Speculation: EncoreAnywhere a patient-accessibility solution

This got long. Really long. Sorry.


Legacy situation (M-Series):
Respironics EncorePro and EncoreViewer have been the data accessibility products for the M-Series, with the Pro product aimed at providers and the Viewer product aimed at patients. EncoreAnywhere launched more recently, has support for the M-Series product, and thus far has been limited to provider access.


Current situation (PR-Series):
EncorePro and EncoreAnywhere have been updated to support data retrieval from the PR-Series. Availability of the updated EncorePro and EncoreAnywhere is formally restricted to providers only. EncoreViewer software has not been updated to support the PR-Series and there is no published plan for Respironics to support patient-accessible data.

User reports of phone calls and other inquiries regarding possible future patient-accessibility of therapy data recorded by PR System One are numerous, but rarely cohesive. The reports contain wildly differing release expectations, although more recently the expectations have narrowed down to be as little as one month away.



While I've seen it suggested (at least in part) before, I'd like to start this new thread dedicated to a theory that:
PhillipsRespironics intends not to update EncoreViewer, in favor of shifting patient access to EncoreAnywhere.

With a corollary of:
Providers will also be encouraged to shift from EncorePro to EncoreAnywhere as soon as feasible.


Now, it's not exactly earth-shattering to speculate that the newest product in any product family would be intended as an eventual successor to the previously existing products. Especially in the software world. But due to the current gap in *any* patient data accessibility solution for the PR-Series, or announced plans, as well as some ramifications of end users being force-shifted from a previously available solution involving a standalone software product to a web-based one with no fallback solution - and my personal interest in seeing my own data - I thought this to be a worthy topic to consider at length, and will start things off by sharing some of my thoughts on the subject.

(continued below as a three-part original post to break it up a bit)

Costs and focus. It's likely the case that EncoreViewer was based on EncorePro, and didn't represent much of an incremental development cost to produce. But when it comes to software, the maintenance and ongoing support costs can't be underestimated. A single unified product is often seen as a way to reduce overall support expenditures vs a fractured product line.

EncoreAnywhere seems designed (and branded) to be that unified product. Data only needs to be obtained once and then summaries are available to multiple parties (provider and clinician, currently). Adding patients as another summary client would seem to be a plausible next step. That feature may have taken longer to develop and test and approve for release to market though; requiring additional authentication (and billing?) features beyond what was supported in the initial EncoreAnywhere versions.

While I'm on the topic of versions… it's probably considered quite advantageous to support a SAAS (software as a service) product vs client-owned software. At upgrade time, you update your server clusters and you're done. Problem? Roll back. Try again after you analyze all the logs from the bad upgrade attempt. Is it always that perfect? Heck no! But it should be less messy than end client support anyway. And in the case of medical software, reduce the potential liability. What happens if you errantly release a software version into the wild that mis-interprets therapy data, and you can't seem to destroy all the internal memos about how the problem could lead to someone setting their therapy device incorrectly. Good luck tracking down all the copies!



Customer relationship. Despite what many of us want to think, Phillips Respironics has publicly affirmed a commitment to consider providers as the major component of their customer base, and the focus of their customer relationship efforts. Please lets not start a flame war here. That's the case, whether you happen to like it or not (I do not). Focusing on EncoreAnywhere is consistent with that affirmation, as EncoreAnywhere primarily supports providers. If EncoreAnywhere changes to include a patient accessibility component, it would most likely still leave providers in a position of power/control. Providers would be ideally positioned to manage the individual accounts permitted to access patient data. I can't think of anyone other than the clinician who might also be charged with this account association responsibility. If they were really slick and on the ball about it, PhillipsRespironics might find a way using certificates or cryptographic keys written by the machine to the SD card and use those to authenticate… no wait, that puts the responsibility (and liability) back toward the manufacturer. So, it's the provider or the clinician, and since the clinician is generally hoping for the provider to handle it - the provider gets it. Hope they realize that with responsibility comes…



Liability. Which is probably the major consideration. You could almost just replace that word with 'fear', and it drives a lot of product decision making, especially as you look higher up a management chain. Potential liability has touched almost every talking point I've put out so far, so i'll limit this section specifically to the big stuff. Respironics was recently purchased, right? Now it's Phillips Respironics, and I'll bet a whole dollar that at least one lawyer sitting on the Phillips side of the table during those buyout talks thought about potential liabilities that might be laying around, buried deep within this company they wanted to buy.
I haven't bothered figuring out if EncoreAnywhere was an existing project, or if it was a new project since the buyout. But regardless of which owner conceived of that product, EncoreAnywhere is specifically listed as HIPAA compliant, and I don't see that advertised for EncorePro or EncoreViewer. Maybe those products don't need to be, since they aren't quite as exposed to the internet quite as obviously as EncoreAnywhere, but regardless - you show management one product with a HIPAA sticker on it and another two without… guess which will get the green light and which will be roadmapped for sunset.

