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[Equipment] AutoCPAP w/o insurance - How to let doc have remote access?
#1
AutoCPAP w/o insurance - How to let doc have remote access?
Hi!

I'm new to the board. It appears to be a really useful place for sleep apnea patients to exchange ideas.

I was a respiratory therapist in the early 70s and used CPAP on premies in a NICU . Familiar with principles, though technology has obviously changed a great deal.

Last Spring I had an at-home sleep study done locally which showed extremely severe OSA, then had a bad experience with a DME supplier. I was astonished at how little they knew. They got pressures wrong , set me up with wrong type and size of mask, and then were unbelievably slow in correcting these issues. On top of that, the "rent" they charged under the insurance agreement was almost $300 per month with a minimum of 10 months before patient could exercise option to purchase! I could see a premium price being charged for equipment of this type if (and only if) the DME rep was capable and responsive. But 4-5 times the price? For getting the settings wrong and slow response?

I gave the device back to them, went to another doctor that wasn't affiliated with the local DME. Sleep study done at Johns Hopkins showed much less severe OSA with far less desaturation and far fewer events (which made more sense in light of how few symptoms I have -- no snoring at all with no headaches or fatigue).

Got back in touch with insurance. They sent me to another local DME. The rep there said the sleep disorder clinic at Johns Hopkins "got the order all wrong" and confirmed that I would have to rent the device for 10 months before I could buy it.

I could see where that was headed. So I ordered the same device (DreamStation AutoCPAP) from help medical supplies Commercial Link Removed a fraction of the cost. I didn't use insurance because they are worse than useless for this purpose.

So, finally, the question: Does anyone know who I can contact at Philips Respironics so that the wireless connection accessory on this system can be be made available on Encore so that the docs at Hopkins can connect to my system?

The sleep disorders clinic at Hopkins and I want to eliminate the middle man (DME) from this arrangement. They're happy with me controlling the system if need be. (I had to do that last Spring anyway.) Do you think Philips will help me with this, or am I going to have to just carry the SD card to Hopkins periodically? It would be easier if my docs there could actually see the data and communicate with me by phone concerning the data. I live several hours away.

Am I overlooking anything?

BTW, I've already titrated my starting pressure (up to 8.0 from the original 6.0) and got my AHI down from 20.0 to 1.6 within the first 10 days. Max pressure is set to 14.0, but there have been no actual pressure excursions above 9.6. I've used the system all night, every night with no problems other than a little dry mouth on occasion. Using under-the-nose DreamWear mask. Chin strap hasn't helped with dry mouth, but it's not a serious problem.

Thanks!
JP



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#2
RE: AutoCPAP w/o insurance - How to let doc have remote access?
(01-10-2019, 02:29 PM)japers Wrote: Am I overlooking anything?

E-mail attachments. Periodically, you remove card from machine, set write-lock tab, read card on computer, create zip file on disk of all card files, e-mail that zip file to doctor or nurse, remove card from computer, clear write-lock tab, put card back into machine. Doctor or nurse extracts mail attachment, unzips, and loads data into Encore. No Sneakernet required if both you and the doc or nurse are comfortable with doing it that semi-high-tech way.

OBTW, there's much more data available via the card than via the modem. Whether the doc or nurse wants that additional stuff or intends to do anything with it is another question.

P.S. Oh, yeah, welcome to the board.
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#3
RE: AutoCPAP w/o insurance - How to let doc have remote access?
I'll have to facepalm myself for not thinking of that. I could have checked with Hopkins to see if that would work for them.

Thanks for this, Fats. (Great screen name, BTW!)

Yes, I imagine they'll let me send the data that way. I think they were hoping some of the office staff at the clinic could use an Internet connection to access the device via Encore for official charting purposes. We don't have to do any of compliance stuff since insurance isn't involved, but they do put results from Encore right into the patient's chart.

Interestingly, my docs down there said that they use SleepyHead for analysis when dealing with a couple of patients who want to confer with them about results from use of that software at home. So, the Hopkins forlks are not like the docs near my home who apparently have drunk too much of the local water.

Maybe I shouldn't have bothered buying the wifi accessory.

It may take a little time to get this sorted, but I'll report back with what I learn.

I appreciate your help, Fats! Have a good day! You've made mine better!
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#4
RE: AutoCPAP w/o insurance - How to let doc have remote access?
You're welcome. By the way, in case this corrects a misapprehension, the wireless module is not wi-fi (802.11); it's a cellular modem. Your machine is never an Internet-of-Things device; it just makes a cellular call periodically to upload its data. The manufacturer (Philips or Resmed) stockpiles the data and makes everything available to the DMEs, indexed by machine serial number. The DME uses the manufacturer's server via the Innertubes. The doctor or nurse gets everything from the DME. Except in your case. Smile (And my case, and a bunch of others.)

That's also true of the Resmed machines. I haven't used the Philips machines, but I remember from another discussion here a few months ago that there is one big difference between the two: the Dreamstation modem actually calls a phone number that has been given to it beforehand, but a Resmed machine (Air10 or S9) simply communicates with the nearest (or strongest-signal) cellular site and IDs itself by its IMSI; it doesn't call a phone number, so it never needs or wants one. It also works worldwide.

