DME actively discourages use of software?!

[comstosf]

Howdy from a newly-minted hosehead!

In the month between my titration study and followup appointment, I did a fair amount of homework on the machines themselves & life with a CPAP -- including, of course, reading threads here -- so when I walked into my DME's office for the familiarization and training, I had a list of 11 questions on my iPad all ready for the asking. The DME praised me for doing my homework and asking the questions I did (one of which required a call to Respironics to answer)...except for asking about software to read my machine's SD card.

I was, in no uncertain terms, very strongly discouraged from attempting to read the data on my CPAP's SD card, even though I knew the EncoreViewer software was available. They stated that it was "too easy" to nuke the compliance data and/or change the settings; that if I downloaded the data from the card before they did, they wouldn't be able to download it on a followup visit.

I'm a computer programmer by profession & training, and I find their arguments (at the least) highly unusual, not to mention hypocritical given all the talk they threw around about patient empowerment & participation. How they expect me to be able to change the prescription/settings from a VIEWER application is itself very odd, particularly if the SD card is set read-only before I put it in my computer. If there are any possible problems indicated by the data, I'd really like to know about it before the next followup. Even though I told them I wasn't interested in fooling with the prescription or tampering with the data, they wouldn't budge, so I left it at that.

The only way their argument makes sense is if the CPAP itself will nuke the data after I reinsert the card, under the assumption that the data was downloaded when I removed the card; is this true? Even if it doesn't erase the data, will the machine squeal on me with something like a "card removed" event logged on the card after I put it back in the machine?

In any event, to avoid any complications, I don't plan on purchasing the software until the machine is paid for; I don't want the DME telling my insurance that I was "noncompliant" on that basis and socking me with the other half of the cost.

Thanks!

[Pugsy]

The only way their argument makes sense is if the CPAP itself will nuke the data after I reinsert the card, under the assumption that the data was downloaded when I removed the card; is this true? Even if it doesn't erase the data, will the machine squeal on me with something like a "card removed" event logged on the card after I put it back in the machine?

Geez, either DME is telling a bold faced out right lie or they are sorely informed. The RT at my titration study told me it was against a FEDERAL law for me to have the software. My DME knows I use the software and we talk about the reports often as I get over there now.

EncoreViewer is indeed read only software, it cannot or will not make any difference to any data the DME might obtain from the software. Removing it to check it yourself will NOT make one tiny bit of difference. There is nothing in the software that might tell on you for using software. They cannot tell if you removed the card or not from using it in EncoreViewer.

Now with EncorePro (which reports look just like EncoreViewer) there is the danger of erasing the card because during the upload of the data there is a default choice to "erase the card", so a person has to remember to uncheck that box before uploading data. I have done this once, last Sunday, wasn't paying close enough attention to what I was doing and my mouse click to remove the check mark didn't stick and the card got erased. That accident would be the only type of accident that might alert the DME to the user using software.

Hope this eases your worries about using the software, especially with EncoreViewer. They have zero way of knowing with this version of the software.

[roster]

. They stated that it was "too easy" to nuke the compliance data

Ditto what Pugsy said. Also the compliance data can always be checked from the display on the machine where it is never erased. In fact that is the way compliance data is checked on machines with no cards.

If my insurance company ever wants the DME to check my compliance, I am taking in my travel machine and my stationary machine with data cards left at home. The DME can check compliance from the two displays. As DMEs go they may need instructions on how to add the hours together.

I will never let any DME touch my data card!

Get what you can out of DMEs and medical professionals but ultimately you should be in control of your therapy as you seem to have learned quickly.

[mayondair]

You cannot nuke data or change settings using Encore viewer, you need Encore pro to do that . Your insurance company is not interested in your compliance as much as your DME(that's how they get paid) So if I were you I'd get Encore viewer and not worry. If you want to change your machine settings you can do it manually, just ask , search posts, or go to Apnea Board.com for a clinicians manual. The card will not snitch on a download, only a pressure change. If you want Encore pro, search topics or ask, someone will get you going.it is a bit fussier to use, does show waveform. DMEs are a good source of half truths, lies and misinformation, better to monitor your own data and not wait on them to download every few months or to care if your therapy is effective. JMO. kathy

[DocWeezy]

And in reality, your insurance company will NOT care if you tweak your own pressures....the DME will most likely try to give you a scare story, but the insurance company really doesn't care as long as they get reports that you are actually using the machine.