How about the patient perspective. As a patient, it creeps me out that I need to submit all data collected by the machine, anytime I want to have the possibility of viewing the therapy data personally. In a perfect world, I'd be able to separate the compliance data from efficacy data and submit compliance-only data to the provider. The therapy/efficacy data would be available for me to view anytime with no third party interaction or storage/retention, and I could directly decide to share relevant subsets of that data with my provider or clinician at my discretion.

Instead, I find it disturbingly likely that I'll be presented with a single option. Which is to submit all my data to the manufacturer-provided data center, where the data is interpreted and summaries made available to my provider, my clinician, and me. Note also that those definitions of "my provider" and "my clinician" are designated by someone else - presumably by my actual provider?
All of which exists today with the exception that I only get to see my data in printout format. Oh, and I can only get the data to that data center by handing my SD card to my provider and having them upload it (they erroneously refer to it as downloading).

So the big enhancement I'm predicting is that PhillipsRespironics will eventually update EncoreAnywhere such that my provider can grant me an account (at whose recurring cost?) for me to access EncoreAnywhere from my computer, and that it'll accept the data from my card, attached to that computer. Thus saving me a trip to my provider, allowing me to do the updates more frequently (daily) and look at my data on my computer screen rather than via provider printout. OK, so while that actually sounds kinda close to the level of convenience I want… I somewhat detest the level of privacy I would have to concede. I've got to trust everyone else with my data. And no, that HIPAA seal of approval really doesn't convince me! That's designed to protect other parties, and only marginally protects my data. I have no compelling reason to share my therapy/efficacy data with anyone else, besides who I choose to. But this system would remove any or at least most data sharing decisions from my purview. It might not even work if I don't have an ongoing provider, and may require them billing at regular intervals.

And how do I know the manufacturer is protecting the data at that center. Sure it's required by law. But laws get broken every day. And data protection isn't some exact science. I'm not even particularly convinced that the manufacturer wouldn't use the data themselves. It'd have to be awfully tempting while spending real dollars on test and certification efforts that a comparatively gigantic warehouse of real-world data was just sitting there nearby. The lure of convincing just the right folks that "oh yah, we'll anonymize the data before we analyze it" would just be lingering out there for someone to exploit to do more with less budget. It's happened. People have been caught doing exactly that.

So yah, I guess I can be labeled as a bit more tinfoil hat than most - but even without the privacy issues that crawl under my skin… there's still the issues of cost and complexity. If the provider must be involved, that's more complex than it needs to be. If the provider isn't involved, who bills for the cost of this service?

I suppose I'm getting ahead of myself here, as I don't know if anyone's even going to agree that EncoreAnywhere represents a likely patient-acessibility solution. But if it is in their plans, to the exclusion of a solution more like EncoreViewer, then I've got more questions and concerns than I've got actual relief that my wait for software should finally be over soon.

What do you think?

Speculation is futile for all but an Arbitrageur.

The fact that Encore Pro 2 is readily available to anyone may inhibit the future charging for software which enables one to utilize all the features of a product as designed and advertised.

When one buys a product, why should one have to pay again to access its features? Costing of the various models, Pro vs. Plus in this situation should have covered the costs associated with both hardware and software production. The software development is actually a subset of the software development efforts accomplished in the provider software development. Incompatibilities with Microsoft latest operating systems and no Apple support are key issues, but as the provider version and virtual machines are readily available, the issues are surmountable.

Sleep well and prosper!

FinceMgr wrote:Speculation is futile for all but an Arbitrageur.

heh, I'm not an investor - just was stressing (irrationally) about my AHI trend and some recent large leak time reported on the LCD. So frustrating to see problems, know there are tools to investigate/analyze with, but not have those tools. I focused on my lack of those tools and my increasing depressing thoughts they might never be available in the way I wanted. Feel a bit ashamed about that now, really.

