Digitalization in CPAP/APAP treatment.

Digitalization is an ever-present topic in our society. It is an unstoppable trend and like many innovations, offers opportunities. But it also poses risks. It can play an important role to support well-founded decision-making so that high-quality infrastructure and healthcare can be maintained despite the increasingly serious shortage of specialist staff. Indeed, digital pathways may even bolster aspects of sustainability. Yet, particularly in medical care, innovations are accepted haltingly, coming up against well-established structures, regulatory provisions and policies governing cost reimbursement.

What status has digitalization achieved in CPAP/APAP treatment? The devices keep up with technical progress and offer data transfer options such as cellular communication for telemonitoring by a Healthcare Provider (HCP). As a rule, the data channel is used to change device settings and comfort functions remotely. Studies have shown that telemedicine leads to increased CPAP usage and improves treatment outcomes. Furthermore, digitalization saves time and travel expenses and avoids CO₂ emissions.

Some studies failed to demonstrate any benefits. In every case, the real-life implementation of a new method is critical. Simply sending data does not improve treatment. What happens with the data can. It’s important to consider:

• which patients in which treatment phase receive support through telemedicine? All of them? Those with initial difficulties? Those with specific comorbidities?
• how the data are used to derive interventions. Proactively based on specific thresholds? Reactively in response to reports of problems?
• how telemedicine procedures are integrated into the healthcare process and combined with other components;
• which previous healthcare process the telemedicine is compared to. A timeconsuming, fairly costly one with a correspondingly good outcome or the opposite?
• how reliable the technology is. Including data transmission and measurement of therapeutic efficacy by the CPAP devices, e.g., with validated detection of any remaining nocturnal respiratory events.

Another hard-to-answer question revolves around who assumes responsibility for remote care. In many healthcare systems, the CPAP provider is responsible for optimizing the device or mask, for example, and encouraging patient acceptance of the treatment. More HCPs use data transmission, despite additional costs, to improve their processes and services and thus increase their attractiveness.

The attending physician is not always on site to supervise CPAP therapy. The provider too needs access to the data and other patient information. In telemedicine, privacy and data security remain a challenge, but a solvable one. An even more serious barrier in many countries is the lack of reimbursement for incurred costs. Healthcare systems in which patients bear the cost of medical services can implement innovations faster. Even countries with reimbursement systems are introducing remuneration for telemedicine services or allowing existing reimbursable services to be provided over telemedicine channels.

Digital tools support the patient directly. Today they are available as apps for smartphones or tablets. The tools simplify device operation with touchscreen interfaces, e.g., allowing the patient to adjust the size of the display as needed. Digital features aim at increasing patient motivation for treatment and help to resolve simple questions – with no waiting times or the need to call on increasingly scarce qualified staff members. The prisma APP for the Löwenstein medical devices is a good example that lets us show how effective digitalization can be for improving adherence and treatment outcomes.

Are patient apps really competing with telemedicine? Are apps and telemedicine at odds with conventional care? Absolutely not! Rather, the smart combination of multiple components leads to modern, efficient CPAP care. A well implemented patient app can help resolve simple questions and improve patient motivation for CPAP treatment. If assistance from the HCP or medical team is required, the app will say so and allow the patient to transmit data to the specialist. Then the time that specialists need will be used as effectively as possible.

Our recently published study demonstrates impressively the potential of the prisma APP for improving adherence to and efficacy of PAP treatment with no additional work for increasingly stretched specialist staff¹.

Reimbursement for the healthcare provider depends on the use of telemedicine. The patient’s treatment adherence with the support of telemedicine directly influences reimbursement. The data flows from the CPAP device to the device manufacturer’s cloud, typically to the HCP’s ERP software, which processes reimbursement settlements over a digital interface. Patient apps are being used to improve adherence.

Early published criticism said that device settings did not get enough attention and that some patients still experienced many nocturnal respiratory events despite telemonitoring. Medical specialists and professional associations have been drafting recommendations with relevant intervention protocols. In some cases, the reimbursement rate for conventional house calls applies when physicians personally check on affected patients using telemedicine tools, i.e., video or telephone calls and digitally transmitted CPAP data.

Official data on the efficacy of the digitalized care system are not available. Therefore, Löwenstein Medical conducted a survey among HCPs and physicians in France.

In response to the question of whether telemedicine had improved therapy adherence, 32% of HCP staff and 25% of physicians said the improvement was significant and 42% HCP staff and 75% of physicians said the improvement was minor. Just over 47% of HCP staff and 75% of physicians saw a major improvement in outcomes. Mixed responses were received to the question about whether telemedicine had increased or reduced costs. Around 80% of those surveyed in both professional groups said they would like to retain telemedicine.

We learned a great deal from customer feedback from which other countries now can benefit. Our new generation of prisma devices includes telemedicine options for a mobile interface or Bluetooth^Ⓡ interface. The devices are thus equipped for the future and ever-changing healthcare processes.

With the telemedicine software prisma CLOUD, HCPs and medical specialists can provide care more flexibly in accordance with previously made service agreements. For example, data can be forwarded to ERP, practice or hospital software and combined with the other case data. The Bluetooth interface connects the devices with prisma APP, the digital assistant for patients.

With the patient’s consent, the app communicates in the background with prisma CLOUD. The logo and contact address of the HCP or healthcare professional can be displayed optionally in the app. Treatment data can be sent to the medical professional in prisma CLOUD via the prisma APP even in areas with no mobile reception. The prisma devices provide digital signal data to our Samoa, Scala, and Sonata diagnostic devices to make possible the best titration or treatment monitoring. Our prisma devices offer a vast array of options for modern CPAP care with digital components.

Here we have purposely avoided specifying any one healthcare process via the technology. After all, many different routes lead to the goal. Depending on the healthcare system, available capacity and the reimbursement policy for services provided, users can select the appropriate options from our treatment portfolio for Sleep-Disordered Breathing. Elements of digitalization are expected to play an important role. In some countries they already do, but in others it may take several more years. We offer the necessary solutions and continuously develop them further.