Wireless Monitoring Thoughts

[thecpapguy!]

http://cpapguy.blogspot.com/2016/05/wir ... rtant.html

**I have just been talking with some patient's about what wireless monitoring actually is, so I put a topic of it on my blog. I just wanted to share. Just for reference I only speak about the manufacturers wireless monitoring software and download software available - nothing to do with self monitoring home through a program such as sleepy head. If you are looking into doing monitoring at home then do a search of the forum for more information!**

Depending on what brand of positive pressure device that you own it may have the capabilities to have wireless monitoring. Some of the more modern machines have these components built into the actual chassis while most of the older models have an external drive that attaches to a specified port allowing these machines to communicate wirelessly. This technology varies between manufacturer as well with some companies offering wireless download possibilities and others not. Regardless of these fun facts, the question maintains whether or not wireless monitoring is something beneficial and should new positive pressure therapy patients seek out equipment providers with these possibilities? In short terms, my answer is yes.

First and foremost, I have a pet peeve when it comes to this particular capability and let’s be clear. Wireless monitoring technology has been available for years. Developed in the late 1990’s and put into place in the early 2000’s positive pressure machine manufacturers have been using it to enhance the overall satisfaction of therapy for over a decade. The reason that this is a point of interest for me is that a lot of technicians, respiratory therapists and providers like to market it stating that this technology is incredibly new and cutting edge. However, it has been available for years. The only point I would make is that the technology available today, compared to a decade ago, is much easier to use, provides more data to providers and is much better at tracking compliance. So, what the technology does in that context is certainly cutting edge, but only due to the advances made since first established. If you need further proof, look at the diagram I found on the right. I don't think the electronics in the diagram is exactly current!

Now! On to the more important question. My short answer is yes, but let me explain. I have seen the studies and unfortunately to print them and look at them again I must pay to do so (a whole other blog topic). So I don’t have these studies to show and quote, only retaining from my memory. Regardless, CPAP users that have used the wireless monitoring, versus not, showed a higher compliance rate to using their positive pressure device. That is a pretty rationale way of saying that wireless monitoring will help with the acclimation of wearing a mask throughout the night with pressure applied!

Some new patients are intimidated by this feeling that it makes the CPAP even more intrusive than what it has to be. After all, you have to wear an interface with air sent to you throughout the night. Who would want to invite even further discomfort? Wireless monitoring is not intrusive and is rarely ever even noticed. Being monitored via wireless does not mean that any provider can see you as you sleep or access your banking account! It simply means that whenever needed that the durable medical equipment (DME) company and assigned provider can evaluate your positive pressure currently without you having to bring your machine, or data card, to them.

Veteran patients with older model machines may qualify for the use of wireless monitoring as well, depending on your DME provider and specific model of positive pressure device. The new models of CPAP, Auto-CPAP and Bi-Level all have these capabilities and it is entirely up to the DME providers to purchase the technology - or not. This cost would typically be inclusive to the price of the CPAP unit. For example: A new patient receives a new Resmed Airsense 10 Autset CPAP and the DME provider has purchased the wireless capability making the wireless monitoring possible with no further cost to the patient. This concecpt may change for a patient seeking to utilize wireless monitoring with their dated machine. The Resmed S8, S9, and Airsense 10/Aircurve 10 series all are capable along with the Respironics M-Series, System One, and Dream Station. The Fisher and Paykel Icon is the only machine made by "F&P" that has these capabilities. An external wireless module is attached to a port on the machine transmitting the data to the manufacturer assigned program. (it should also be noted that this must be done through a DME provider, you cannot private purchase for wireless monitoring) These older models may not have this "inclusive" pricing and the patient may have to pay an out of pocket an fee to utilize the wireless monitoring.

Regardless to if you are a new patient or a veteran user this technology simply makes everything work more smoothly for both the patient and providers. I know that can certainly sound like a sales pitch, but I feel that it is true. If you are having any problem with using your positive pressure therapy, then a download of your nightly use is crucial. So, think of it this way. If you were to call your provider with questions or concerns your provider can complete a download of your data while you are speaking with them, adding more information for them to review. With the information off of the machine and your communication, a clearer picture can be constructed; this will provide a better chance for a patient’s comfort and compliance.

Wireless monitoring also helps with reimbursement through insurance. A great number of issues require medical equipment companies (DME) to provide a download of information from a new patient’s CPAP device showing whether or not the patient is using the machine over a specific date span. With wireless downloading available this information can be downloaded and submitted easily without any contact with the patient.

Also, to be completely clear - there is a difference between the wireless monitoring systems and the mobile application used by positive pressure users in the more modern machines. These applications provided by manufacturers work on a more personal level and do not communicate with your providers in the same manner. So this information is about the wireless monitoring system for your CPAP providers, not the applications for personal use by patients!

