Advantages and Limitations of Old and New Methods
From SD cards to WiFi to smartphone apps, the development of new technology has allowed sleep medicine providers to more conveniently and efficiently view patient data.
By Cassandra Perez
In recent years, new and increasingly convenient technology for PAP therapy data downloads has been implemented by manufacturers. In addition to added convenience, new transmission methods help achieve better communication between the patient, the treating provider, the insurance company, and the home medical equipment (HME) company. In many cases, they also encourage obstructive sleep apnea patients to play an active role in monitoring their own progress.
Angela Giudice, RPSGT, director of clinical sales and education for 3B Medical, says enabling a variety of data download methods is important because of the different capabilities and needs of physicians and patients. It’s not one size fits all. “Our customers and their patient base are in varied parts of North America,” Giudice says. “Some have easy access to lightning fast Internet and can take advantage of things like WiFi, and others live in areas where access is very limited to modern convenience.”
With consumer technology rapidly changing in the United States, such as the widespread adoption of smartphones, PAP manufacturers must evolve too. Jim Doty, senior director, field marketing, North America for Philips Respironics, says, “By having numerous ways of retrieving data, a durable medical equipment (DME) company doesn’t have to worry about being locked into one method of data retrieval and can adapt easier as new options become available or become the preferred method for patients.”
A newer data download method is smartphone-friendly websites and mobile apps. Jeremy Malecha, vice president of product management in Global Healthcare Informatics for ResMed, explains that the Air10 CPAP machines have built-in wireless communications capabilities that securely transmit therapy data to ResMed’s AirView and U-Sleep patient management platforms, as well as to the myAir patient engagement platform that allows patients to view their own data. The myAir smartphone-friendly site enables patients using Air10 machines to conveniently see their data on their smartphone (or laptop or desktop computer). Malecha says self-monitoring is an excellent way for patients to stay motivated, and the website has yielded positive compliance results.
Human Design Medical (HDM) also offers wireless smartphone-friendly data transfer. “HDM offers sleep data syncing via Bluetooth in the iOS and Android platforms with its Z1 Auto. The Nitelog App is available as a free download from the App Store and the Play Store,” says Steve Moore, general manager, sleep, of HDM. “After syncing with your handheld or tablet device, the sleep data can be e-mailed to a healthcare provider.”
Doty says that Bluetooth is not always compatible with all apps, although it is compatible with Philips’ DreamMapper patient management app, which has been shown to increase patient engagement in therapy.
For Drive DeVilbiss Healthcare, the SmartLink App is the most popular method for PAP data downloads. Brian Palmer, director of marketing, sleep, for Drive DeVilbiss, says, “Patient engagement in therapy has been shown in a number of studies to improve compliance. The SmartLink App not only provides a patient with easy to understand information about their therapy but also provides simple to follow help videos for basic needs.”
The IntelliPAP 2 from Drive DeVilbiss has three methods of obtaining data from the patient, with communication and downloads via a Bluetooth connection to the patient’s smartphone being the primary means. According to Palmer, with wireless communication via the SmartLink App and a patient’s smartphone, there is no additional cost to the patient or the provider.
A QR code is another smartphone-friendly method for data downloads. At 3B, the QR code works with a free app available on Apple and Android phones. The app asks the patient to scan for QR code report. The scan takes about 3 seconds, then a report (or series of compliance reports, depending on which code—overview or more detailed—is scanned) shows on the phone. Following the scan, the patient gets several options for the data, which can then be uploaded to the iCodeConnect record database. Giudice says, “QR code scanning is very fast and produces an easily decipherable report right on your smartphone. The app is free; the only downside is having to have access to the PAP machine to scan the screen.”
A significant benefit of wireless communications is the automatic transmission of CPAP treatment data. “Built-in wireless communications are the gold standard. They require no additional hardware and transmit CPAP treatment data automatically without burdening the patient or HME with additional tasks,” Malecha says. Malecha adds that wireless connectivity also enables HMEs to troubleshoot remotely, which can save money and time. Moore echoes a similar sentiment and says, “Syncing via Bluetooth and e-mailing a date range of data is by far the easiest method.”
