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7/7/2010
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Telehealth Helping Patients Sleep Better

As medical technologies and health IT evolve, so too is the use of web-based, remote diagnostic and monitoring tools that allow clinicians to test and track patients for illnesses at home. But for some patients, telehealth advancements are also bringing a better night's sleep.

As medical technologies and health IT evolve, so too is the use of web-based, remote diagnostic and monitoring tools that allow clinicians to test and track patients for illnesses at home. But for some patients, telehealth advancements are also bringing a better night's sleep.While devices like glucose meters and weight scales can help clinicians remotely monitor the condition of chronically ill individuals at home, the emergence of wireless, web-enabled testing devices are starting to make new diagnoses possible too.

Not only can the telehealth devices allow at-home patients to be monitored and cared for while they're in more familiar, comfortable environments than a hospital or doctor office, but the remote testing can be a lot less costly than the services provided in traditional healthcare facilities, too.

Such is the case for testing of obstructive sleep apnea, or OSA, a serious condition in which patients stop breathing while asleep.

In OSA, a patient's air passageways relax and narrow during sleeping, sometimes closing completely, Dr. Lee Surkin, a cardiologist and sleep specialist with practices in Greenville, N.C.

The brain, when deprived of oxygen, wakes the patient sometimes repeatedly, leading to sleep deprivation and other health concerns.

In some instances, OSA can even lead to death. For instance, OSA can worsen heart problems in some patients. Also, sleep disturbances are also believed to play a role in the eventual development of other health issues, such as type 2 diabetes, as patients age, he said.

Typically the testing for OSA takes place in sleep labs and involves a polysomnography, or PSG study. During a PSG evaluation, a patient spends one or more nights sleeping in a sleep lab, while being observed by technicians and hooked up with wires to equipment that monitors breathing, heart rate, and a host of other biometric measures.

However, in Surkin's practice over the last six months, the doctor has been using at-home devices from Watermark Medical called the Apnea Risk Evaluation System, or Ares, to test dozens of his patients for obstructive sleep apnea.

"There are actually about 80 different sleep disorders," said Surkin. The testing done with Ares can help diagnosis OSA, the most prevalent form of sleep apnea, as well as two other forms of sleep apnea.

Unlike sleep lab testing, the at home testing using Ares allow patients to sleep under their own roofs--without a handful of wires being attached to the body-- which helps provide medical specialists with a more accurate look at the patient's typical night sleeping in their own bed, without restrictions to tossing and turning, Surkin said.

The Ares testing device includes a cap that adjusts to size to fit snugly on the patient's head. The cap has built-in sensors that monitor air flow, body position, effort breathing, oxygen saturation, heartbeat and several other biometric measures.

The recordings are stored in the device, which gets returned to the physician's office. While most ARES tests require only one night of monitoring, the device can be used to store data for up to three nights of monitoring.

The patient returns the Ares gear to the physician's office. Data is transferred from the device to the doctor's computer via USB, and is then downloaded via the web to Watermark's servers, where the data is read analyzed by a team of board- certified sleep medicine professionals. Usually within 24 hours, full reports are sent to the patient's doctor, who makes the final diagnosis and determines the appropriate treatment. Typically, sleep lab tests often take several weeks to complete a report.

The at-home testing is much easier on the patient, and can also be used to track how treatments, such as oral devices places in a patient's mouth of nose mask worn at night, are working, said Surkin.

Because of the inconvenience and disruption of sleep lab testing, many patients suspected of sleep apnea decline the test or fail to show up at sleep centers , said Sean Heyniger, CEO of Watermark.

Ares also features an online survey that patients complete to help doctors screen whether an individual should undergo the at-home sleep test for OSA.

Also propelling at-home sleep testing, besides its convenience, are changes in how payers reimburse for sleep analysis, said Heyniger. About two years ago, the Centers of Medicare and Medicaid said it would cover at-home sleep testing, and that in-lab testing was no longer the only acceptable method to diagnosis sleep apnea, he said. This gave a green light to at-home sleep testing for OSA such as Watermark's ARES, he said.

The at-home testing is significantly less costly than lab testing. The costs associated with the Watermark Ares home test is about 10% of the in-lab sleep study, according to Watermark.

The average cost for a lab sleep study ranges from $1500 to $3,000, with the out of pocket cost for the patient around $700. However, the cost of a at-home sleep test using Watermark's Ares, the average at about $250, with the out of pocket cost for the patient around $40, according to a company spokeswoman.

In-home sleep tests have apparently caught the eye of CA Technologies, which recently infused Watermark with a $15 million capital investment. The equity investment is CA's foray into the emerging software-as-a-service-based healthcare cloud market, said Heyniger.

As part of its investment in Watermark, CA also now holds a minority stake in the company and two seats on Watermark's board.

InformationWeek has published an in-depth report on this year's Healthcare Information and Management Systems Society conference. This report offers the best healthcare IT advice, insight, and analysis coming out of that conference. Download the report here (registration required).

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