So, these are my reasons for wireless monitoring and the strengths that it provides. For a brand new CPAP user, it may be pivotal for clearer communication. However, for a patient that is a veteran to positive pressure therapy it could be less valuable. Regardless of your situation, it can be hard finding the right provider to give you the machine you wish to receive. So before moving forward with purchasing your new positive pressure device do your research and decide if wireless monitoring could be an important factor for you!

I provided a list below of the wireless monitoring technology provided by Resmed, Respironics, and Fisher and Paykel. It will depend on the provider of your choosing to which of these wireless monitoring services that they use.

Sleep well!

[Arlene1963]

Even though I own my CPAP machine (long story) I decided to go along with a recommendation that I try out a local company here after an overnight titration at a hospital, and so I'm currently using their loaner machine with wireless monitoring.

I haven't found it at all invasive. To me, nightly monitoring adds another layer of reassurance that my treatment is optimal without me having to stress about it. I love this!

So yes, I agree with your assessment of wireless monitoring.

EDIT: I've changed some info here a year later, because I was too new to know better when I originally posted this. Now I am much less keen on wireless monitoring and think patients need to be shown how to take care of themselves from the start!

[Sonnyboy]

Hi "thecpapguy",

My comments below are not directed at you. Obviously you care about your patients and do your best to stay on top of things, however, in general my concerns regarding wireless monitoring include:

1. " without any contact with the patient."
Is this the ultimate goal? How can therapy possibly be evaluated without the patient?

2. This forum works because members are hearing directly from the patient, reviewing graphs when needed, and there is continual oversight by the more experienced members, not to mention operating twenty fours hours a day, 7 days a week for members who need help.

3. A patient working for my DME, not a respiratory therapist, set-up my equipment and gave me instructions on use.
I had to show this patient instructor how to get into the clinician model to change settings. I knew how to do this because this forum taught me the importance
of entering this mode to check to make sure I wasn't being given a used machine. How do I really know who in the office is
evaluating my therapy through the wireless device and if they are qualified to do so? Are they going to change my settings without my permission?

4. I always get copies of my medical records and in your scenario it almost sounds like signed DME records need to be a part of the permanent medical record and
accessible to patients.

5. Are new patients getting a false sense of security that they are being taken care of?

[chunkyfrog]

I agree with Sonnyboy.
Few of us are privileged to have a caring, competent caregiver like thecpapguy.
The rest are reason enough for some of us to be wary of Big Brother medicine.
Some even resent the most minimal invasion, fearing the effects of unseen meddling by
someone who may easily be unqualified, uneducated, or even uncaring.
My DME provider is competent and seems to be trustworthy,
but I choose not to expect much in the way of "extras", as I know they are overworked, too.

[jnk...]

Wireless Monitoring Thoughts

Please stop wirelessly monitoring my thoughts.

I don't just wear this tin-foil hat for looks, ya know.

[jnk...]

. . . whether or not wireless monitoring is something beneficial

Any tool can be used or misused, depending on many factors related to the user of the tool. So to me, that question is as meaningless as "whether or not a knife is something beneficial."

Most DMEs in the US, in my opinion, have failed to use the tools that they all already had for patient health. So to me, the nature of DMEs needs to be addressed more so than the nature of what technology tools may or may not be available to provide them more information to ignore. Until you replace every DME employee with people educated enough and paid well enough in a system designed to financially reward someone to care about long-term patient outcomes, technology is a moot point. If there is no money-into-pocket motivational mechanism in place to ensure proper implementation of protocols based on efficacy data received by ANY technological means, that has to happen before the nature of the technology becomes relevant.

The payers are not going to pay for something that will require widespread DME education for widespread adoption on all machines sold by all DMEs, so I file it under sales gimmick. And the broken system cannot be fixed by a technological gimmick that is mostly in place for the convenience of DME people who care only about getting compliance figures for the purpose of getting paid. In other words, it was designed for DME convenience in getting paid and not for long-term patient health. Yes, certain wireless approaches may help to offset the problems of DMEs being too lazy or incompetent or disengaged to remember to download the proof of compliance the old way to send it to the payers. But my point is, if so, sell it to the DMEs, not the patients.

I have seen the studies

Were they double-blind using the average DMEs out there? If not, they are meaningless too, since they weren't conducted in the world we live in.

Just my opinion.

[BlackSpinner]

All of that assumes that there is an intelligent trained person on the other end looking at the data. My experience is that the janitor probably knows more then the DME employees.

As far as I am concerned the whole DME/insurance argument is a load of crap. Your profit is not my concern.

