Locked out

sleepngo · Post by **sleepngo** » Tue May 22, 2007 5:18 pm

I may be getting a REMstar ABIPAP with BIflex, but my Sleep Technician says I will be locked out and wont be able to regulate my CM pressures. Can they lock you out or is there a way to bypass the lock out feature? I now have a REMstar M series auto with C-Flex and am able to change my MIN and MAX pressures I also track my data via encore pro 1.8 software, will I be able to track my data on ABIPAP using encore pro 1.8 software? Thanks for any help.

Dan

Snoredog · Post by **Snoredog** » Tue May 22, 2007 5:32 pm

they have NO way to track if you have changed settings, you access it the same way you do with your current machine, but use the <> keys next to the On/Off button.

Just don't take your SmartCard in with you, adjust it yourself and you won't need to hassle with the RT.

If you have the software you can also change the setting via it.

sleepngo · Post by **sleepngo** » Tue May 22, 2007 7:33 pm

Snoredog wrote:they have NO way to track if you have changed settings, you access it the same way you do with your current machine, but use the <> keys next to the On/Off button.

Just don't take your SmartCard in with you, adjust it yourself and you won't need to hassle with the RT.

If you have the software you can also change the setting via it.

Thanks Snoredog. I was concerned that I wouldn't be able to make allowances for the different type mask that I use, I sometimes use a FF mask and two different nasal mask, all three have different flow rates. My APAP doesn't seem to be able to adjust fast enough for the different flow rates, so I make minor changes that help keep my AHI's under control, thanks again.

Dan

rested gal · Post by **rested gal** » Tue May 22, 2007 11:31 pm

sleepngo wrote:I may be getting a REMstar ABIPAP with BIflex, but my Sleep Technician says I will be locked out and wont be able to regulate my CM pressures. Can they lock you out

No, they can't "lock" you out of the clinical menu. As Snoredog said, you access that menu by jumping through the same hoops of plug and buttons that you use with your REMstar Auto.

sleepngo wrote:I also track my data via encore pro 1.8 software, will I be able to track my data on ABIPAP using encore pro 1.8 software?

Yes.

akcpapguy · Post by **akcpapguy** » Wed May 23, 2007 12:29 am

Like everyone else here has said, this is currently not possible.

However, there is a large push from the Physicians for their to be some sortof "Lockout code" to be put in place that must be entered before you can access the setup menu. You can bet that the first company that puts this in place will recieve a big recommendation from a large majority of doctors.

I know atleast 1 of the major suppliers of CPAP's already has this developed on their software and are currently testing it.

I know this news does not bode well for users of APAP who like closely monitor their AHI and tweak their pressures.

I am not endorsing this type of change, i am merely reporting what I have been told.

blarg · Post by **blarg** » Wed May 23, 2007 1:41 am

akcpapguy wrote:I know this news does not bode well for users of APAP who like closely monitor their AHI and tweak their pressures.

Guess we'll just have to doctor shop until we find one that thinks we should actually get treatment. Their loss.

Oh, and can I laugh now if you can just get around it by putting a new scrip on a card with Encore which we "shouldn't" have now anyway?

Wulfman · Post by **Wulfman** » Wed May 23, 2007 11:03 am

akcpapguy wrote:Like everyone else here has said, this is currently not possible.

However, there is a large push from the Physicians for their to be some sort of "Lockout code" to be put in place that must be entered before you can access the setup menu. You can bet that the first company that puts this in place will recieve a big recommendation from a large majority of doctors.

I know atleast 1 of the major suppliers of CPAP's already has this developed on their software and are currently testing it.

I know this news does not bode well for users of APAP who like closely monitor their AHI and tweak their pressures.

I am not endorsing this type of change, i am merely reporting what I have been told.

Some random thoughts.....

