Tag Archives: home testing

Man vs. Machine

Giving Automatic Scoring a Second Thought

Changes in technology have been exponential over the last two decades. The industry has advanced significantly by software innovation. In our to wholeheartedly welcome these enhancements to our processes, we sometimes forget that technology in the form of automation is meant to assist, not replace, our skilled technologists.

To automate or not to automate the scoring of sleep studies remains an ongoing debate in our industry and with software giants looking for ways to expand service offerings, the discussion is unlikely to end any time soon. While the notion of computerized analysis holds the promise of decreased staffing costs and increased efficiency, the reality of this premise is far less simplistic. One would no doubt question the rationale behind the insistence that a plane does not require a pilot in light of autopilot technology. Yet there exists a movement that would apply such logic, resulting in the ultimate redundancy of scoring technologists.

Whether as a primary or secondary resource, a registered technologist is essential for an accurate analysis of a patient study—period.

Sleep medicine is still very much a human-centered industry. With over 80 different currently documented, nothing comes close to replicating the and contextually- reliant assessments made possible by intensive, real-life training and experience.

Any sleep facility or homecare company that are uses automatic scoring as a one-for-one alternative to human analysis is neglecting the clinical aspect of patient care. What begins as a well-intentioned, cost-cutting measure emerges as a practice that risks undermining the credibility of an entire industry.

Like every industry, efforts to streamline business and make processes leaner are present in sleep medicine. What we are seeing, however, are moves to market such software as a turnkey solution—completely undermining the specialized nature of sleep scoring and the skills, knowledge and training that go into delivering this process. Laboratories that wish to remain reputable should take a critical look at automated scoring and question whether the absence of registered technologists involved in this process is putting patient care in jeopardy.

The Reality of No Regulations

None of this is to say that automated scoring is without value. On the contrary, it can prove to help the technologist become a more effective clinician—especially as automation matures and is improved.

Early detection, of irregularities, cost-efficiency and timely performance are just some of the benefits that automated systems bring to the table. To ignore these benefits would be denying progress for the sake of it. However, as the sleep industry is itself still coming of age, it remains vulnerable to unscrupulous business models that risk tarnishing an entire sector by making patient care an after thought.

Discount scoring services have gained significant traction with unsustainably low price points underwritten by unregistered and clinically inexperienced scoring staff. What such practices fail to respect is that scoring is far more than an objective matter of computation. There are qualitative factors that only trained, registered and clinically experienced technologists can assess.

With minimal regulation of the effects of automatic scoring currently in place, the credibility of an entire industry rests on education and best practices. While sleep medicine awaits increased governance to prevent such fly-by-nights from infiltrating a valuable healthcare service, automation could aid in the standardization of certain scoring processes. As long as laboratories incorporate the technology primarily as a labour- cutting device, it may prove to be detrimental.

Assist not Replace

Another area of concern lies in the homecare and sectors. Level III sleep studies are being conducted and automatic analysis is being used for diagnosing patients going against the recommendation to have a secondary review by a Registered Technologist.

In such a case, automated scoring is not only the primary but the solitary mode of analysis. But scoring software can never comprehensively analyze a Level III study—results must be reviewed and assessed against clinical correlation. Software should be viewed as serving a complementary function in that it assists an RPSGT, who later verifies the automated scores manually and cross-references them with clinically-obtained observations.

Furthermore, one must consider the long-term impact of reliance on scoring software. Crucial information is gathered in the RPSGT’s current role as a front-line, integrated health- care professional. The knowledge and skills that arise from working with different patients and various symptoms and conditions could be lost should technologists be removed from the equation.

Know What You’re Getting Into

Pharmacists have also found their profession impacted by automated “advances”. The automated dispensing model they were recently introduced to have raised questions about accountability as dispensing errors can put patients (and businesses) at risk.