It seems like everyone makes more money when the patient is kept ignorant and passive. It's YOUR therapy and YOUR body and no one cares more about it working well than you do. Don't let someone else's preference for ignorant and passive patients keep you from taking control of and managing your own therapy.

Weezy

[HoseHedVet]

I've been a hose head for 10 years using Risperonics and ResMed stuff. Yesterday I received my DeVilbiss Intellipap AutoAdjust with Smart Flex. After 10 years I finally got a machine that I wanted instead of one that provided the best kickback to the DME.

The software, modules, cards, and cables available for this machine I believe will be able to provide my physician enough data to preclude another expensive sleep study. Like you my DME violently argued against the software and told me my insurance would not cover it. So be it. The price of the software package is less than a third of the out-of-pocket my last sleep study cost. I'm planning on buying the software package on my own and collaborating with my doctor without third party intervention.

DME's are dinosaurs headed for extinction in cyberworld. That's why they protest about us being able to take charge of our own health care so they can stay in the cash flow loop.

[Pugsy]

It seems like everyone makes more money when the patient is kept ignorant and passive.

This does seem to be the norm for most. So sad. I would think that it might actually improve sales if people would encourage patients to take an active role in all this. They make zero money if the machine sits in the closet. While a understand that some people might not care about data and are content to let the DME try to wave his magic wand, I just don't understand this reluctance to educate patients more if the patient wants to be educated.

Maybe it is a power struggle, maybe it is poor education on their part, maybe they are just doing things like it has always been done, maybe they are just plain lazy and don't want to have to try to work to figure things out.

[Lizistired]

You got the high level BS because you were informed. The low level BS is: "But your prescription is only for a CPAP."
What was the question they had to call Respironics to answer?
If I had waited for the powers to adjust my therapy.... I would be waiting next January.

[danimal71]

Since I switched DME's I don't need to bring them my sd card. They know I have the software and are fine with me printing out a download and emailing it to them. The first DME never asked me for the card.....I'm assuming that BC\BS Illinois didn't require it for a pay out on the machine as my machine has been fully paid for.

As long as you are informed they can't push you around. Know your rights and what you are covered\entitled for.

[DoriC]

Quote from DME when I asked about software - "Too much knowledge is dangerous"!! Of course!

[roster]

I would think that it might actually improve sales if people would encourage patients to take an active role in all this.

A great kernel of truth Pugsy!

The history of business shows in the longrun, those companies who are fully engaged in a partnership of mutual benefit with their customers are indeed the most profitable and the most enduring.

Of course that is in relatively free markets and may not apply in this heavily regulated market which favors the entrenched suppliers against us consumers.

[comstosf]

I can see them discouraging the purchase of EncorePro, which aside from pure cost, assumes a fair amount of technical knowledge on the part of the person installing it. Given that software's target audience (DMEs and sleep doctors), and the fact that it's usually professional IT departments installing & supporting it, I can (somewhat) live with that.

But EncoreViewer? That's kind of hard to swallow.

In the DME's defense, it could be they didn't know about the existence of EncoreViewer (which I somewhat doubt), or maybe they're simply unable/unwilling to take phone calls from patients asking about every little aberrant data point that shows up, or do tech support for the software itself; that's quite understandable.

As much as it would be wishful thinking, though, I would have preferred that they told me that directly and not try to cloud the issue with some garbage about nuking compliance data. But, like everyone's said, DMEs seem to like passive patients because they make more money. I suspect that if they were really that concerned about it, they'd put tamper-evident tape over the card slot and make people bring in the whole machine for followups. If they want compliance, they'll certainly get it from me; I know how important this is to my health & well-being and to that end, I'll certainly do everything within my knowledge and ability.

