Telemedicine seems to be the healthcare of the future — but is it a viable option for sleep apnea management?
It wasn’t long ago that any form of medical care required an in-person meeting with a physician, no questions asked. Now, however, healthcare has evolved alongside technology, and the use of telemedicine has become increasingly commonplace.
Surprisingly enough, telemedicine isn’t an incredibly recent development. Forms of this technology date back to the early nineteenth century, although telemedicine in its current form only originated in the 1960s. Over the past decade, however, there have been major advancements in telemedicine, allowing it to shift from being available primarily for the military and space technology sectors to becoming a viable option for most populations in the US.1
The ability to communicate with a clinician using telecommunication technology alone is invaluable, enabling patients in even the most remote areas to access the healthcare they need — to an extent. Telemedicine has its limits, as many conditions still require in-person examinations and treatments. Yet, it still offers extraordinary promise, particularly for individuals with conditions that might inhibit driving, such as sleep disorders. So what can telemedicine offer these individuals?
A Wide Range of Options
Although the extent to which a physician can rely on telemedicine for obstructive sleep apnea (OSA) management will vary between practices, it can be used for initial evaluations as well as follow-up visits. Physicians can recommend sleep studies, share results, write prescriptions and make pressure adjustments, all through telecommunication. However, some state laws require initial visits to take place in person.2
“We see all sleep disorders in our clinic — including OSA, narcolepsy, insomnia and circadian rhythm disturbances,” said Seema Khosla, MD, FCCP, FAASM, medical director of the North Dakota Center for Sleep in Fargo, N.D. “We can do almost all of it via telemedicine, as long as we recognize potential limitations.”
For many people, both healthcare professionals and patients, telemedicine may seem somewhat unnatural, as it so clearly pushes away from what is truly the norm in medicine. After all, how can a physician truly evaluate a patient without seeing them face-to-face? However, physicians that use telemedicine for OSA management maintain that is far more similar to in-person visits than one might expect.
“Our protocols are identical to the in-person visit,” said Khosla. “The history taking is the same, the criteria for undergoing a sleep study are the same, the insurance requirements are the same.”
“We envision telemedicine having application in nearly every sleep and pulmonary disorder, if properly developed with appropriate quality controls, checks and balances,” added Jaspal Singh, MD, MHA, MHS, professor of medicine in pulmonary, critical care and sleep medicine for the Carolinas HealthCare System in Charlotte, N.C.
Not Always a Perfect Match
While there are countless opportunities for telemedicine to help individuals suffering from sleep apnea, that doesn’t mean that telemedicine is a good match for everyone.
“Patients who should not utilize telemedicine are those that are suspicious of the quality of care they might receive,” Singh said. Also, he added, “Those with very complex medical and sleep problems might best be served by traditional office visits.”
Just as telemedicine might not be a comfortable option for all patients, it might not be the best fit for all physicians. “What I have learned is that you need to be comfortable with technology and have the ability to be nimble — to problem-solve on the fly,” Khosla said. “If you are not comfortable with technology or you don’t do well with little unpredictable hiccups, you should probably stick to in-person visits. The same applies to patients. If they are uncomfortable with this idea or are hard of hearing, I might recommend that they be seen in person. The patient always comes first.”
Countless Benefits
If both the physician and the patient are able to determine that telemedicine is a viable option for OSA management, the benefits of this alternative to the traditional in-person visits are seemingly endless. Patients in underserved areas can access medical care for their OSA without worrying about transportation, and patients who might be hesitant to pursue medical care due to difficulties travelling may be more likely to get the attention that they need.
“Telemedicine has really allowed our patients to have more convenient access to specialty care,” Khosla said. “My practice is in North Dakota, where the weather is often a hindrance to travel. Telemedicine allows patients to be seen efficiently without having to travel as far.”
While the advantages of telemedicine may seem most obvious for the patient, the physician is also sure to experience the benefits of this technology. “I would love to say that the patient benefits most, but the reality is that travel works both ways,” Khosla said. “I don’t have to travel to an outreach clinic. I also think that this allows us to draw from a larger area to fill our clinic schedule.
“Interestingly enough, our no-show rate for the telemedicine clinic is much lower than for in-person visits,” she added. “I think that people who live in rural areas appreciate the convenience of telemedicine.”
Telemedicine offers countless benefits for patients and physicians alike, but that doesn’t mean you should be ready to abandon your in-person practice entirely. Healthcare will always require the availability of physicians for in-person medical evaluations, particularly for complicated health issues and patients who aren’t comfortable with the required technology. Still, telemedicine is a viable alternative for many patients who require follow-up consultations. Could it be a good fit for your practice?
Sarah Sutherland is on staff at ADVANCE. Contact: ssutherland@advanceweb.com
References
1. World Health Organization. Telemedicine: opportunities and developments in member states. 2010.
2. Singh J, Badr MS, Diebert W, et al. American Academy of Sleep Medicine (AASM) position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders. J Clin Sleep Med 2015;11(10):1187–1198.
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