FinceMgr wrote:The fact that Encore Pro 2 is readily available to anyone may inhibit the future charging for software which enables one to utilize all the features of a product as designed and advertised.

I was out of town for the holidays and had missed your Dec24 posting. You win two internets. Appreciate it immensely.

FinceMgr wrote:When one buys a product, why should one have to pay again to access its features? Costing of the various models, Pro vs. Plus in this situation should have covered the costs associated with both hardware and software production. The software development is actually a subset of the software development efforts accomplished in the provider software development. Incompatibilities with Microsoft latest operating systems and no Apple support are key issues, but as the provider version and virtual machines are readily available, the issues are surmountable.

Couldn't agree more. That's how it should be. And yes, those surmountable issues are nearly trivial to me. Strolled right thru 'em. Even if i did still have a physical PC lying around with XP installed, I'd still have only used a VM with no networking interface active. That's just how i roll.

FinceMgr wrote:Sleep well and prosper!

Thank you! I'm doing much better today. Focusing my OCD^H^H^H 'attention' on my personal data analysis instead of focusing it on "what if they never release Viewer, and why the heck has Pro 2.x still not materialized online". Feeling better already and looking forward to a more restful night tonight.

I might do a little more posting today about Vibratory Snore and its possible relation to Large Leak, but at least I should be posting more related to what other folks on this board care about, instead of scaring almost everyone off. Really can't state enough how much I appreciate your response to this post and your other postings related to the larger topic, which I had somehow missed. Thanks.

It's easy for me. Don't even have to read these posts. Just don't buy or recommend a Respironics machine.

I can see where something like this could possibly work. Take your card out of your machine put it in your reader and send the data off, then put your card back in your machine. Wait we already have had that capability years ago it was when they put modems on the back of our cpaps. They stopped doing that because it didn't work.

Ok now jump forward and you have pt's who have viewer software and pt's who have the pro software. We do the smae as above but are able to see our data and some pt's like me email the pdf report or an actual copy of my data file to me DME. We also have people who don't care what their machine says, they only have cards in it so their DME can show the insurance company that they have been compliant.

I would think it would be best to allow the pt to download their own data view it and send a copy off to their DME. The DME gets the info they need and or want and so does the pt. The added benefit to the DME is they don't have to have that pt make a 30 minute appointment just to check their data. If their are problems or adjustments needed after reviewing the data then the appointment is made then.

Gerry

Gerryk wrote:I can see where something like this could possibly work. Take your card out of your machine put it in your reader and send the data off, then put your card back in your machine. Wait we already have had that capability years ago it was when they put modems on the back of our cpaps. They stopped doing that because it didn't work.

They kept modems as an option in the new PR-Series. That alone suggests they didn't stop doing it entirely. I imagine they may have had some unexpected issues at one point, but the modems are still available. Probably to address any existing cases they originally intended to address, plus the additional/future edge-case of someone without internet access (which applies to almost nobody on this forum, obviously) in the case my EncoreAnywhere suspicions are correct.

Gerryk wrote:Ok now jump forward and you have pt's who have viewer software and pt's who have the pro software. We do the smae as above but are able to see our data and some pt's like me email the pdf report or an actual copy of my data file to me DME. We also have people who don't care what their machine says, they only have cards in it so their DME can show the insurance company that they have been compliant.

All existing Viewer and all legally-acquired-by-patients Pro software (by definition limited to version 1.8 ) does not support PR-Series. The methods you describe above are indeed effective and reasonable. But only applicable up through M-Series and not beyond, for folks who choose to adhere to the official policies of the manufacturer regarding software.

For someone with PR-Series today, with no modem, those options you list are just not available. The patient needs to physically deliver the SD Card to their provider for any party to view/save/print a report. Other than manually deleting some of the files on that card first (not exactly a good plan if someone needs to demonstrate long-term compliance), there's no way to selectively share data with that provider - they get it all. And in original form (not a printed report) which is stored in their database (or the Anywhere database, as was the case for my DME), subject to their current and future data retention policies.

Gerryk wrote:I would think it would be best to allow the pt to download their own data view it and send a copy off to their DME. The DME gets the info they need and or want and so does the pt. The added benefit to the DME is they don't have to have that pt make a 30 minute appointment just to check their data. If their are problems or adjustments needed after reviewing the data then the appointment is made then.