I know I'm not the first person to ask about it, because the place that did my PSGs and prescribed the CPAP (and who also run the DME I'm dealing with) said that they've had engineers who want to (or actually do) change the pressure settings. In fact, the next sentence out of their mouth when I was told that I was getting a CPAP was: "Now, these things have data cards in them. I know you're a computer programmer, but don't be tempted to fool with the card." Speaking for myself, I'd be pretty nervous changing the pressure settings without professional advice. But otherwise, I believe I have the moral (if not legal) right to know everything that's happening, or may/can/will happen. And let's face it, being able to analyze the data appeals to me professionally

As for the question that they had to call Respironics for, it was whether or not the machine had an altitude adjustment (it does). The other questions I had were answered quite nicely; in fact, in one case (hose management) they explicitly mentioned cpap.com

Thanks for your help and advice, I'll definitely be hanging around

[Janknitz]

They stated that it was "too easy" to nuke the compliance data and/or change the settings; that if I downloaded the data from the card before they did, they wouldn't be able to download it on a followup visit.

Welcome to the world of mushrooms where DME's want to keep you in the dark and feed you bullsh*t

Two things your DME was worried about:
1. They don't understand what Encore Viewer is and worry that there might be a loss of compliance data which means that they wouldn't get paid. After the first month (for MOST (not all) insurance companies, including Medicare) your compliance is documented, and the compliance data ceases to be important.

2. If you have access to your data, they can't charge you and your insurance company to download the data for you.

Good for you for not falling for the DME lies.

[roster]

I can see them discouraging the purchase of EncorePro, which aside from pure cost, assumes a fair amount of technical knowledge on the part of the person installing it. Given that software's target audience (DMEs and sleep doctors), and the fact that it's usually professional IT departments installing & supporting it, I can (somewhat) live with that.

At least as far as cpaptalk members are concerned, I find the level of expertise in dealing with software that runs on PCs is much higher here than the level of expertise in the doctors' offices, sleep labs, and DME offices that I have visited. And I have been in many medical offices (they are my clients) on business and a few as a patient.

But otherwise, I believe I have the moral (if not legal) right to know everything that's happening, or may/can/will happen.

That is the big, basic issue

Speaking for myself, I'd be pretty nervous changing the pressure settings without professional advice.

I know 13-year old diabetics who measure their blood sugar and determine dosage and timing of their insulin shots or adjust their insulin pumps. This is much more dangerous than adjusting one's CPAP pressure, however managing their own insulin is allowing these kids to lead a safer, healthier life.

With a little knowledge and the right tools (software), most CPAPers can tweak their machine settings and achieve an optimal therapy. Think about the sleep lab titration. They only had one night to get it right while you were sleeping in a strange environment with many devices hooked to you and strange people watching and listening to you. You were also experiencing CPAP for the first time. These are very difficult conditions under which to sleep and be titrated properly.

I spent three nights in certified sleep labs and they did not get the titration anywhere close to right and did not fully understand how my body was reacting to CPAP. Thankfully after a few weeks at home in my own bed using the software, I began to understand my condition better and changed the pressure settings to achieve a good therapy. I have shown my sleep doc what I did and after a combative first visit, she is now in agreement with my management of my own therapy and when I visit she asks, "Which copies of your reports did you bring me today? What settings are you using now?"

in one case (hose management) they explicitly mentioned cpap.com

Well your DME hit one homerun!

Good luck with the therapy,

[DocWeezy]

Speaking for myself, I'd be pretty nervous changing the pressure settings without professional advice. But otherwise, I believe I have the moral (if not legal) right to know everything that's happening, or may/can/will happen. And let's face it, being able to analyze the data appeals to me professionally

Everyone must work within their individual comfort zone. I was this way for about a week...then I discovered that it wasn't that difficult to start to understand the data, and to discover that my treatment was actually improving with some small tweaks. During my first follow up visit with my sleep doc, I told him what I was doing and what I had done and he was thrilled. So I asked him for the boundaries within which to adjust my pressures and machine settings without hurting myself, and his response was to do whatever I wanted because there was no way to hurt myself with the machine--the most that would happen would be that I wouldn't sleep well. I never did do anything extreme, just small tweaks with pressure ranges and comfort settings, and within a month I had found my sweet spot. It would have taken several months if I had had to wait for a doctor's appointment, then made a small tweak, and had to wait for another, etc. Because my beginning level pressures were too low (didn't sleep enough during titration study to get anything close to an accurate pressure), I may well have given up if it hadn't been for the knowledge gained here and truly taking control over my treatment.

I'm not trying to encourage you to do anything you are not comfortable with--far from it. Just wanted to let you know that as you learn more, your thoughts may change--it certainly happened to me! As the old saying goes: knowledge is power!

Weezy