It goes without saying that human error can, has and will occur in any facet of healthcare. To be certain, accuracy is one of the dominant selling points of many automated systems used in other fields. However, the rush to market this form of technology may fail because the underlying technology is immature and needs time to evolve as it finds a permanent home within the sleep medicine industry. Even if automatic scoring technology matures to the point that algorithms can account for most variables, it still cannot contend with even the common clinical problems and complexities that come with sleep disorders in order to perform accurate scoring.

This is not to say that automatic scoring has no place in the streamlining of sleep laboratory operations. On the contrary, as time progresses and automated software has been tried and tested perhaps this may well become a fixture in sleep facilities.

But with no current regulations governing the use of such software, it is imperative that we consider the following disclaimer: automatic scoring exists to assist technologists, not replace them.

Natalie Morin, RPSGT is president and CEO of Sleep Strategies Inc., a provider of professional scoring and consulting services for sleep disorders facilities worldwide.

Man v Machine: Automatic scoring exists to assist technologists, not replace them

Giving Automatic Scoring a Second Thought

Changes in technology have been exponential over the last two decades. The sleep medicine industry has advanced significantly by software innovation. In our enthusiasm to wholeheartedly welcome these enhancements to our processes, we sometimes forget that technology in the form of automation is meant to assist, not replace, our skilled technologists.

To automate or not to automate the scoring of sleep studies remains an ongoing debate in our industry and with software giants looking for ways to expand service offerings, the discussion is unlikely to end any time soon. While the notion of computerized analysis holds the promise of decreased staffing costs and increased efficiency, the reality of this premise is far less simplistic. One would no doubt question the rationale behind the insistence that a plane does not require a pilot in light of autopilot technology. Yet there exists a movement that would apply such logic, resulting in the ultimate redundancy of scoring technologists.

Whether as a primary or secondary resource, a registered technologist is essential for an accurate analysis of a patient study—period.

Sleep medicine is still very much a human-centered industry. With over 80 different sleep disorders currently documented, nothing comes close to replicating the nuance and contextually-reliant assessments made possible by intensive, real-life training and experience.

Any sleep facility or homecare company that are uses automatic scoring as a one-for-one alternative to human analysis is neglecting the clinical aspect of patient care. What begins as a well-intentioned, cost-cutting measure emerges as a practice that risks undermining the credibility of an entire industry.

Like every industry, efforts to streamline business and make processes leaner are present in sleep medicine. What we are seeing, however, are moves to market such software as a turnkey solution—completely undermining the specialized nature of sleep scoring and the skills, knowledge and training that go into delivering this process. Laboratories that wish to remain reputable should take a critical look at automated scoring and question whether the absence of registered technologists involved in this process is putting patient care in jeopardy.

The Reality of No Regulations

None of this is to say that automated scoring is without value. On the contrary, it can prove to help the technologist become a more effective clinician—especially as automation matures and is improved.

Early detection, identification of irregularities, cost-efficiency and timely performance  are just some of the benefits that automated systems bring to the table. To ignore these benefits would be denying progress for the sake of it. However,  as the sleep industry is itself still coming of age, it remains vulnerable to unscrupulous business models that risk tarnishing an entire sector by making patient care an after thought.

Discount scoring services have gained significant traction with unsustainably low price points underwritten by unregistered and clinically inexperienced scoring staff.  What such practices fail to respect is that scoring is far more than an objective matter of computation. There are qualitative factors that only trained, registered and clinically experienced technologists can assess.

With minimal regulation of the effects of automatic scoring currently in place, the credibility of an entire industry rests on education and best practices. While sleep medicine awaits increased governance to prevent such fly-by-nights from infiltrating  a valuable healthcare service, automation could aid in the standardization of certain scoring processes. As long as laboratories incorporate the technology primarily as a labour-cutting device, it may prove to be detrimental.

Assist not Replace

Another area of concern lies in the homecare and sectors.  Level III sleep studies are being conducted and automatic analysis is being used for diagnosing patients going against the AASM recommendation to have a secondary review by a Registered Polysomnographic Technologist.