Though wireless data transfer is a convenient choice, one disadvantage is that it is not an option for patients who do not have access to a wireless network.
Drive DeVilbiss utilizes a second wireless method called SmartCode, which is an alphanumeric sequence that provides summary information, such as usage and leak, remotely. “The benefit of SmartCode is it can provide patient information remotely no matter where the patient lives and whether or not a patient has cellular coverage or WiFi in their home,” says Palmer. “In addition, our SmartCode Rx feature can be used to remotely make changes to the patient’s pressure.” SmartCode technology uses a proprietary encryption method that allows therapy and usage data to be generated and compressed into onboard codes and appear on the PAP device display. The encrypted data codes can be communicated over the phone, e-mail, or text to generate compliance and clinical reports. SmartCode technology is included in every Drive DeVilbiss model device.
The drawback of SmartCode, according to Palmer, is the patient needs to provide a code for this technology to work and the data transmitted is summary data only. However, as sleep medicine professionals can get data from 100% of patients, data can be retrieved remotely, and the patient is able to track their own therapy, this technology can offer several noteworthy benefits.
Cellular Modems and WiFi.
Cellular modems and WiFi are two additional wireless methods for the transmission of patient data. A built-in cellular modem is a device that adds wireless 3G or 4G connectivity to a PAP machine. The built-in cellular modem allows therapy data from the CPAP machine to transmit to a cloud-based patient management system. Giudice says a cellular modem is an excellent tool that can work almost anywhere and has been a constant in the PAP industry for years. Giudice explains, “Cellular is always ‘ON,’ it requires zero patient interaction, and is a great alternative for those situations where a patient may not be comfortable with using technology.”
However, Palmer says downsides include that this method does not increase patient engagement and it can add additional costs to PAP units.
With regard to WiFi-transmitted downloads, Palmer explains that WiFi allows healthcare providers to retrieve data remotely, making it a convenient option. However, he says this method does not cover all patients, and a notable disadvantage is the need to set up WiFi in a person’s home or have a patient figure out how to connect WiFi if they do not already have it. Giudice also says patient access to WiFi is a primary drawback of this method, and says this option may not make sense for people with no home Internet access though “statistically those numbers are quickly dwindling.”
Many patients already have WiFi and smartphones, allowing for a multitude of different PAP data download methods. But for those who don’t have these capabilities, setting up WiFi and/or smartphone access exclusively for PAP may not be realistic.
For patients and healthcare providers who prefer manual downloads, USB and SD cards remain options on many devices. For example, ResMed Air10 and S9 machines have SD cards available. Drive DeVilbiss offers a built-in SD card for its IntelliPAP 2 for physicians who want to see detailed data. Palmer says, “If a physician wants to see the high resolution flow data, then the SD card is the most efficient means of downloading this type of data.”
SD cards have the ability of working with 100% of patients—they work whether the patient has Internet or other connectivity—and the data obtained from them is typically more detailed than that available via wireless methods, Palmer posits. According to Doty, SD cards also allow data to be readily handed off to sleep medicine professionals, another advantage.
Additionally, computer software programs can enable transmission of data via wired connections. For example, HDM offers Data Viewer for its Z1 CPAP and Z1 Auto. Patients use the HDM-provided USB cable to connect their PAP with their personal computer. The data is so transferred and then uploaded into the Data Viewer program, which is a free download on HDM’s site. Data Viewer allows for both patient viewing and provider viewing of the data.
Manual methods, such as transferring data from PAP to laptop via USB cable, are tried and true
The drawback of both SD cards and USB stick downloads is slower speeds and the inconvenience of manual involvement, according to Malecha. However, he says they may still be necessary options for certain patients. An additional drawback of SD cards may be financial costs. Palmer says there is more logistics involved and potentially more cost involved in getting the SD cards back from patients.
