Problem Solvers

Sharpening Sleep Monitoring

How providers can improve their patient monitoring programs.

• By David Kopf
• Sep 01, 2015

Today’s healthcare market comes down to one word: outcomes. Nationwide, both in public- and private-payor-funded health, there is a focus for all healthcare professionals in the care continuum to optimize patient outcomes. And in no market is this more evident than sleep therapy.

There has been an imperative among providers of sleep therapy equipment to provide systems that let physicians and other health professionals involved in the patient’s care remotely monitor the patient’s progress, and tweak the therapy as needed. These systems started out as data cards that would be reviewed later, after submission, but now, thanks to technology, sleep providers can offer systems that let doctors monitor patients that day.

“Patient monitoring and data management solutions can more quickly and efficiently help providers identify patient issues proactively and address them early on for increased patient compliance,” explains Rob Levings, vice president of Healthcare Informatics at ResMed. “These technologies may also include automated patient coaching assistance, which has been shown to significantly reduce labor associated with coaching, and can also help boost patient adherence to therapy.

“Increasing efficiency and positive patient outcomes benefits providers by reducing their cost of operation and appealing to referral sources,” Levings continues. “At ResMed, we offer several technologies that assist HMEs with patient monitoring, tracking, and management, helping both providers and patients achieve better outcomes.”

By working with the physician, the provider can set thresholds within the monitoring system. This means that the doctor can go about his or her business and be alerted by the provider when there is an event. Moreover, the sleep provider can provide up-to-the-minute reports on how a sleep patient is faring through the night and whether or not his or her PAP therapy needs adjustment. Moreover, through a blend of automated and live communications methods, they can consult with patients and even ensure they are complying correctly.

And by providing this constant flow of crucial patient data, the provider establishes itself as an expert resource and partner for physicians, sleep labs and every stakeholder in the patient’s care (including the patients themselves). The data that outcomes-oriented referral partners expect, and appreciate, becomes is a critical business differentiator, and the HME provider becomes an indispensable element in the process.

Furthermore, remote monitoring can also help providers maximize the business they are getting from each client. As providers contact patients as part of their communications and coaching efforts, they can use those dialogs to generate new revenue. For instance a sleep patient might ready for resupply items or other DME products related to his or her condition. That contact can be leveraged to make those transactions and fill new orders.

Whether looking at all new business models, or just trying to make the most of existing ones, monitoring and communication yield optimal patient outcomes, improved partner and patient relationships, better market differentiation, and the kind of information that can lead to new revenues.

How to Improve Monitoring

But what are some key elements in how sleep providers can implement a successful patient monitoring practice? There are many ways that providers can sharpen their monitoring game in terms of technology, patient interaction, and referral coordination. Mark D’Angelo, sleep business leader for Philips Respironics shared a list of elements he says are key in a successful patient monitoring practice:

• Providers should offer virtual coaches via desktop and mobile devices to provide patients with information on topics such as obstructive sleep apnea; tips on mask fit and cleaning; and insight into their apnea hypopnea index (AHI).
• Respiratory Therapists should have educational tools to guide patients on how to use products.
• Providers should clearly implement remote patient compliance tools such as SleepMapper (which have demonstrated a 22 percent increase in patient compliance rates) in order to ensure patients adhere to therapy.
• Monitoring of CPAP usage should be ongoing, with a focus on the early part of the process, so providers can view a patient’s performance and make necessary adjustments.
• Providers should implement an automated resupply process, from tracking patients who may be eligible for new supplies to helping patients order supplies via phone, text, or email, to create more efficient operations and encourage adherence.

False Positives

One hitch in sleep patient monitoring is that too much automation can be troublesome, according to Matt Hitchings, product manager for Fisher & Paykel Healthcare.

“There have been many advancements in CPAP patient monitoring technology over the years, which has aided in the provider being able to see their patients’ sleep data more affordably and easily,” Hitchings said. “However, the challenge for providers has still remained of making the best use of that information to manage the compliance of all of their patients, without letting any fall through the cracks.

“Some software systems available today have attempted to address this problem by automating an action when a patient has met certain conditions (e.g. low compliance, a high AHI, etc.),” he continued. “However, the strict rules that determine whether a patient should be intervened, or should not be, have potential to produce a false positive or false negative if there were other factors that were not considered.”

So for F&P and companies like it, the challenge has been to negate those false positive. Hitchings says F&P’s InfoSmart Web reports on at-risk patients in an alternative way, with a customizable dashboard that lets providers decide which information is displayed in the patient list, and also how the list is ordered.

“This means that a provider can, for example, see their patients ordered by the highest amount of leak, while being able to see average pressure and AHI values in the same line,” he explains. “This means a provider can make the decision whether the patient needs to be intervened by seeing the most crucial information, rather than rely on an automated system alone.

“Instead, the provider could choose to order patients by AHI, and in the same line, compare to the patient’s diagnostic AHI (which can be entered manually from the sleep study results),” he continues. “This allows the provider to determine if a higher than average AHI would require intervention, or if is probably just because the diagnostic AHI was very high.”

However, Hitchings emphasizes that hands-on care will continue to play a pivotal role in the sleep therapy process: “… There will always be a need for a human element to provide the most optimal patient outcomes, and the most success in their businesses,” he says.

This article originally appeared in the September 2015 issue of HME Business.