With telemedicine becoming a part of the healthcare landscape, the AASM establishes guidelines for its use in sleep medicine.

Telemedicine, or the use of telecommunication and information technologies to provide clinical healthcare, is quickly becoming a part of the healthcare landscape. The American Academy of Sleep Medicine (AASM) recently released a position paper for the use of telemedicine in sleep medicine in the Journal of Clinical Sleep Medicine. The AASM Taskforce on Sleep Telemedicine supports telemedicine as a means of advancing patient health by improving access to sleep medicine specialists, but says this improved access must be anchored in attention to quality in sleep disorder diagnosis and treatment. As such, the taskforce has developed specific guidelines intended for sleep medicine practitioners who may want to integrate telemedicine into their practice.

Telemedicine: Guidelines, Benefits, and Limitations

According to the AASM, as the number of those seeking healthcare expands and the number of healthcare professionals lessens, more efficient and accessible ways to provide services beyond the traditional office model are needed, especially in sleep medicine. Safwan Badr, MD, staff physician at the John D. Dingell VA Medical Center and the Detroit Medical Center and professor and chief of the division of pulmonary, critical care, and sleep medicine at Wayne State University School of Medicine, says via e-mail, “Sleep is important to overall health and through the use of these new telemedicine recommendations, board-certified sleep medicine physicians can reach new populations as telemedicine grows. By increasing the reach of our specialists, more individuals will be able to seek help.”

Telehealth applications are increasingly seen as tools to deliver cost effective care and increase accessibility, and sleep medicine already utilizes telehealth applications for the diagnosis and monitoring of sleep apnea. Badr, an AASM past president, adds, “Telemedicine is growing in popularity based on the increasing use of technology and the consumer demand, and it is important that sleep specialists are prepared. Based on the limited number of sleep specialists and their varying geographic distribution, telemedicine provides a good alternative to help patients who might not otherwise have access.”

However, as telemedicine is an emerging form of patient care, there are limitations as insurance and state regulations come into play, Badr says. For example, some states do not allow for controlled substances to be prescribed to a patient that the provider has not seen in person.

Despite the limitations, there are clear benefits to this new practice, and greater access to sleep medicine specialists may help those who suffer from sleep disorders and related ailments. Badr says, “Technology is always advancing, and with the benefits of a home sleep apnea test, and the ability to follow up with live interactive telemedicine, there is the opportunity to treat many who otherwise might not have received care.”

Taskforce Recommendations

The new guidelines on telemedicine developed include a range of ideals, from the role and responsibilities of sleep medicine providers to the quality of clinical care standards. To begin, the group writes that clinical care standards for telemedicine services should mirror those of in-person office visits, including all aspects of diagnosis and treatment.

According to the AASM, the roles, expectations, and responsibilities of providers involved in the delivery of sleep telemedicine should be clearly defined. In addition, appropriate technical standards should be upheld throughout the telemedicine care delivery process. Clinical judgment should also be exercised by sleep medicine providers when determining the scope and extent of telemedicine applications in the treatment and diagnosis of patients.

“With regards to sleep telemedicine, healthcare providers have different roles and responsibilities as the nature of the visit differs than an in-office visit,” Badr says. “All healthcare providers, whether at the originating or distant site, prioritize providing top quality care to the patient. No matter what the delivery model, the primary responsibility of all healthcare providers is to provide the highest quality patient care.

Another AASM guideline notes that the use of telemedicine services and its equipment should adhere to strict ethical and professional standards so it does not violate the intent of the telemedicine interaction while striving to improve patient access and quality of care. As one of the most significant benefits of the use of telemedicine is providing access to patients who may not otherwise have it, “physicians and other healthcare providers in specialties such as sleep medicine need to stay up to date on the current technology to better reach these geographically diverse populations and help more people,” Badr says.

The new guidelines also note that time for data management and quality processes should be recognized in value-based care delivery models. In addition, quality assurance processes should be in place for telemedicine care delivery models that aim to capture process measures, patient outcomes, and patient/provider experiences with the model(s) employed, according to the AASM.

In regards to reimbursement, the taskforce recommends that “live interactive telemedicine” for sleep disorders be recognized and reimbursed in a manner competitive or comparable with traditional in-person visits. The group also proposes that when billing for telemedicine services, it is recommended that providers, patients, and others rendering services understand payor reimbursement. Financial transparency throughout the telemedicine delivery process is also recommended.

Badr says it is important to recognize that state laws establish the parameters for telemedicine coverage. “As telemedicine continues to gain broader acceptance, it is expected that even more services will become eligible for reimbursement. Sleep specialists need to become familiar with the law in their state and payor reimbursement policies when integrating sleep telemedicine,” Badr says.

For future research, the taskforce suggests that methods that aim to improve the utility of telemedicine should be explored, including the use of patient presenters and add-on technologies. Also, as the use of sleep telemedicine may possibly expand, further research is needed on the impact and outcomes of its use in sleep as well as healthcare in general.

Overall, according to the taskforce, the practice of telemedicine should aim to promote a care model in which patients sleep specialists, and other healthcare providers strive to improve the value of healthcare delivery in a coordinated fashion.

The Future of Telemedicine in Sleep

As sleep is an essential part of overall health, the use of these proposed recommendations can help board-certified sleep medicine physicians reach new populations as telemedicine grows. However, the future use of telemedicine in sleep may be dependent on new research affirming its benefits, including research specifically comparing patient outcomes of office visits versus telemedicine visits. Badr explains, “As of now there is no data to demonstrate the overall satisfaction of patients or providers when using telemedicine in sleep medicine. This data could be beneficial to opening up regulations and expanding coverage for telemedicine services.”

In addition, telemedicine in healthcare may become more commonplace as the technology evolves and becomes more readily accessible. “With sleep disorders as common as they are, the need for board-certified sleep medicine physicians far outweighs the current number of specialists. Telemedicine helps expand patient access to sleep expertise by eliminating the geographic limitations,” says Badr.

One possible concept for the expansion of telemedicine in sleep is wearable device technology, which is continuously evolving. Badr says, “These devices are already progressing since their original form, and while they do not yet monitor sleep at the same levels as a sleep test, with further technology advancements they could become beneficial in the world of telemedicine and sleep medicine.”

Overall, the guidelines in the new position paper are intended to provide recommendations that will help sleep specialists understand the issues and boundaries involved in telemedicine. Badr states, “[The guidelines] will give sleep physicians a vision for how they can integrate telemedicine in their practice in order to improve patient access and provide patient-centered care.”

Cassandra Perez is associate editor of Sleep Review.