Giudice adds that SD card downloads can be frustrating because most patients will have to mail or hand deliver the card, making the data transmittal more inconvenient than via other methods. Doty agrees and says there are many steps and a lot of interaction with the card and device when SD cards are used, which may be a possible disadvantage.
A telephone and interactive voice response (IVR) system called iCode with IVR are additional download tools, both of which are offered by 3B Medical. “iCode with IVR is available anywhere you have a phone. It works internationally, on a landline or a cell phone,” Giudice explains. “The voice recognition feature is easy to use and the call walks the patient through gathering the codes off of the PAP machine.” Giudice cites having to physically get the iCode off the machine as the only drawback of this particular system.
Popularity of Different Download Methods
According to Malecha, cellular connection has been the best received by patients as well as HME providers. “At ResMed, we favor built-in cellular communications because they create a seamless connection between patients and their caregivers, allowing data to flow unobstructed to the people who need it when they need it,” says Malecha. “They also help an HME streamline its business. When cellular is built in and ready to go, HMEs don’t need to worry about juggling multiple connection options and modules.”
According to Moore, Nitelog is the most popular offering from HDM “because of the ease of syncing with a tablet or smartphone.”
Giudice says the popularity of download methods varies in different area demographics, but believes the most popular methods are cellular, WiFi, and QR code. Giudice cites the availability and ease of uploads for the popularity of cellular methods, while WiFi allows a patient to access the data anywhere an Internet connection is available. For healthcare providers, Giudice says the QR code is very popular, particularly when physician offices ask for PAPs to be brought in during a patient appointment.
Cellular appears to be the most popular for customers of Philips Respironics because it is straightforward and requires no action on the patient’s part, according to Doty, adding that WiFi is increasing in popularity. “WiFi is beginning to gain ground because of the added features WiFi can offer. This feature includes more frequent calls during the day, which allows for more seamless prescription changes and nightly waveform therapy reports for DMEs and physicians as opposed to cellular, which provides only weekly reports,” says Doty.
Technology for the Future
With more advanced download methods available for therapy data, there is a possibility of older techniques being phased out. Malecha says, “As built-in wireless connectivity becomes more and more popular, USB sticks and other traditional methods will phase out. As technology improves, so too will the options for efficient and secure data transferring.” But others predict alternative future scenarios.
Palmer expects cellular modems to be phased out over the next 5 years. Palmer says, “This method is too costly and unnecessary given that smartphone usage continues to grow and provides better, and more user-friendly, interaction. The built-in cellular modem cannot provide this type of patient engagement.”
Doty says none of the methods will be phased out in the future, but predicts more widespread use of WiFi. “It is likely we’ll see a shift from a predominantly cellular modem market to WiFi. With WiFi becoming easier to use and the increase in households having WiFi, it will begin to overtake cellular as the option of choice,” says Doty. “We would like to see WiFi continue to grow since downloading and streaming of video is easier via WiFi and opens up the doors for many new features and designs in the future that would benefit both patients and DMEs.”
Giudice also does not believe any of the available data download methods will be phased out. “We don’t think any of these ways will be phased out simply because not all patients, doctors, clinics, or DMEs have access to all ways of accessing data. The reasons are endless and devising new and inexpensive or free ways of capturing data is the only way to ensure that patients’ needs are continually met,” Giudice explains.
In the future, smartphone apps may increase in importance. Palmer says, “I’d like to continue to see more adoption of smartphone apps for the benefits of providers and patients. Providers not only benefit with getting data wirelessly transmitted, but also have an additional resource in the patient’s pocket to provide help to the patient.”
Of course, there is also the likely possibility that future data downloads will be transmitted via methods that are yet to be invented. “With all the new developments in technology, the sky is the limit for PAP data recovery and transfer. I think we are only starting to devise ways to transmit that data,” says Giudice.
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