Virtual Extension of your Sleep Laboratory

Imagezzzz Virtual Extension of your Sleep LaboratoryNatalie Morin
President & CEO, Sleep Strategies, Inc.

A behind the scenes look at how sleep scoring services aim to form seamless partnerships with clients.

The use of sleep scoring services has gained tremendous momentum as more and more hospitals and sleep labs change their internal operations to incorporate this progressive business practice. Over the course of the last decade the process of scoring sleep studies in-house has increasingly moved out of the laboratory and into the hands of specialized scoring service companies. This reflects not just a desire to cut costs, but a recognition of the value that a third party can provide as part of a strategic concentration of sleep laboratory resources.

By now, most hospital administrators and directors are aware that sleep record outsourcing can deliver more than just labour cost savings. By freeing up staff to work on marketing, community outreach and patient initiatives, sleep record outsourcing allows for the generation of new revenues, increases in productivity and the management of risk that would have been previously unaffordable. However, sleep record outsourcing offers more immediate benefits as well. Sleep scoring firms have the ability to provide rapid turnaround and perhaps the highest level of scoring quality available by registered technologists. Where cost cutting often forces labs to stretch their labour power—simultaneously jeopardizing patient care—most sleep scoring services are exclusively devoted to the sole task of ensuring the meticulous analysis of sleep studies. The level of quality available from a third party specialist is near impossible to achieve in a hospital or lab where there exists multiple duties to which need attending.

With so many benefits to be had by outsourcing sleep scoring, one might inquire as to why it isn’t yet standard practice. According to Chad Doucette, V.P. Sales & Marketing of Sleep Strategies Inc., “Many clients have told us that they were hesitant about the process at first—doubtful that an outside firm could easily integrate with pre-established internal procedures. But once they realized how a little initial diligence results in a seamless long-term relationship, their concerns are usually eased.” This article will familiarize readers with the step-by-step process of aligning with a scoring service. Using one of the industry’s leading scoring companies as a guide, it will show you how Sleep Strategies Inc. has managed to remain at the top of the game by not merely acting as a service provider, but as a virtual extension of their clients’ labs.


When it comes to the decision of whether or not to bring a sleep scoring service on board, scoring is surprisingly not the primary task on the agenda. The first question a sleep facility manager must ask themselves is WHY—why should we consider outsourcing our sleep studies? Begin by comparing your situation to the following statements made by various Sleep Strategies clients before they came on board:

  • “Over the course of the last few months our lab has experienced a number of HR issues. Most importantly, we haven’t been able to find enough registered sleep technologists.”
  • “Hospital administration has slashed our operating budget forcing us to scale back over-time hours.”
  • “We have such a backlog of sleep studies that our patients sometimes have to wait weeks before receiving results.”
  • “We don’t have a devoted quality department.”
  • “We’re looking to expand our facility but don’t know if we can afford additional staff.”

The above are just some of the factors that commonly lead hospitals and labs to outsource their scoring. Whatever your reason, remember that once the decision to hire a scoring service has been made, you are hiring a partner for your sleep lab—one who must be trusted with your business practices and patients. Choose wisely.


Demand for sleep studies has increased so significantly that it’s now surpassing the number of registered sleep technologists available—which means, if you’re not careful in your selection process, you could easily end up with an under-qualified scoring service. Below are five key questions to ask any potential scoring service:

  • Do you have RPGSTs (registered polysomnographic technologists)? This is a must for efficiency and accuracy of test scoring, but don’t assume it’s a given. Establish in advance whether an RPGST will be handling the scoring process in its entirety—not just supervising the process.
  • What about a Quality Assurance Department? A reputable scoring company will have a designated quality-assurance department. This department should have a program which includes: routine review of all scoring technologists, inter-rater reliability and audit reviews as well as scoring guarantees with a policy for re-scoring.
  • Do you perform manual scoring? For the most reliable results, a registered technologist should score sleep studies manually. Automatic software scoring is not as accurate.
  • Do you have Liability and Errors & Omissions Insurance? A sleep-scoring company should carry the same level of insurance as your sleep laboratory. This should include general liability as well as errors & omissions insurance.
  • Is management separate from scoring? In some organizations, the person scoring your studies is the same person managing the company. Favour scoring services with a devoted management team, separate account reps and an RPGST committed solely to the task of scoring your studies.

Remember, qualified institutions will welcome such questions. Aligning yourself with a reputable service will not only enhance productivity and efficiency, but let’s not forget: your reputation too.


Once you’ve decided on your ideal scoring service provider, the question that now remains is: how to get started? While the beginning phases of integrating with an external provider should be treated meticulously, the process need not be painful. “At Sleep Strategies we see ourselves as an extension of a sleep laboratory,” says Natalie Morin, president & CEO, Sleep Strategies Inc., who adds,” when clients are done asking us questions, we make time to ask a few of our own.” What Morin means by this is that for Sleep Strategies, the pre-scoring integration phase begins with the completion of a scoring questionnaire. This allows a lab to convey their expectations to the service provider, who in turn is equipped with the requisite understanding of pre-existing scoring criteria.