Gee....with all of this "sophistication", I wonder if they'll finally develop a way to set the internal time from the keypad? (if should happen to be Respironics)

Do the physicians feel THAT threatened? (their "control" over OUR therapy and the potential loss of income on their part)

That concept (of the physician changing or ordering changes of pressures) brings up an interesting situation.......that in most cases, the DMEs would still probably have to perform the changes. They would have to know the "secret code", too......

Over the past couple of years, we've been "blessed" with posters (usually anonymous "guests") who have stated/advised/warned that it's "against the law" for users/patients to change their own pressure. Yet, NONE have been able to cite ANY laws to back up their rhetoric. How can the manufacturers, doctors and DMEs enforce something like this if there are no legal restrictions on it?

"Talking out of both sides of their mouths".......On one hand, there are those who do studies of the "compliance" of this therapy.....or lack thereof (and then complain about the low numbers).....and yet (like the study "dsm" cited) those who become more knowledgeable about their therapy, have a higher rate of compliance. We've SEEN it here on this forum. Personal involvement equals better compliance.
How many times have we seen someone post (some variations of): "I wish I'd have found this forum sooner.", "I didn't know I had more options.", or "I gave up on my therapy and after finding this forum, I want to re-start it."?

Also, I doubt that that "secret lockout code" could be kept a SECRET.....for more than a couple of milliseconds.

'Nuff said for now......

Den

johntee · Post by **johntee** » Wed May 23, 2007 5:33 pm

Wulfman wrote:On one hand, there are those who do studies of the "compliance" of this therapy.....or lack thereof (and then complain about the low numbers).....and yet (like the study "dsm" cited) those who become more knowledgeable about their therapy, have a higher rate of compliance. We've SEEN it here on this forum. Personal involvement equals better compliance.

Couldn't agree more, Wulfman. As a new user (just over 1 week) who doesn't yet have the card reader, I can tell you that it's a shame the machines don't give you more useful information.

My wish list --
A "leak test" mode to let you know if you've got any significant leaks. (I fiddled with the Hybrid for 5 days, and never could get a decent seal, based on the overnight numbers and how I felt. But I couldn't distinguish any leaking before I went to sleep, partly because of the noisy exhaust. So I'd fiddle and hope I got it right, only to wake up in the morning and realize I had gotten no therapeutic benefit.

A daily number, rather than 7- and 30-day averages. I guess they don't want people micro-managing their therapy, but in the beginning days (or weeks or months), you need some feedback to determine (objectively) if you're doing things right and getting benefit. If you don't know that, many people would assume CPAP is just not the answer for them and stop trying to be compliant. (When it could be high leak rates, or pressure that didn't stop all the apneas, etc.)
As it is, I'm trying to calculate my daily numbers using the 30-day averages the machine's given me each day of the week I've had it. I thought I had a good formula to calc that, until today's Leak Rate calc'd at a negative 3.6 liters... I'm just going to take that to mean I've eliminated the leaks... (using OptiLife mask now).

When I get the reader I'll know more about what's happening, and if things need to be tweaked more. So I certainly hope the manufacturers "wake up" and realize if they take the software and readers away, they'll have more drop-outs (and thus less people to sell their overpriced --and non-refundable-- masks to).

_________________

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JimW · Post by **JimW** » Wed May 23, 2007 5:40 pm

Wulfman wrote:Also, I doubt that that "secret lockout code" could be kept a SECRET.....for more than a couple of milliseconds.

Unless, of course, each machine has its own personalized code...
Envision a black market for machines with codes included.

johntee · Post by **johntee** » Wed May 23, 2007 5:43 pm

Gee....with all of this "sophistication", I wonder if they'll finally develop a way to set the internal time from the keypad? (if should happen to be Respironics)

This is a bit of a detour on the topic, but --
On the Remstar Auto M, I didn't find any way to set a date/time... When I do eventually get the reader and software, will I see the machine's data corelated to time of day? Or will it be "Start + 1 hour, Start + 2 hour, etc., with no sense of the actual time of day?

(I go to bed at different times each day, so I can't just count the hours from, say, an 11PM bedtime to determine the real time an event happened.)