In such a case, automated scoring is not only the primary but the solitary mode of analysis. But scoring software can never comprehensively analyze a Level III study—results must be reviewed and assessed against clinical correlation. Software should be viewed as serving a complementary function in that it assists an RPSGT, who later verifies the automated scores manually and cross-references them with clinically-obtained observations.

Furthermore, one must consider the long-term impact of reliance on scoring software. Crucial information is gathered in the RPSGT’s current role as a front-line, integrated healthcare professional.  The knowledge and skills that arise from working with different patients and various symptoms and conditions could be lost should technologists be removed from the equation.

Know What You’re Getting Into

Pharmacists have also found their profession impacted by automated “advances”. The automated dispensing model they were recently introduced to have raised questions about accountability as dispensing errors can put patients (and businesses) at risk.

It goes without saying that human error can, has and will occur in any facet of healthcare. To be certain, accuracy is one of the dominant selling points of many automated systems used in other fields. However, the rush to market this form of technology may fail because the underlying technology is immature and needs time to evolve as it finds a permanent home within the sleep medicine industry. Even if automatic scoring technology matures to the point that algorithms can account for most variables, it still cannot contend with even the common clinical problems and complexities that come with sleep disorders in order to perform accurate scoring.

This is not to say that automatic scoring has no place in the streamlining of sleep laboratory operations. On the contrary, as time progresses and automated software has been tried and tested perhaps this may well become a fixture in sleep facilities. But with no current regulations governing the use of such software, it is imperative that we consider the following disclaimer: automatic scoring exists to assist technologists, not replace them.


Natalie Morin, RPSGT is president and CEO of Sleep Strategies Inc., a provider of professional scoring and consulting services for sleep disorders facilities worldwide.



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The Dental Decade of Obstructive Sleep Apnea Treatment

It wasn’t a scientific survey, but if the level of discourse at the recent APSS meeting was any indication, sleep physicians are warming up to dental sleep medicine.

Flex with new logo The Dental Decade of Obstructive Sleep Apnea Treatment

The decade of dental of sleep medicine may have quietly kicked off in the halls of this year’s Associated Professional Sleep Societies’ meeting in San Antonio. In a marked change over last year, vendors have encountered acceptance where they had previously found reluctance.

SomnoMed, an Australia-based dental sleep medical com- pany and makers of the SomnoDent® MAS devices saw the subtle shift firsthand. It started with an overall tone of positiv- ity that quickly morphed into an infectious enthusiasm. At last year’s APSS in Seattle they were still getting questions about clinical data and people asking about white papers and publi- cations. This year, they heard totally different questions, such as: ‘Where do I find SomnoMed to work with?’.

The new line of inquiry amounts to a huge shift in a rel- atively short amount of time. A year ago, attendees wanted proof, but this year more are convinced. The new mindset is at least partly due to a concerted educational effort on the part of SomnoMed and others. Focused communication to the medi- cal market has hammered home the message that oral appli- ance therapy is backed by solid evidence, with more to come in the near future.

Ralf Barschow, CEO of SomnoMed agrees that medical acceptance is higher than last year, but he believes clinicians will ultimately embrace oral therapies on a much larger scale. Along with greater acceptance, Barschow noticed a lot more traffic coming to their booths this year, with serious inquiries outnumbering the casual fact finders. “We had more people taking contact details and networking than at any other time. I would characterize the interest as sensational.”

Next year’s APSS will be held in Minnesota and could be another milestone that mirrors the situation with home sleep testing. The analogy with works because just like that facet of sleep medicine, dental therapy has taken time to settle in and gain acceptance with certain segments of the market. Full polysomnograms were once considered infinitely superior to home tests, just as it was once considered unthink- able that oral appliances could be a better choice than CPAP.

Now people realize that patients are different and options are a positive development. SomnoMed’s latest innovation the RCMP (Remote Controlled Mandible Positioner) allows physi- cians in the PSG setting, along with a technician, to basically titrate throughout the night to determine whether the therapy will work, and to determine where the bite must be to get the optimal results.

