"please keep me updated about oximeters "
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Ruminations on Home Testing's Emergence in the Market
excerpting from a private conversation i had with a friend (on a no-names basis to protect the identity of the innocent ;-)
"I support the HST as an additional tool. I also see it as an easier way to get more people diagnosed. If the insurance companies use it as a replacement to the PSG instead of an additional tool I see more problems on the horizon for sleep. You have to see that this system is about what is best for the insurance companies, and has very little to do with pt care. I support the HST, but I am not so sure about the Watermark program. If this program were to catch on I believe it would be a step backwards in pt care as far as sleep is concerned. Everything would be done remotely via the primary care physician and Watermark. Under their system not once in the process would the pt talk to an educated sleep anything. I believe that this system would give the DMEs more power while crushing all sleep labs other than hospital based. I understand that the HST may enable more people to get diagnosed. That is huge, but what will be the sacrifice? I wish I knew. What I do know is that it will not fall on Watermark, the physician, or the insurance company. That only leaves one player in this game to take the hit. The patient.
The key to getting more people diagnosed and treated is lowering the price of the REQUIRED test. Not coming up with cheaper versions that only encompass one sleep disorder. I know that 85% of all sleep patients are inflcted with simple apnea. 40% of those have other underlying sleep problems. If the HST and auto titration become gold standard a huge number of people may never get the treatment they need.
It is all about the pts. If you take care of them emotionally, mentally, and physically then they will take care of you financially. There are no shortcuts when we are gambling with lives. "
The key to getting more people diagnosed and treated is lowering the price of the REQUIRED test. Not coming up with cheaper versions that only encompass one sleep disorder. I know that 85% of all sleep patients are inflcted with simple apnea. 40% of those have other underlying sleep problems. If the HST and auto titration become gold standard a huge number of people may never get the treatment they need.
It is all about the pts. If you take care of them emotionally, mentally, and physically then they will take care of you financially. There are no shortcuts when we are gambling with lives. "
Views: 114
Replies to This Discussion
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Permalink Reply by Lee Longnecker on
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You really want to send more jobs over seas??
There arent any jobs left here as it is...you cant fish any more...no manufacturing left here....all we have left is healthcare and the service industry.Scoring may not be exciting...but it does employ people.
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I have done MANY un attended studies over the years. There are too many variables to home studies. One of the big problems are teaching the patients to use the equipment properly. A lot of people are intimidated by simple electronics. Most of the home studies turn out technically inadequate. Patient pull of probes and dont replace them. Some remove wires in there sleep and dont even know it. Not to mention that until now the devices available for home studies could NEVER be used by the patient, at home. They are too complicated for the masses. There is a place for un attended studies. But I dont think they can completely replace studies in the lab.
Banyon said:Here is 4 cents back to you Rock.
Your in-lab PSGs are not accurate. False negatives are a big problem for labs.
Dr. Barry Krakow has stated publicly that false negatives are such a problem in his lab that it has often taken three nights to diagnose patients.
Dr. Mack Jones has written about the extensive problems he had getting a diagnosis from in-lab PSGs.
You use equipment in your labs to make a diagnosis. The HST uses equipment to make a diagnosis.
Using infrared cameras and microphones to watch and listen to people sleeping rarely adds to the diagnosis.
People come into your lab anxious about a foreign experience in a strange envrionment. They do not sleep the same way, if at all, in your sleep lab as they sleep at home. Since they are not sleeping like they normally do, you have great problems with proper diagnosis and accurate titration.
Docs using in-lab PSGs and titrations give people a prescription for a pressure and if they become compliant, it is assumed everything is fine. The great majority of all patients could improve their therapy if they had a little education and a data-capable machine and patient software to use at home.
Sleep labs have no idea what the AHI of their treated patients is.
Your argument started out justifying in-lab PSGs with concern over the small percentage who don't have "simple" apnea. Now you find your argument crumbling, so in your latest post you reverse directions and are willing to disregard the "enigmas" as you now call them. Argue one way. Both doesn't work.
You know very well there is a huge population of undiagnosed. Getting them all in sleep labs for multiple night studies is extremely expensive and impractical and would take years while these people are left untreated.
Let's get multiple sets of HST equipment in every medical office in the country, get all the patients screened and send the positive screeners home with a HST unit.
Next we have to figure out a practical, inexpensive and quick way to get the positive testers titrated.
Don't get discouraged. There will be plenty of job opportunities for you in sleep medicine. Even if you want to continue doing lab PSGs, there will be plenty of job opportunities for you.
However, mass diagnosis of the population will not be done in labs. It will be done at home using HST or some other tools that have yet to be developed.