Wulfman · Post by **Wulfman** » Wed May 23, 2007 7:39 pm

johntee wrote:
Gee....with all of this "sophistication", I wonder if they'll finally develop a way to set the internal time from the keypad? (if should happen to be Respironics)
This is a bit of a detour on the topic, but --
On the Remstar Auto M, I didn't find any way to set a date/time... When I do eventually get the reader and software, will I see the machine's data corelated to time of day? Or will it be "Start + 1 hour, Start + 2 hour, etc., with no sense of the actual time of day?

(I go to bed at different times each day, so I can't just count the hours from, say, an 11PM bedtime to determine the real time an event happened.)

John,

The only way to "set" the time in the REMstar machines is to send it back to the factory. They are set to GMT at the factory. When you download the data from the card, Encore Pro converts your computer time zone to what is shown on the reports. Unfortunately, the internal clock on the REMstars "leaks" time.....somewhere in the vacinity of about a minute a month.....so it will eventually appear that you're going to bed EARLIER. The other side of that is it'll appear that you're getting up earlier, too.

Good luck,

Den

akcpapguy · Post by **akcpapguy** » Wed May 23, 2007 10:17 pm

Blarg,

I asked my friend (yes this information actualy came from a friend who is a Medical Maint tech for one of the major CPAP supliers, I have known him for 18 years, 10 of those spent stationed together in the military) if that was going to be possible, he didn't know forsure because his company doesn't use smartcards. (So now you know who he doesn't work for lol) But he did go on to say that he has been told by some of the software guys that the card reader can be set to WRITE only. If this is the case, then I would assume that putting in a new smartcard with a different script wouldn't do any good. However, I don't know enough about programming to know if that is a true statement or not. What's your take on that statement Blarg, could they program the card reader so that it is write only?
I also asked him specifically about the "Lockout code", he said that the code could be set by the DME, and could be individual for each machine. He also said that right now it is only being tested for a numeric code, but there are plans to test it for alpha/numeric.

Wulf,

Believe me I understand the frustration of people who like to monitor their data themselves and make corrections as they see fit, hence my statement at the bottom of my post stating that I do not endorse this type of change. I don't ever remember stating personally that changing your pressure is illegal. However IF someone brings their APAP to me for a pressure check, I am obligated to set the machine to their prescription that is currently on file. If I failed to do this, I would be fired. Ofcourse i am strictly talking about the DME that I work for and not DME rules or any state or federal laws in general.
As far as why Docs feel threatened, i have no idea. I do know though, that some Doc don't trust APAP's to correctly determine Apneas/Hypopneas, and thereofre consider them a useless Smoke and Mirrors show by CPAP companies to sell more machines. <shrug> Either way the decision doesn't really affect me, however I will closely monitor the situation since it will affect my patients.

LyleHaze · Post by **LyleHaze** » Thu May 24, 2007 4:27 am

My doctor was adamant that APAP would not "work for me" as well as the machine he intended to give me. (He had a room full of basic M series "plus" machines on hand).
He would seem much more credible if he wasn't dispensing the equipment himself.

As far as machine access, it seems to me like a real opportunity to make this work better. instead of "smart cards" and proprietary card readers, why not just program the xpap to dump HTML formatted charts and graphs onto any USB flash drive that is plugged in? This would be _MUCH_ more accessible to users that want to track their numbers, and would not offer them access to the "settings menu" that the doctors want to keep private.

Yes, I know that writing an embedded USB host can be a bit tricky, but if that's the biggest hurdle, I'm sure they can handle it. I wonder how many charts can be stored on a $20 1 Gig memory stick?

But, I'm not in charge today, and I doubt my idea will result in a job offer from any XPAP makers.

