When you add more HSTs to your practice, consider characteristics such as battery type and report customization options to ensure you select devices that speed your workflow, not slow you down.
The major characteristics of home sleep testing devices—such as type, number of channels, and cost of consumables per study—can be compared objectively side-by-side. Indeed, Sleep Review publishes such a comparison guide annually (the latest being available at www.sleepreviewmag.com/2017/11/hst-comparison-guide-oct-2017). But the value of some other characteristics is subjective. For instance, are reusable or disposable batteries better? That depends on how your workflow is currently set up and on where you anticipate growth in the future.
“For example,” says sleep physician Emerson Wickwire, PhD, at the University of Maryland School of Medicine in Baltimore, “a large practice may have sufficient volume to schedule several hours per day just for HST setup and data capture. At small practices, they might consolidate HST administration into a much smaller block of time, or even use HSTs on limited days of the week.” So take your own setup into account when reading through the subtleties of features to consider.
Does Compatibility with PSG Matter?
Some home sleep testing devices work in sync with a practice’s in-lab polysomnography (PSG) system and software. “In my experience, there are significant advantages to using an HST device that is compatible with in-lab PSG equipment,” says James Blevins, RPSGT, product manager for sleep diagnostics at Cadwell Industries Inc. “Compatibility means less expense for application and server costs. It means less time spent training staff.”
Blevins frequently receives feedback that HST devices that use the software associated with in-lab PSG are typically more feature-rich and efficient to use for scoring. “It also makes the workflow for physicians simpler and more efficient when there is just one application to look at for what studies need to be read, whether they were performed at home or in-lab,” he says.
Edmund Shaw, RPSGT, MBA, senior global product manager, sleep diagnostics at Philips, says, “A lab whose HST and PSG equipment run on the same software platform gains efficiency, and the staff only has one system to learn and maintain. All of a patient’s recordings, whether they were done at home or in the lab, are collected within the same system. More of our customers are integrating with the hospital’s electronic medical record [EMR] via an HL7 interface. It is certainly easier to do one integration project rather than two.”
Though Wickwire agrees that it’s nice to have an integrated system, he says it’s not essential. “There are many thriving HST programs that essentially function as stand-alone programs. Because things are cloud-based these days, it really opens up a range of possibilities,” Wickwire says.
Disposable vs Rechargeable Batteries
A battery being disposable or rechargeable can make or break the timeliness of a practice’s workflow for a number of reasons.
“Reusable batteries require time to recharge while disposable batteries can be removed and replaced very quickly,” Blevins says, adding that as sites perform higher volumes of HST studies, the expense of disposable batteries climbs quickly. “Rechargeable devices can use a single connection for download, recharge, and initialization. While there is time required to recharge the device, the busy times when the patient is in front of the technologist or when trying to retrieve the data from the device are simplified by not hunting for batteries or having to plug the device in, make sure data was downloaded and cleared, and that the computer recognizes it in order to use it again.”
Wickwire says, “There are financial and environmental considerations regarding battery charging for HSTs just like there are for flashlights in your house. Rechargeable batteries are more expensive on the front end but also do less damage to the environment. When you throw traditional batteries away, it is just adding to landfill toxicity.”
Shaw notes that Philips’ Alice NightOne and Alice PDx have the option of both battery types—a decision made intentionally since each type has its own pros and cons.
Additional HST Considerations
Sometimes there are features of an HST device that a clinician might forget to consider the first time they buy or lease but that they are more cognizant of in the future. “We find that clinicians are less concerned with reports for HST devices until after they’ve started using them,” says Philips’ Shaw. “We don’t receive as many questions about customizable reports or making interpretations faster and more efficient for physicians until after they’ve been using the device for a while. Report customization is a common question in PSG, and given that HST volumes can be high, asking about report efficiency should definitely be a question that gets consideration.”
According to Cadwell’s Blevins, clinicians also need to remember that they are going to be using not just the HST device, but the software as well. He says, “Important questions to ask prior to committing to a device and service would be: Is the software robust enough? Does it have integrated HST workflow tools? Can it receive and pass information to the practice’s EMR system?”
Anthony Ferrelli, director of marketing, sleep, at Natus Medical, says clinicians should consider asking about backup signal availability, since an HST study is unattended and occasionally sensors will come off. For example, Natus’ “XFlow” (airflow derived from respiratory effort) “comes in handy when a thermistor or cannula signal becomes un-readable due to sensor movement during an unattended study,” Ferrelli says.
The key, according to Wickwire, is to be mindful when selecting an HST device. “The primary care practice is going to require a device that’s much easier to apply and really takes very little sleep specialist expertise,” he says. “In an accredited sleep disorder center, there really isn’t much reason not to use the most accurate device that you can because, in principle, the technical demands shouldn’t be as much of a factor in a sleep disorder center environment.”
Wickwire also urges clinicians to be aware that the quality of HST technology will continue to increase. “So, you want to go with a device that will be easy and accurate in the short term, and with a company that is going to be sustainable and will keep up with technology in the long term.”
Dillon Stickle is associate editor of Sleep Review.