirements as STS notification, hearing protection fit and training, and annual educational training.

Single entry screens. If going to the hearing testing or to do a hearing test, is the test information on a single screen or as few screens as possible. This keeps the user from getting lost in the software.

NHCA Criteria for review. A National Hearing Conservation Association committee of professionals has developed a set of criteria for baseline revision. How close does the review criteria in the software come to the NHCA criteria.

7. Other services
Are you going to do other types of testing? If so, you do not want a software package for each service. If the hearing software is a module of a larger package, you may wish to utilize the common database for the demographic information. 

8. Other Users
Go see the software in action before you buy.  Sit down at the computer and ask to be walked through the operations. You should be able to catch on quickly.

9. Price
Just because it’s expensive, does not mean it is the best. I have been told several times, “We bought this expensive system because we wanted the best”. The expensive system was inadequate for the job and had to be replaced with a less expensive one that met the specific needs of the client.  Sometimes trafficking people and ease of operation is more important that glitter. 

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