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False negatives have not been, and are not a big issue. They may not sleep as well one night over the next, which could change the AHI or severity of their apnea....However, some one with significant OSA will not have a night where he has no apnea. His RDI may be less but he is still going to have apnea, thus he will be treated. I think you over state the severity of false negatives....False negative on RBD...Sure, you can miss that....Not OSA
Lee Longnecker said:I have done MANY un attended studies over the years. There are too many variables to home studies. One of the big problems are teaching the patients to use the equipment properly. A lot of people are intimidated by simple electronics. Most of the home studies turn out technically inadequate. Patient pull of probes and dont replace them. Some remove wires in there sleep and dont even know it. Not to mention that until now the devices available for home studies could NEVER be used by the patient, at home. They are too complicated for the masses. There is a place for un attended studies. But I dont think they can completely replace studies in the lab.
Banyon said:Here is 4 cents back to you Rock.
Your in-lab PSGs are not accurate. False negatives are a big problem for labs.
Dr. Barry Krakow has stated publicly that false negatives are such a problem in his lab that it has often taken three nights to diagnose patients.
Dr. Mack Jones has written about the extensive problems he had getting a diagnosis from in-lab PSGs.
You use equipment in your labs to make a diagnosis. The HST uses equipment to make a diagnosis.
Using infrared cameras and microphones to watch and listen to people sleeping rarely adds to the diagnosis.
People come into your lab anxious about a foreign experience in a strange envrionment. They do not sleep the same way, if at all, in your sleep lab as they sleep at home. Since they are not sleeping like they normally do, you have great problems with proper diagnosis and accurate titration.
Docs using in-lab PSGs and titrations give people a prescription for a pressure and if they become compliant, it is assumed everything is fine. The great majority of all patients could improve their therapy if they had a little education and a data-capable machine and patient software to use at home.
Sleep labs have no idea what the AHI of their treated patients is.
Your argument started out justifying in-lab PSGs with concern over the small percentage who don't have "simple" apnea. Now you find your argument crumbling, so in your latest post you reverse directions and are willing to disregard the "enigmas" as you now call them. Argue one way. Both doesn't work.
You know very well there is a huge population of undiagnosed. Getting them all in sleep labs for multiple night studies is extremely expensive and impractical and would take years while these people are left untreated.
Let's get multiple sets of HST equipment in every medical office in the country, get all the patients screened and send the positive screeners home with a HST unit.
Next we have to figure out a practical, inexpensive and quick way to get the positive testers titrated.
Don't get discouraged. There will be plenty of job opportunities for you in sleep medicine. Even if you want to continue doing lab PSGs, there will be plenty of job opportunities for you.
However, mass diagnosis of the population will not be done in labs. It will be done at home using HST or some other tools that have yet to be developed.
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OSA does not come and go....you either have it or you dont.
Lee Longnecker said:I have done MANY un attended studies over the years. There are too many variables to home studies. One of the big problems are teaching the patients to use the equipment properly. A lot of people are intimidated by simple electronics. Most of the home studies turn out technically inadequate. Patient pull of probes and dont replace them. Some remove wires in there sleep and dont even know it. Not to mention that until now the devices available for home studies could NEVER be used by the patient, at home. They are too complicated for the masses. There is a place for un attended studies. But I dont think they can completely replace studies in the lab.
Banyon said:Here is 4 cents back to you Rock.
Your in-lab PSGs are not accurate. False negatives are a big problem for labs.
Dr. Barry Krakow has stated publicly that false negatives are such a problem in his lab that it has often taken three nights to diagnose patients.
Dr. Mack Jones has written about the extensive problems he had getting a diagnosis from in-lab PSGs.
You use equipment in your labs to make a diagnosis. The HST uses equipment to make a diagnosis.
Using infrared cameras and microphones to watch and listen to people sleeping rarely adds to the diagnosis.
People come into your lab anxious about a foreign experience in a strange envrionment. They do not sleep the same way, if at all, in your sleep lab as they sleep at home. Since they are not sleeping like they normally do, you have great problems with proper diagnosis and accurate titration.
Docs using in-lab PSGs and titrations give people a prescription for a pressure and if they become compliant, it is assumed everything is fine. The great majority of all patients could improve their therapy if they had a little education and a data-capable machine and patient software to use at home.
Sleep labs have no idea what the AHI of their treated patients is.
Your argument started out justifying in-lab PSGs with concern over the small percentage who don't have "simple" apnea. Now you find your argument crumbling, so in your latest post you reverse directions and are willing to disregard the "enigmas" as you now call them. Argue one way. Both doesn't work.