But in neither case is it Internet communication, nor does the CPAP machine or wireless module have an IP address.

Also, with no cellular communication, you won't be able to use Dreammapper (Philips) or myAir (Resmed).
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#5
RE: AutoCPAP w/o insurance - How to let doc have remote access?
Since the dr.'s office uses Encore to d/l your sd card all they need to do is enter the serial number of your device in the "prescription" tab in the Encore profile they created. Once the serial # is in Encore the information will automatically go into your Encore file.

The dreamstation can utilize either a cellular modem or wi-fi modem. It is removable/replaceable unlike ResMed.
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#6
RE: AutoCPAP w/o insurance - How to let doc have remote access?
Yes, I saw the modem being offered online, but this is different.

In this case, the accessory I purchased is a DreamStation WiFi Access DOM. It's used by logging in to a locally available WiFi network using the WPA passkey. I know that it works over the Internet because the previous DreamStation from the first DME I used was the same. I monitored its activity directly with Airsnort and then monitored its traffic through my router.

Unfortunately, the device allows the user control only of establishment of the connection to the local network. It's data output is controlled entirely by the proprietary firmware / software onboard the DreamStation with no determination by the user as to where the data goes from the network. Apparently the first one sent data to the DME and to Philips. Got lots of dumb e-mails from both confirming that they were monitoring my compliance. Nice to know that I'm paying extra to have my privacy violated.

Can you guess that I'm a bit of an Open Source software enthusiast?

I'm guessing that this WiFi accessory may only have become available fairly recently? I know that the first DME rep kept confusing it with the cellular modem he had in his bag. I created a separate isolated network for the DreamStation because I didn't want I device I didn't control having access to my local network.

This DreamStation has Bluetooth built in, so DreamMapper does work with my Android phone even without a cellular modem or wifi donnection accessory. DreamMapper is pretty limited, though, isn't it? Though I guess it may be about as much as most patients may care about.

I hope to get some time soon to install SleepyHead on one of my Debian systems and start examining it and using it to analyze my data. The software is available directly from the main software repository on this GNU/Linux distribution. Very convenient.

Also, the process of getting my OSA treated has been pretty simple, so far -- once I got past the insurance company and the first couple of DME suppliers.

Again, thank you for helping make sure a newcomer keeps his feet on the straight-and-narrow. It's a scary world out t here. I find myself a little dismayed that my insurance company and the local medical supply companies were obstacles instead of helpers in this process.

Best regards,
JP
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#7
RE: AutoCPAP w/o insurance - How to let doc have remote access?
(01-10-2019, 03:34 PM)dmeRT Wrote: Since the dr.'s office uses Encore to d/l your sd card all they need to do is enter the serial number of your device in the "prescription" tab in the Encore profile they created.  Once the serial # is in Encore the information will automatically go into your Encore file.  

The dreamstation can utilize either a cellular modem or wi-fi modem.  It is removable/replaceable unlike ResMed.

So the folks at Hopkins only have to enter the serial number themselves? Nothing has to be done by Philips? That's great!

I'll let you know how it goes.

Many thanks!

JP
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#8
RE: AutoCPAP w/o insurance - How to let doc have remote access?
(01-10-2019, 03:37 PM)japers Wrote: Yes, I saw the modem being offered online, but this is different.

In this case, the accessory I purchased is a DreamStation WiFi Access DOM.

Oho! I stand corrected. Thanks, I didn't know that the 802.11 option was available. That's one for Resmed to catch up with. Cellular came first for the CPAP manufacturers because relatively few patients have had a wireless LAN, so requiring 802.11 access for reporting compliance data would be absurd. ("Here, you must learn all of the super-technical stuff in this manual by next Thursday, or else the insurer will repossess your machine.") Actually I doubt that that'll change much. Many patients are old enough and non-computer-geeky enough that they don't know or care about 802.11, and why should they? That's why wi-fi is merely an option and cellular is preferred. Personally, I prefer the "None of the above" option.

I was also forgetting about Bluetooth, which Resmed also doesn't have yet (no big loss AFAIC). That gives you the same numbers that you can get from the machine's display (as does Resmed's myAir), possibly with the exception of long-term graphs of AHIs constructed from those archived numbers. If you'll be using Sleepyhead, you've got much more than that covered.
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#9
RE: AutoCPAP w/o insurance - How to let doc have remote access?
(01-10-2019, 03:37 PM)japers Wrote: I hope to get some time soon to install SleepyHead on one of my Debian systems and start examining it and using it to analyze my data. The software is available directly from the main software repository on this GNU/Linux distribution. Very convenient.

Possibly fun stuff:  AB Software Support Forum, thread "Sleepyhead Version 1.1.0 TESTING Beta"

(and future relevant threads for future versions)
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#10
RE: AutoCPAP w/o insurance - How to let doc have remote access?
Funny thing about the Bluetooth. Since the DreamStation came with it, I stuck the DreamMapper applet on the Android phone my wife makes me carry. (Don't get me started on "smart" phones.)

When I went to connect the DreamStation to the Android phone I was dumfounded to see that there were 6 other devices with suspiciously similar identifiers within Bluetooth range. I live in a condo with lots of other old people around. Tee-hee.
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