“The unit is completely integrated into the software and the tech is already familiar with the oral appliance for titra- tion,” says Barschow, who’s company custom fabricates the SomnoDent® MAS, a mandibular advancement splint. “It plugs right into the channel and literally, instead of titrating to pressures, it is titrating to advancement in millimeter fraction increments—similar to the way our device can be advanced.”

As a company, it’s all part of SomnoMed’s effort to be viewed as more than just a therapy piece. Instead, the com- pany is looking for a way to determine efficacy, compliance and spread education. There is a SomnoMed Academy, which is an educational entity that generates continuing education credits for the dental and medical fraternity. It started out in the therapy market and the therapy arena.

who wish to get involved can contact the company and purchase a starter kit with collateral materials and three devices. Participating dental professionals may choose to reg- ister for an Awaken Seminar, which is a 2-day continuing edu- cation event that teaches how to prescribe oral appli- ance therapy. “We explain why and how they need to interact with the medical community to get a proper diagnosis,” says Barschow. “However, we have always maintained, and will continue to maintain that it is the physician’s role to treat the patient, diagnose the patient, and once oral appliance therapy is deemed appropriate treatment—it goes over to the dental arena for the fitting of the device. Patient care is for the physi- cian, and diagnosis is for the physician.”

Choice is Key
Like the burgeoning industry, SomnoMed is offering more options to customers. Currently, there are three MAS gold standard products which have been developed, each with dif- ferent clinical indications aimed at OSA sufferers. These in- clude the SomnoDent® MAS Classic, SomnoDent® MAS Flex, and SomnoDent® MAS Edent for the Edentulous patient.

The SomnoDent® MAS is a custom designed sleep apnea oral appliance and has been the subject of numerous strin- gent, evidence-based studies that satisfy the need for a safe and effective treatment for OSA. The SomnoDent® MAS has a number of design features such as: a streamlined design with minimal bulk, which maximizes the size of the lingual space and reduces gagging.

The company touts an excellent fit in both upper and lower arches with anterior and posterior contact for a stable occlu- sion, which prevents tooth movement and minimizes term- pero-mandibular joint discomfort and injuries. The MAS is constructed in two separate pieces that allow patients to open and close their mouths. This allows clear speech, yawning, and drinking without requiring patients to remove the appliance. The ability to communicate clearly while wearing the device is particularly appreciated by patients and their partners.

For more information, visit www.somnomed.com

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Beyond the S9: VPAP™ Tx Lab System

vpaptxlab1 Beyond the S9: VPAP™ Tx Lab System

As the marketing push for ResMed’s S9™ Series reverberated around the 24th APSS (American Professional Sleep Societies) meeting in San Antonio, the San Diego-based company’s VPAP™ Tx Lab System quietly began to build its own momentum. Billed as an “all-in-one” titration solution for sleep labs, the unit contains all ResMed therapies, including adaptive servo-ventilation (Adapt SV), which treats central , mixed apneas, and periodic breathing.

According to Elizabeth Little, VPAP Tx Product Manager at Resmed, most people were surprised to hear the system includes all ResMed’s therapies. They expected Adapt SV to remain separate, and were pleasantly surprised to see it in the mix. “Our goal with the VPAP Tx was to build a product that would be easy for sleep techs to use and extremely comfortable for patients,” said Little. “We studied the work flow of technicians, and minimized the number of steps they need to take. Swapping out the bedside device for one therapy mode vs another was cumbersome, and the way to eliminate that was to put all of our superior therapies in one system. We put lab technicians’ needs at the forefront when developing this product.”

Throughout the conference, Little kept up a continual dialogue with sleep technicians and lab managers about the finer points of the new system. Little reports that many technicians were very impressed with the highly intuitive software. Among the most popular features were the therapy default settings, which are customizable and automatically reset to baseline pressure upon startup, eliminating a step for the tech, and preventing them from accidentally startling the patient with a blast of pressure. Additionally, she pointed out the “Detailed Settings Report,” which provides a complete record of all changes made to therapy during the night, giving them visibility to the performed by the techs, and allowing them to identify areas where training is needed.