We're certainly in agreement there. I just suspect that rather than update the Viewer software, which would closely align with what I (and what I think you) desire, that Phillips Respironics will update EncoreAnywhere to allow for patient accounts. And the same driver packages that were developed for that product to allow clinicians to perform "downloads" (I see as of today why they refer to it that way, I'll retain their backwards usage) will be used to allow patients with internet access and a browser capable of SSL/TLS [aaarrrgghgh, I just checked the requirements list. they're using Microsoft Silverlight. shoot me now] to perform "downloads" as well. New session data could be uplo^H^H^H^H "downloaded" as often as the patient chooses to sign in and attach that SD card, and then it'd be available to all authorized parties (patient, provider, clinician, MIB, etc.). At least that's my cautious, and undesired prediction.

It actually doesn't apply to me as personally anymore, since I have an alternate toolset as of today. So I may just let this prediction rest now and see what happens officially along with everyone else. I do remain convinced that I've got a pulse on their plans though, since it's just the kind of scheme that could be successfully pitched, regardless of its eventual deployment success. I'd be happy to continue responding on this thread, though if there's still interest.

I have had the very same concerns that Anywhere would bypass the patient completely. I encourage people to refuse any machine with a modem for that reason.

I was at an Awake meeting where they asked for a show of hands - how many have phones in their bedrooms? I think they also have a wireless plan for those who don't. I got the impression it would work much like the satellite companies use dial-up reporting for TV use. Remember - the bedroom is for sleeping

Now with the PR1 - it seems the DME's are actually pushing this product. Saying they are the latest and greatest. I think people should also refuse the PR1's until (and unless) user software is available - the same day - for their machine. Any promises will likely be broken and forgotten.

I think the software AND any required readers or other equipment should come in the box with the machine. I also think they should just use a USB drive. They could have the software loaded right on the drive.

I must be dreaming

"I had a dream" that one day the software would be loaded on a USB drive AND would be 'included' "in the box" with the machine - I HAD A DREAM!!
Gumby said it dreamit!!

Doze EP 1.8 was not sold to pt's. Their is a difference between pro and viewer. Viewer you just view hence the name the pro version allows you to change the machine setting, put reminders on the card put the prescription on the card and many more things but was not intended to be sold to the pt's.

Have you ever used a computer with a dial up modem? Granted this isn't a large file it is rather small, but it still takes time to dial up, wait for the other end to pick up and do a handshake and connect. Then send the data and confirm it then disconnect. I don't care what they say it will interfere with your phone. If you are on the phone you will hear it pick up and dial or if you are dialing when it is dialing god only knows where you just called.

As far as still having the modem option, if it has the modem option then it would also accept the smart card why not put one of them on there too. I am sure their are some people who use a modem but that is just an expense that the insurance companies aren't going to keep subsidizing. It will come down to send your data in or your card to show your usage or we come pick up the machine.

As far as what's on the damn machine as far as a data card or what not. I could care less as long as I get my data, put a pink elephant on it and purple pokadots.

Gerry

GumbyCT wrote:"I had a dream" that one day the software would be loaded on a USB drive AND would be 'included' "in the box" with the machine - I HAD A DREAM!!
Gumby said it dreamit!!

Amen to that!

There's no reason they'd even need the added cost of an extra USB drive or even a CD-ROM. The SD card that already comes in the box with with their sticker on it has plenty of room to spare. That SD card has 1GB capacity (in my case), and I've used ~8MB so far in almost 2 months. At that rate, it'll take me a decade to fill maybe half the card. Even if my estimate were off by a factor of double, triple or more... it will still take years to fill half that card. The other 500MB is more than enough room for a patient version of their software; they can make an installer much smaller than that. So without even changing their existing volume purchasing, or in any practical way limiting the holding capacity of their existing data cards, they could make that dream a reality!

The SD Card is UDF formatted (essentially the successor to ISO-9660, for those who care) and would be a fine place to put a patient software installer file. It can be read easily by both PC and Mac (hint, hint! that's a peek at my dream for software). The patient has to access the SD Card anyway to get to the data; why not put the software installer there too. Or if you were suggesting they scrap the SD card in favor of a USB card, that works just as well by me too. I would just want there to be one data device, not two; don't really care if it's SD or a USB flash drive as long as they pick just one.

