We have chain of custody bracelets for the In Home Sleep Testing devices (IHST’s) that one of our medical staff watches the patient put on via Facetime, Skype, or Facebook Messenger video chat. They verify the patient’s identity via driver’s license or other forms of ID and then watch the patient apply the bracelet. If a bracelet is cut off then the test is invalid and won’t work. Should an employee not have access to one of the methods above we will work with the employee to find a medical provider in their area that will affix the bracelet and sign a chain of custody affidavit stating that they applied it to the correct person and verified the identification of the individual.
ApneaLink studies will be performed on all patients. The sleep coach will educate the patient on how to use the equipment when they call to get the chain of custody bracelet attached. The equipment consist of a belt that wraps around the patient’s chest, a finger probe that attaches to the chain of custody bracelet, and a nasal cannula inserted into the nose and also picks up mouth breathing to decrease the number of retests. Tape is included into each unit so the equipment can be taped into place to keep it from coming off.
The patient will be able to change the batteries and use the device the following night. The chain of custody bracelet will need to remain on the patient the following day, but should not pose a problem if worn during the day.
We contract with board certified sleep medicine physicians in areas where these individuals reside. These same physicians will interpret the record and make him/herself available to go over the report and provide long-term care. The sleep physician will prescribe Automatic Continuous Positive Airway Pressure (APAP) for the patient diagnosed with Moderate to Severe Obstructive Sleep Apnea. We provide this treatment program along with compliance reporting.
If Rocky Mountain Sleep Disorders Center provides the APAP, then all patients will be monitored to make sure they maintain compliance. A chip inside of the APAP device allows us to track, monitor and even troubleshoot anywhere the patient is. Reports can be sent to the employer showing that the patient is complaint with their APAP as often as they deem necessary. It can be setup to automatically be sent to the employer at regular intervals or the employer can request them when they want them.
The APAP devices automatically download to the cloud based system daily when the machine is turned off. The CPAP machines run off cell towers for getting the information into the system. Should the patient live or travel to an area where cell service is not available for download then a chip can be inserted into the machine which would then be sent in for download at determined intervals. Once the chip is reinserted then it will acquire all the data that is on the machine while it was not in. ResMed, the manufacturer of the S10 APAP device, has contracted will all cellular towers world-wide, which decreases the need for the chip. Almost all of the United States has the capability of having the machine download via cell service. The patient would have to live in a very remote location for this not to work.
We have personnel on call that will help the patient trouble shoot the machine and equipment 24/7. Our respiratory therapist goes thru the entire setup and use of the equipment with the patient when they initially receive the APAP. Ongoing support is available at any time for the patient.
We monitor all patients to make sure that APAP is correcting their sleep apnea. If we notice a download showing that APAP is not effective in treating their sleep apnea, then the patient will be referred back to the sleep physician and a formal in lab titration study may be necessary.
If we are billing insurance it can take 2-4 weeks for the insurance to authorize the study if a prior authorization is needed. If no prior authorization is needed or we are billing the company directly for the study then the equipment can be sent out as soon as the employee contacts RMSDC to confirm their information and a date for testing is arranged with the patient.
Once the equipment is sent generally via USPS, it takes 2-3 business days for the patient to receive the equipment. The sleep coach will be available that night if that is when the patient wants to do the study.
Typical turnaround time from when the IHST is sent to the patient to when the report is available is less than 2 weeks. If the patient wears the device on the night he/she received the unit, and then ships it back to us the following morning, the entire process can take one week or less. Typically it takes 1 week for the machine to be sent out, the patient to do the test and then for the patient to ship it back. Then the report is scored/reviewed by a sleep technologist and then sent to one of our contracted sleep physician’s for review and interpretation.