While a reputable scoring company will always score studies to meet AASM standards, individual sleep labs will typically have their own nuances or additional scoring criteria that they wish to have upheld. “The scoring questionnaire is the foundation for providing the successful delivery of sleep scoring,” says Doucette, who believes that one-size-fits-all solutions have no place in the world of scoring. “Good doctors and technologists have put years of experience and training into refining their scoring processes,” he adds, “It’s important that we tailor our approach to reinforce, not negate, the nuanced and varied habits of each of our clients.”

Once the scoring questionnaire is completed it is then subject to a detailed review by Sleep Strategies’ Quality Assurance department. Questions and clarifications are often necessary at this phase to ensure the team of registered technologists assigned to a given account fully understands their client’s scoring perimeters, which extend beyond industry standards. “No two sleep labs are the same and no two medical directors are the same. This questionnaire process allows us to adhere to strict standards while still honouring how one lab differs from another in its scoring technique,” Doucette emphasizes.


Delivering patient information over the Internet can be a simple, convenient and cost effective method for data transfer, as long as the method is secure. Provided that the scoring service provider uses a reputable transfer system, electronic methods of information exchange can allow for the delivery of sleep study results in record turnaround times.

“Ensuring that your sleep scoring service has a HIPAA compliant data transfer system is key”, says Morin, who explains that most such well-developed transfer systems are not only reliable, but also easy to install and operate. “Our transfer system is considered one of the most user-friendly systems that exists. Our clients regularly remark on its ease of use and simplicity,” says Doucette. However, what is perhaps even more important than ease of use is having a technical support team on hand to assist clients and ensure that the transfer system runs effectively and securely. “24-hour turnaround times is a lofty goal. We wouldn’t make this promise to our clients if we didn’t have faith in the useability and reliability of our software,” Doucette goes on to say.


The scoring questionnaire has been filled out and the transfer system has been installed to allow for the relay of patient sleep studies. The next step—once again—involves the Quality Assurance department. This time, they’re looking to review clients’ pre-scored, in-house sleep studies. Providing a scoring service with several internally scored “gold standard” studies allows a sleep scoring service provider to compare and cross reference real-life scores with the preferences outlined in the questionnaire results.

In doing so, ambiguities can be identified and resolved before the third-party scoring begins. In this sense, a good scoring service also serves as an external consultant who can identify inconsistencies and make recommendations for improvement. This process simultaneously gives the scoring service an example of a lab or hospital’s unique scoring protocols and procedures. For example, Hypopnea definitions can vary from facility to facility. Many doctors also want to see additional events scored, such as EKG arrhythmias, as opposed to just commenting on them—a good scoring service will have mechanisms to observe these client preferences.


Once the scoring questionnaire and “gold standard” studies have been reviewed and all questions answered, Sleep Strategies asks for several patient sleep studies to be sent for the test scoring phase. This allows the client to assess the sleep scoring company’s approach before signing off on quality and allowing the scoring process to begin.

As is the case with most business partnerships, a service agreement will need to be signed to ensure such issues as patient confidentiality and adherence to process are fulfilled. Any sleep service that does not require clients to sign an agreement should be viewed with suspicion. Service agreements outline turnaround times, pricing structure, cancellation terms and confidentially requirements. For many hospitals the vendor will also need to provide proof of insurance at this phase, as well as a signed business associate’s agreement.

With the paper work out of the way, it’s now time to start the scoring process.


A sleep scoring service is a busy operation. Organizations such as Sleep Strategies score studies for hospitals and sleep labs across the country. “On any given month, Sleep Strategies is scoring thousands of sleep studies. Each sleep lab has their own scoring nuances, turnaround times and expectations. We have some clients that are expanding, others that are going through accreditation and some that are dealing with unexpected growing pains—adapting to the various rhythms of each clients’ operations is a necessary part of our success. Flexibility and timing is everything in this business,” says Morin.

Scoring services are typically made up of various departments, such as a general polysomnography division, a specialized pediatric division and a research division, for example. In order to coordinate the multiple interests competing for attention, a scheduling department may also be necessary. This attention to detail is key so that all contracted scoring deadlines are met. ”Our scheduling department along with our specifically developed and proprietary scheduling software ensures our clients’ sleep studies are scored on-time, every time,” explains Morin.

Constructing a successful scoring service is more than just a matter of employing the best RPSGTs to conduct scoring; it requires a team of professionals from account executives, administrators, clinical directors, quality assurance managers to uphold the level of scoring this sector of sleep medicine has built its reputation on. “The true success of Sleep Strategies lies in the foundational belief that a scoring service is more than just a vendor for a sleep lab. We see ourselves as an extension of each and every one of our sleep labs and hospital partners,” says Morin, who hopes that such partners will continue to recognize the cost savings and efficiencies that come with bringing on a sleep scoring service.

Natalie Morin, President & CEO, Sleep Strategies Inc. proves that incorporating a scoring service as part of an operational business strategy can assist sleep labs and hospitals significantly cut costs and increase productivity.

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