[thecpapguy!]

Hi "thecpapguy",

My comments below are not directed at you. Obviously you care about your patients and do your best to stay on top of things, however, in general my concerns regarding wireless monitoring include:

1. " without any contact with the patient."
Is this the ultimate goal? How can therapy possibly be evaluated without the patient?

My reference to having no contact with the patient is in regards to the billing of the positive pressure device. Instead of having to have an in-office download down (by possible negligent and uneducated technicians) and wasting the patient's time, this "compliance" download only completed to show that the patient is using the therapy to submit to insurance can now be completed with no hastle to a patient. I don't agree when wireless monitoring is completed without any contact to the patient. I couldn't agree more with you that the ultimate goal should not be little to no contact.

2. This forum works because members are hearing directly from the patient, reviewing graphs when needed, and there is continual oversight by the more experienced members, not to mention operating twenty fours hours a day, 7 days a week for members who need help.

I'm not trying to read to far into thoughts, but am I highly unexperienced? Or is your reference simply saying that wireless monitoring can be easily completed by utilizing this forum with like more educated individuals than you would find in a medical equipment company?
I don't work in DME any longer. I work for a sleep physicians office primarily with all positive pressure patient's and as a sleep technologist during the night. Within two weeks I will be a certified technologist. Hopefully I can offer some help to a patient along the way. That is why I love this forum despite most negativities.

3. A patient working for my DME, not a respiratory therapist, set-up my equipment and gave me instructions on use.
I had to show this patient instructor how to get into the clinician model to change settings. I knew how to do this because this forum taught me the importance
of entering this mode to check to make sure I wasn't being given a used machine. How do I really know who in the office is
evaluating my therapy through the wireless device and if they are qualified to do so? Are they going to change my settings without my permission?

No guarantees here at all. However, there are some good technicians in the world and some bad ones. If a user finds a good one then the wireless monitoring may be beneficial. If not, CPAPtalk.com it is.

4. I always get copies of my medical records and in your scenario it almost sounds like signed DME records need to be a part of the permanent medical record and
accessible to patients.

To my knowledge, this wireless download should be printed and placed in the patient's record. I couldn't agree more with you.

5. Are new patients getting a false sense of security that they are being taken care of?

I think there are equipment companies in the industry that use the wireless monitoring system to either lure patient's for money with negligent care and there are some that don't.

[thecpapguy!]

All of that assumes that there is an intelligent trained person on the other end looking at the data. My experience is that the janitor probably knows more then the DME employees.

As far as I am concerned the whole DME/insurance argument is a load of crap. Your profit is not my concern.

I would agree with you, that the profit of the DME company should be at the least of any users concern. However, compliance should be at the upmost priority and sometimes when a download can be completed with little intrusion to the patient (pending every situation of course) it streamlines the process. I feel, in my opinion, that the overwhelming number of DME companies has failed the general patient population. It is despicable. Not only in patient care, but in the billing process of the positive pressure unit. The bill is submitted very late, inaccurate and the cost to the patient is higher than should be; or lower than should causing even further problems. So, with the access to compliance information much easier it is possible that the reimbursement process is easier for these companies. In turn the billing is processed easier making the experience for a new positive pressure therapy patient likely much more satisfactory.

And I do not work for a medical equipment company. I worked in that field for nearly ten years and currently work with a sleep physician assisting in the psotive pressure patients and also as a sleep technologist. I have no profit on this subject.

That is a long way of saying, "DME sucks, but maybe there are some things that can help".

[DreamStalker]

No offense cpapguy but some patients are generally less interested in their own health management than the for profit motivated health system ... and no amount of intervention by a DME or sleep doctor's office will help them become more compliant cpap users.

As others have noted, initial education of the patient by the doctor is at the root of any level of compliance or the lack thereof.

And speaking of "root" -- did you know? Something that the vast majority of doctors have forgotten, is the root origin of the word "doctor" -- which comes from the Latin word docēre ... it means "to teach".

[thecpapguy!]

No offense cpapguy but some patients are generally less interested in their own health management than the for profit motivated health system ... and no amount of intervention by a DME or sleep doctor's office will help them become more compliant cpap users.

As others have noted, initial education of the patient by the doctor is at the root of any level of compliance or the lack thereof.

And speaking of "root" -- did you know? Something that the vast majority of doctors have forgotten, is the root origin of the word "doctor" -- which comes from the Latin word docēre ... it means "to teach".

I would agree with you, certainly. However, I do think that wireless monitoring is a technology that can be used to not only help a user with assuring the process of adherance to his/her machine is somewhat more simple.

It seems that I have uncovered yet another topic that most users seem to dislike.