You know very well there is a huge population of undiagnosed. Getting them all in sleep labs for multiple night studies is extremely expensive and impractical and would take years while these people are left untreated.
Let's get multiple sets of HST equipment in every medical office in the country, get all the patients screened and send the positive screeners home with a HST unit.
Next we have to figure out a practical, inexpensive and quick way to get the positive testers titrated.
Don't get discouraged. There will be plenty of job opportunities for you in sleep medicine. Even if you want to continue doing lab PSGs, there will be plenty of job opportunities for you.
However, mass diagnosis of the population will not be done in labs. It will be done at home using HST or some other tools that have yet to be developed.
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Permalink Reply by Banyon on
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What Dr. Krakow and Dr. Jones have written about false negatives in the sleep lab is very convincing.
I am curious whether you guys ever have any negatives in the lab and if so, what you did about them.
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Permalink Reply by RockRpsgt on
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I have never had a false negative. None of my pt's have ever had to have a repeat study due to tech or equipment error. A big part of our job is trouble shooting. I take that part as serious as any other. I too have read all of the research studies as well as Dr. Mack's book. I am not saying that they are wrong. They do have supporting data. I just have not seen the false negatives that they talk about. I also have not had the same level of postive results from the HST units. That is not to say that I have not seen good results from them. My experiences are along the same lines as Lee's. As far as the Watermark goes I have only seen it here and through their own marketing campaign. None of the labs in my area, or any of the techs I know have had a chance to play with them. I do find that odd. If I had built a better mousetrap I would want the people with the most experience to test them for me. Doctors, scientist, and researchers do not perform sleep studies. They did however create the job of the sleep technologist to do so.
Banyon said:What Dr. Krakow and Dr. Jones have written about false negatives in the sleep lab is very convincing.
I am curious whether you guys ever have any negatives in the lab and if so, what you did about them.
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Permalink Reply by Amy on
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jsut another little thought...what about the pts we find with other issues, plms, bruxism , rem behavior disorder. Not to mention the other things we have found in labs such as cardiac arrhythmias, seizures and nocturnal asthma.
I do think that home sleep testing is good in some patients but not all.
I also think that the issue of titration on cpap is not all that well addressed. I do like auto titrating cpap for some patients but it is not a full proof way of getting pts compliant. As a tech, scorer, manager I can tell you we spend a lot of time with the patient prior to the study and also during the study to get to right mask and pressure that a pt can tolerate and still fix the osa.
I will not comment on the Watermark model because I really do not know enough about it to make an informed decision about them.
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Rock Hinkle said:I have never had a false negative.
Banyon said:What Dr. Krakow and Dr. Jones have written about false negatives in the sleep lab is very convincing.
I am curious whether you guys ever have any negatives in the lab and if so, what you did about them.
Thanks Rock, but my question was not about false negatives. It was about negatives.
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I do not think that I understand your question. What negatives are you talking about?
Banyon said:What Dr. Krakow and Dr. Jones have written about false negatives in the sleep lab is very convincing.
I am curious whether you guys ever have any negatives in the lab and if so, what you did about them.
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In this case, "negatives" mean patients undergoing a single in-lab PSG who then get a diagnosis of normal breathing while asleep. "Positive" would mean the PSG shows they do have SDB.
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If the MDs do their job prperly there should be minimal negatives.
Banyon said:In this case, "negatives" mean patients undergoing a single in-lab PSG who then get a diagnosis of normal breathing while asleep. "Positive" would mean the PSG shows they do have SDB.
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If someone makes it to us it's because they have acknowledged that something might be wrong. If not them, then their partners, roommates, or docs have taken notice to something. That is the only negative that I have ever experienced in conducting sleep studies. It is our job to find the source of whatever problem we are presented with. That is what the PSG is for. The terms negative or positive are subjective. There is always some useful info that can be taken from the PSG. Sometimes that info is negative and sometimes positive. this all depends on how the information is presented and how it is taken in. Like Lee says it is up to the doc to eliminate negatives.
I wish that I could explain to all of you how becoming a sleep technologist has changed me for the better. The time that I get to spend with my pts has become an addiction like no other that I have experienced before. The human vulnerability that is seen during a sleep study is overwhelming. The trust that my patients put in me is humbling. Until you have put a person in that situation and had them talk to you about the problems concerning their family, money, and stresses only to have it verified on the PSG screen you will never truly understand how important the PSG is. To have it downplayed by an actigraphy machine that only records six channels and removes all personal interaction is insulting to the profession and pts that I have come to love.
Banyon said:In this case, "negatives" mean patients undergoing a single in-lab PSG who then get a diagnosis of normal breathing while asleep. "Positive" would mean the PSG shows they do have SDB.
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