The hearing health care delivery model has changed over the past several years. Many hearing care providers now have multiple offices and provide consulting services on site at nursing home facilities, senior centers and patients’ homes. Universal Newborn Hearing Screening (UNHS) programs are placing more children into early intervention and pre-school programs managed by educational audiologists.

These changes make it necessary for hearing care professionals to manage larger, more complex client databases. Attempting to do this by hand can be confusing and inefficient, and can increase the potential for making errors.

NOAH System 3 is designed to provide a stable environment for large databases, as well as a utility for establishing portable database files. The system’s earlier 2.0a stand-alone version provides a feature called the “Single Client Import/Export” utility. This feature allows the import and export of patient records, but it has some limitations. In the latest version of the software (v. 3.0), these limitations have been removed and replaced with features that allow for multiple client import/export and robust action-merging capabilities. This article will look at a few examples of how these new capabilities can be used in an everyday business or practice, as well as provide step-by-step instructions for single and multiple file import/export.

Patients in a Group Living Situation
The “Client Group” field in the “New Client” screen of NOAH System 3 has been developed to provide an easy way to identify the residents of individual sites (e.g., clients in a particular nursing home). The new feature helps automate the export process. When you are ready to visit the nursing home, export the client files with the appropriate Group Number to a NOAH 3 import/export file, then transfer them to your laptop computer. This can be accomplished either by copying the file to a floppy disk or directly to your laptop via your office computer network. Next, import that file into the NOAH System 3 on the laptop. Once on-site, the needed fittings or fine tunings for each client can be performed, and all the actions are saved into the system. Upon returning to the office, reverse the process by exporting the same client files from the laptop’s database to the NOAH 3.0 files. Then re-import that file to the main database.

Diagnostic Work Settings
In settings like children’s hospitals or schools, the hearing care professional evaluates patients and makes recommendations, but may not actually dispense hearing instruments. Using the new system, the professional can perform and record all the pertinent data—including puretone and speech audiometry, impedance and real ear measurements. These measurements can be entered into the system manually or by using NOAH-compatible test equipment.

A “Journal” entry with detailed recommendations can also be created. The new system automatically records the date and the initials of the clinician making the entry. This “Journal” action can later be recalled and printed by right-clicking the “Session Browser.”

The next step is to export the patient’s record to a file (see above for the import/export instructions). Be sure to modify the “Release of Information” forms to include the fact that you now have the capability of electronic transmission. If the receiving party has Internet access, the exported file can be emailed to the dispensing professional or physician. They will import the file, perform and save the fitting, export the file and send the file back to you. When returned, you simply re-import the file and merge the new information into your database. Virtually any verification testing result can be documented with the system. If more adjustments are needed, the above procedure is simply repeated.

Multi-Center Records and Research Projects
Whenever researchers collect data from multiple locations, the sample represents a realistic scenario within a real-world setting. Management and manual entry of that data (i.e., collation, typing, etc.) often requires resources that might be put to better use elsewhere.

Using the new system, the principal investigator defines a “Group Number” for the project, and then includes it in the documentation for selecting participants. Participating audiologists edit the client records of the patients involved and include this Group Number in the appropriate patient files. Data is collected according to the research design and entered into the system.

At regular intervals, the participating centers export all client files with the appropriate Group Number to an import/export file and email it to the principal investigator. This researcher then imports all of the files into one database. The principal investigator can utilize the new XML export capability to extract not only the demographic and fitting information on the research subjects, but also the audiogram data.

The XML “dump” is raw data, and requires a custom-written application to convert it for analysis. However, this feature allows researchers unprecedented access to data stored within the system, including the audiogram data. For researchers working on several projects, NOAH 3 allows work and maintenance within multiple databases, called “Database Profiles” (details on this can be found in the “Help” menu).

Step-by-Step Import and Export of Client Files

Fig. 1. To export a single file, click on the client’s name and select Client Export.

Exporting a Single File:
1. Select a client: From the “Client Register,” select a client and right-click on his/her name.

2. Select “Client Export” (Fig. 1): The software provides three views to help you find the client:

• The “All Clients” tab shows all your clients. The previous version’s (v. 2.0) limit of 100 clients has been removed.
• The “Recent Clients” tab displays a list of recent clients. Set the number of names displayed in this view by selecting “Tools” and then “Options.”
• The “Search for Clients” tab allows for the construction of complex search strings containing up to three parameters connected by the Boolean criteria “and” or “or.”

Fig. 2. The Export Wizard is designed to assist with multiple file transfers.	Fig. 3. A variety of export data formats can be chosen when exporting files.

Exporting Multiple Files:

1. From the “Client Register,” click “File” (#1 in Fig. 2).

2. Click “Client Export” (#2 in Fig. 2 and Fig. 3).

3. Selecting the File Format: At this point, the “Export Clients Wizard” is activated (Fig. 2). This step-by-step guide assists in exporting the client file(s) in one of three different file formats:

• The “Native” format allows the exported data to be integrated into another NOAH database. This can be helpful when one of your clients moves to a new city or if you provide services in patients’ homes.
• The comma-separated format for demographic, fitting and remote data can be imported into a spreadsheet or database for the purpose of data analysis, or into a word processor for mail merge requirements.
• Professionals in academic and research facilities who need more extensive data analysis may use the XML format. This provides access to the demographic, fitting instrument and fitting remote, as well as public audiogram data for all clients.

Select the file type that best suits your needs (usually the Native format) and click “Next” to continue.

Fig. 4. Individual clients from the Selection List can be chosen (top screen) or an entire Group Number can be used to select a group of clients (bottom screen). The latter can be particularly useful for research and data analysis tasks.

4. Selecting Which Client Files to Export: The new system provides two ways to select a group of clients to be exported. If you know the client names and want to manually select each one for export, click the “From the Selection List” button on the screen (Fig. 4). For a consecutive list of clients, click the first client name, hold the shift key, and then click the last name in the list. For a non-consecutive list, click the first name, hold down the control key and then select the file of each client you want to include in the export. An alternate way is to use the Group Number discussed earlier (Fig. 4). Click the “Group Number” button, and then select the appropriate Group Number from the pull-down list. This will automatically select all the client records that contain the selected Group Number.

When finished selecting which files you want to export, click the “Next” button on the lower right of the screen.

Finishing Up
Fig. 5. File names can be as descriptive as needed and are saved as “nha” documents.

The final step to exporting client records is selecting a file name and location (Fig. 5). Since NOAH 3 is a true Windows program, it supports long file names. It’s a good idea to take advantage of this and make file names as descriptive as possible. The file location can be a floppy disk, another folder on the same hard drive, a network drive or a CD-ROM disc. The system saves export files with an “.nha” extension.

A moving bar shows the progress of your export. Once all files have been exported, the message “Successfully Exported X Clients” is shown, where X equals the number of client records. Click “OK” to continue. The file that has been created now has a complete copy of all the actions, sessions and client data for each client file selected.

Conclusion
In recent years, NOAH has become a standard platform used in the programming of hearing instruments. Over half of all hearing instruments are now programmable or DSP, and many (if not most) are programmed using NOAH-compatible software. The recent 3.0 version of the platform has been designed to provide better (and more) options for client files, as well as the import/export and the data-mining of those files.

This article was submitted to HR by Brad Ingrao, MSEd, coordinator of audiology information services at HIMSA (Hearing Instrument Manufacturers’ Software Assn.), St. Paul, MN. Correspondence can be addressed to HR or Brad Ingrao, HIMSA, 2550 University Ave. West, Ste. 241N, St. Paul, MN 55114; email: bingrao@himsa.com.