Time to go to work.
LyleHaze

Wulfman · Post by **Wulfman** » Thu May 24, 2007 6:09 am

akcpapguy wrote:Blarg,

I asked my friend (yes this information actualy came from a friend who is a Medical Maint tech for one of the major CPAP supliers, I have known him for 18 years, 10 of those spent stationed together in the military) if that was going to be possible, he didn't know forsure because his company doesn't use smartcards. (So now you know who he doesn't work for lol) But he did go on to say that he has been told by some of the software guys that the card reader can be set to WRITE only. If this is the case, then I would assume that putting in a new smartcard with a different script wouldn't do any good. However, I don't know enough about programming to know if that is a true statement or not. What's your take on that statement Blarg, could they program the card reader so that it is write only?
I also asked him specifically about the "Lockout code", he said that the code could be set by the DME, and could be individual for each machine. He also said that right now it is only being tested for a numeric code, but there are plans to test it for alpha/numeric.

Wulf,

Believe me I understand the frustration of people who like to monitor their data themselves and make corrections as they see fit, hence my statement at the bottom of my post stating that I do not endorse this type of change. I don't ever remember stating personally that changing your pressure is illegal. However IF someone brings their APAP to me for a pressure check, I am obligated to set the machine to their prescription that is currently on file. If I failed to do this, I would be fired. Ofcourse i am strictly talking about the DME that I work for and not DME rules or any state or federal laws in general.
As far as why Docs feel threatened, i have no idea. I do know though, that some Doc don't trust APAP's to correctly determine Apneas/Hypopneas, and thereofre consider them a useless Smoke and Mirrors show by CPAP companies to sell more machines. <shrug> Either way the decision doesn't really affect me, however I will closely monitor the situation since it will affect my patients.

The card reader functions (of the existing ones available), whatever it does depends on the software controlling it and the type of heads on the reader. If they have both read and write heads then the program can control either. When a device "writes" data, it has to send an electric charge to the device. Remember, the values of the electronic bits are either on or off....1 or 0....and depending on how they are arranged depends on the value of what information they're writing......letters or numbers.

Yes, I understand the "requirements" of the DMEs setting pressues, etc. What has been the argument of some of the "mysterious guests" (going back as long as I've been on the forum) is that the individuals are not allowed to change their own pressures. This is inconsistent with patients such as diabetics who control their own insulin levels/doses or other medications that doctors/pharmacies trust us to take as prescribed..

As far as the accuracy of these machines...... I doubt that the companies would invest the amounts of money they did on this technology for "smoke and mirrors" (sales), and I'm sure they tested them at length before putting them on the market. HOWEVER.....assuming that they're reasonably accurate, I believe they at least serve as a "benchmark" for our therapy. And, it's definitely cheaper than having to go to the doctors all the time.....who only seem to ask......"How are you feeling?"

Den

blarg · Post by **blarg** » Thu May 24, 2007 6:32 am

akcpapguy wrote:What's your take on that statement Blarg, could they program the card reader so that it is write only?

Most definitely they could. The statement I made was specific to Respironics machines. With encore, you can create a new prescription. Basically the idea is that if the smart card is sent in for compliance checking, and the doc sees something that (s)he wants to change, then all they have to do is stick a new scrip on the card and send it back out to the patient. The patient then inserts the card and the new settings are transferred to the machine. Pretty handy for doctors that actually manage their pateints' therapy. No trips to their house or anything.

It's entirely possible, however, for a manufacturer to write the software without this feature. I just thought it would be funny if it were Respironics and they left that feature enabled, because I'd just use Encore to give myself scrips then.

akcpapguy wrote:I also asked him specifically about the "Lockout code", he said that the code could be set by the DME, and could be individual for each machine. He also said that right now it is only being tested for a numeric code, but there are plans to test it for alpha/numeric.

Well, this just gives all of us more incentive not to use our B&M DMEs if they're not going to be helpful. I'm sure that if I bought the machine from an online vendor, they wouldn't have set a code.

When will they realize that anyone who wants to change their pressure settings WILL, regardless of how many walls they put in place to stop it? There will always be a way. There has to be, because the DMEs need to service the machines.

Locked out

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Re: Locked out