A bilevel function delivers two treatment pressures—one for inspiration and one for expiration—and provides control over a variety of bilevel therapy modes. This integrated approach is a first for ResMed, and Drew Terry, senior director, product management, sleep SBU, says that a few months into the launch has seen many labs convert to the new unit with success. “The techs like the easy layout,” enthuses Terry. “They can go from CPAP mode to bi-level mode during the testing process, and it does it in an intelligent way—giving full control while also making recommendations. New technicians won’t spend a lot of time figuring out how to set things up. It’s automatic but it also allows you to make any necessary adjustments.”

After sleep lab technicians use the VPAP for titration, patients may ultimately go home with an S9 CPAP. Those that opt for this route will get many of the same features and technologies that served them during testing. “They can sleep with the Easy-Breathe Waveform, which synchronizes pressure with natural breathing patterns,” says Terry. “They will get the same ultra-quiet therapy in the home that they experienced in the lab. By maintaining consistency between the lab and home therapy, you are maximizing the patient’s chance for success.”

vpaptx2 Beyond the S9: VPAP™ Tx Lab System

Competitive Concerns
On the home care side of the sleep business, HME providers were left reeling in July when CMS announced new winning bid prices in the competitive bidding program. Unless legislative remedies derail the program, home care providers in 9 of the nations metropolitan areas will take a 32% cut in their allowable for CPAP units in 2011.

Currently, sleep labs must refer all CPAP patients to an HME to fulfill the prescription. “Some reports have shown that more people are considering dispensing, and that is something sleep lab owners may consider when looking at all the forces on their business,” says Terry. “Getting into the home care side of the business is another opportunity, and I think a lot of people are considering it. It’s a relatively small percentage of labs that are doing it right now—probably less than 20%. It’s a different business than running a lab.”

It is a competitive business environment for labs and many labs are looking for additional ways to serve their patients and grow their business. “They are considering how they might include in their service offerings,” says Terry. “Although the revenue for a home test is less than what the in-lab tests are, labs are looking at that as a way to bring in additional patients who maybe would not have come into the lab anyway.”

S9 Still in Spotlight
Despite reimbursement uncertainties, trade show season has been kind to San Diego-based ResMed as the company continues to market its S9™ flow generators. The makers of the Swift and Mirage CPAP masks are spreading news of the S9‘s treatment technology in an attempt to create maximum value, an attribute that company officials say is even more important during uncertain times. “Our goal in the development of the S9 was to create a system that offers more than any other device on the market–more comfort, more control and more style–so users can feel confident about incorporating it into their lifestyle, and health care providers can be confident that their patients are receiving the highest quality of treatment,” said Terry.

Terry says the S9 represents a new approach to patient compliance, essentially making it easier for users to accept CPAP on their own terms. “It puts them in control of the details that make the difference in their personal comfort, like EPR™ level and humidification settings,” adds Terry. “It has intuitive menus and dials to make it easy to adjust. It reduces noise to a virtual whisper, so it won’t disrupt a sleeping partner. And it comes in a stylish design that looks like something they want to have at their bedside.”

With the S9 Series, ResMed has introduced a number of improvements, including Enhanced AutoSet™ and Easy-Breathe algorithms—and an improved Easy-Breathe motor for low noise levels. The S9 provides detailed data reporting for clinicians, and a complete S9-compatible wireless compliance management package to streamline business efficiencies. A humidification system with Climate Control intelligently adapts to the user’s real-time environmental conditions to provide optimum performance and humidification delivery. An innovative SlimLine™ tube eliminates tube drag.

Ultimately, the S9 is a large part of the overall push toward greater innovation in what will surely be a huge decade for sleep medicine. Companies big and small are all angling to serve the growing market, and Terry acknowledges that competition is fierce.

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Elizabeth Little is Product Manager Sleep, based with ResMed in San Diego, CA.

For more information, visit www.resmed.com

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