Gerryk wrote:Doze EP 1.8 was not sold to pt's. Their is a difference between pro and viewer. Viewer you just view hence the name the pro version allows you to change the machine setting, put reminders on the card put the prescription on the card and many more things but was not intended to be sold to the pt's.

That's my mistake then regarding 1.8. Thought I'd seen that it was previously available (although no longer) to the public at large in Australia or something if I recall, and represented the last version that anyone outside the provider/clinician community could have legitimately acquired. I understand the similarities and differences between Pro and Viewer, and their target audiences. The fact that Pro's been updated and Viewer still has not been updated to support PR-Series is partially driving my suspicions about EncoreAnywhere, since it should have been so easy to produce a standalone Viewer product months ago, if that was anywhere on their software roadmap.

Gerryk wrote:Have you ever used a computer with a dial up modem? Granted this isn't a large file it is rather small, but it still takes time to dial up, wait for the other end to pick up and do a handshake and connect. Then send the data and confirm it then disconnect. I don't care what they say it will interfere with your phone. If you are on the phone you will hear it pick up and dial or if you are dialing when it is dialing god only knows where you just called.

Yah, modems are quite antiquated. No reason for most patients to have one, the exceptions being cases where it's unlikely for the patient to have a periodic internet connection and a computer that meets the EncoreAnywhere minimum requirements, and lives too far away to regularly travel to their provider/clinician. Probably not a lot of folks.

Gerryk wrote:As far as still having the modem option, if it has the modem option then it would also accept the smart card why not put one of them on there too. I am sure their are some people who use a modem but that is just an expense that the insurance companies aren't going to keep subsidizing. It will come down to send your data in or your card to show your usage or we come pick up the machine.

Full agreement there too. The scenario I've been talking about could significantly reduce the number of modem-included machines they'd need to sell. My prediction is that EncoreAnywhere will be extended to allow accounts for patients, and those patient accounts would closely mirror the previous capabilities of EncoreViewer, but with support for both M- and PR-Series. I think if we've had a disconnect, it might be that you're assuming I'm referring to a hypothetical patient accessible EncoreAnywhere that only includes the currently-available modes of data upload (via modem from home, or via card at a provider/clinician office). Rather, I'm expecting that if EncoreAnywhere is made available to patient logins, that the same card reader driver integration (they call it Data Card Server http://encoreanywhere.respironics.com/W ... server.htm) that happens between the EncoreAnywhere portal and the card reader at a provider/clinician office PC, will be available to the patient's PC at home too.

A patient would presumably log in to the EncoreAnywhere portal, and present a user/pass combo identifying them and bringing up their account details and the ability to view reports of any previously uploaded data. If connecting from a machine where they have sufficient administrative rights (presumably their home PC, though possibly also from a PC at work or 'anywhere' really) they could click to component-download and install the Data Card Server (requiring Silverlight) which would also let the patient upload their most recent data from the card. To the patient, after the Data Card component installation (probably not any more involved that what the full product Viewer installation would have represented) it would very much resemble the user experience of EncoreViewer,with the notable difference that they would have to have an internet connection, at least for most operations, with some offline capabilities possible depending on which Silverlight or HTML5 features the designers use. The advantages to the provider/clinician are that since the uploaded data goes to the online database (HIPAA-compliant, if you believe them) they get immediate access to that uploaded data as soon as any of their patients connect. Each time a patient makes an update to see their own data, all the other authorized users can see the updated data and run reports on that data as well.
Gee, wonder if the insurance companies will ever request direct access to that database too. Lemme think real hard on that. It's a real head-scratcher. Okay, the cynic in me is taking over, time to stop.

Gerryk wrote:As far as what's on the damn machine as far as a data card or what not. I could care less as long as I get my data, put a pink elephant on it and purple pokadots.

If my suspicion here is true, the data will indeed be patient-acessible from that card or any future elephant/pokadot interfaces. Patients just might need to cede that in order to look at their data, they will potentially implicitly and possibly unknowingly consent to it being uploaded to the manufacturer sponsored/hosted online repository as well. Probably a non-issue for most folks, really. Not my cupa tea though.

As a patient, I legally purchased Encore Pro 1.8 from cpap.com before it was pulled from the market.