Key Resources and Best Practices for Sleep Labs Amid COVID-19 Pandemic
(Last updated: 3/24/20)
In light of the COVID-19 pandemic, sleep labs are facing a variety of new challenges and many unanswered questions. The American Academy of Sleep Medicine has been updating its COVID-19 FAQ section on a daily basis.
The EnsoData team wanted to highlight and provide valid resources to help answer some of the recurring questions that we are hearing within the sleep medicine community.
What we’re hearing from the sleep medicine community:
Overall, our data is showing a slight decrease in PSG and HST testing volumes across the nation.
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During the COVID-19 emergency, many patients will be at home and taking special notice of their health for a number of weeks. We’ve heard a number of groups suggest they will seize this opportunity by ramping up phone or text-based CPAP adherence programs. A randomized trial published in 2015 indicated the potential benefits of a phone-coaching program.
“[Our] study shows that Sleep Apnea/Hypopnea Syndrome (SAHS) patients who benefit from phone coaching are statistically more compliant to CPAP than a standard support group is. A simple phone coaching procedure based on knowledge of the disease and reinforcement messages about treatment benefits helps to improve CPAP adherence in SAHS patients.”
Sedkaoui et al. BMC Pulmonary Medicine (2015) 15:102
Another study on this topic is linked here:
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Speaking with several independent HST facilities, we have anecdotally heard cases of both an increasing and decreasing testing volumes depending on factors like referral source. Groups who rely heavily on referrals from Dental affiliates have most notability seen a decrease in volume with most dentists’ offices closing at this time in locked down cities. On the other hand, some groups who advertise online or leverage multiple referral channels have seen a slight increase in HST volumes.
Currently, the three most commonly asked questions:
1. Should sleep facilities, including independent laboratories, decrease or halt non-essential services to limit exposure?
In some states with anticipated acceleration in community-based spread, some independent sleep laboratories are canceling non-essential diagnostic testing until otherwise advised by their health system and local, state and CDC officials. (read more here)
2. Should sleep facilities stop dispensing HSAT devices while COVID-19 is spreading?
Some sleep laboratories are dispensing HSAT units through mail delivery to reduce patient contact, while others are suspending services for a limited time, with decisions made on a case-by-case basis. (read more here)
3. Is enhanced cleaning/disinfection of CPAP, HSAT and PSG equipment needed in response to COVID-19? Is soap and water enough to disinfect a CPAP mask?
AASM recommends following manufacturer recommendations* and using existing CDC guidelines regarding cleaning and disinfection. Upon a patient’s recovery from COVID-19, it may be advisable to replace filters, given the lack of data regarding the possibility of re-infection.
Keeping it clean: CPAP hygiene (Philips)
How to clean your CPAP equipment (ResMed)
Telemedicine Capabilities and Resources:
On March 17, CMS expanded payments for telehealth services during the COVID-19 Emergency. The key highlights are:
- In all areas (not just rural), established Medicare patients in their home may have a brief communication service with practitioners via telehealth mediums
- In all types of locations including the patient’s home, and in all areas (not just rural), established Medicare patients may have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals.
- HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype
Learn more about the CMS Telehealth Expansion here.
Prior to the announcement, we heard a few customers with existing telemedicine programs tell us they plan to shift to remote visits if clinically appropriate and if insurance allows. Others told us this emergency will be the catalyst for starting one. If your sleep lab has closed, or you are seeing a decrease in volume, this may be the perfect time to explore how to incorporate a telemedicine program.
We’ve assembled some information and resources available to all the AASM accredited labs about how to get started with telemedicine.
- How to start a sleep telemedicine program
- Developing a workflow plan
- Understanding hardware and software needs
- Business aspects of telemedicine
- Regulatory, Legal, and Ethical Considerations in the Implementation of Telemedicine
The full AASM Telemedicine Implementation Guide can be found here.
Sleep labs can get access to a telemedicine portal called sleepTM here. AASM accredited labs have access to sleepTM for free. Other telehealth options are:
- Signal: A free app that offers encoded messaging and video systems, Signal is safe and easy to use. You can find step-by-step instructions for conducting your first session with the Signal app here.
- VSee: Any app that satisfies the guidelines put forth by the National Institute of Standards and Technology is certainly appealing. VSee also enjoys widespread use in numerous government agencies, furthering its reputation as a safe and secure option.
- Doxy.me: While it doesn’t have a security level sufficient to meet the National Institute of Standards and Technology, Doxy.me still has plenty to like. Small businesses and solo practices can use the base version for free, while larger practices can take advantage of the perks available in the paid alternative.
