CleveMed Blogs

Happy New Year! Everyone at CleveMed wishes you a safe and successful 2009!

CleveMed is continuing to grow and develop and 2009 is going to be another great year.

The Division of Sleep Disorders is working on expanding their sleep diagnostic product line to include more options for a wide variety of sleep disorder monitoring as well as continue research into new sleep therapies.

The Division of Movement Disorders will be releasing a new version of Kinesia, a quantitative movement disorder monitoring system, in January. The new system will include automated patient evaluations, motor symptom scoring and reports and improved patient and data management. Our goal is to provide a system that will aid clinicians with a method for better symptom management, ultimately providing a better quality of life for their patients.

It should be another exciting year!

We are working on initiating a Wellness Program using information gathered from United Healthcare, COSE, and Wellness Evolution. A survey will be given to participants with a list of topics that they are interested in. After the results are in, the topics with the most consensus will be discussed first, then the rest, and so on. This will be a team focused program emphasizing on what people like to do.

Carole Nittskoff, Chief Administrator for CleveMed, is on a task force with Cleveland State University and other local schools working on the “New Pathway Program.” This program’s primary focus is to give feedback to experiential learners and work with high school and college students to give them a much clearer view on the workplace. It will also assist them with preparedness and show them how to properly use soft skills.

By being a part of this program, it shows that we are educationally oriented. That’s why Carole became involved with it.

Sleep labs are beginning to take advantage of the added simplicity, patient comfort and cost savings associated with wireless technology. If a sleep lab is considering going wireless, it is important that they have each potential supplier in for an actual run through, and preferably allow a 30-day trial at their facility. Some wireless units, for instance Bluetooth devices, have a limited range and may not be suitable for labs with long hallways without added tools. Anyone who has ever lost a connection on a cell phone knows that wireless technology is not yet flawless. If a PSG study is interrupted several times through the night, typically since the amount of PSG data being transmitted is so large, even brief lapses can disrupt acquisition, annoy sleep techs and may affect data interpretation.

If your sleep lab is considering going wireless here’s an important list of questions you should ask potential wireless PSG equipment supplier:

1. What frequency range does the system operate in?
2. How far can the patient be from the monitoring room?
3. How many devices can we have working at one time without interference (cross-talk) risk?
4. What is the battery life of the device under continuous use? You need to make sure the device can stay on at least a full night. (Wireless technology can consume a lot of power).
5. What happens when there is interference – can the device retransmit data? Can it run a “spectrum sweep” of the environment?
6. How difficult is it to change the operating frequency to move away from the interference?

This post draws on the experience of several experts at CleveMed and is an adaptation from “Wireless Polysomnography” as seen in Sleep Diagnosis and Therapy, June⁄ July 2006.

When opening a new sleep lab, the cost of hard-wiring the rooms can be a significant portion of the cost of the installation. The installation team must work with hospital technical staff, often for a day or even two days before systems are up and running. Cabling must be run and tested.

Wireless Advantages:

On the other hand, wireless devices can transmit data through multiple walls without any cables running through ceiling tiles. There are often less components, meaning easier setup and lower risk of individual component failure. Setups outside of the lab become more feasible. For example, mobile diagnostic studies in hotels, long term care facilities or nursing homes mean that a comprehensive sleep diagnostic service can come to the patient instead of the patient having to come to the lab for a PSG. Hospital networks, wireless or intranets are used to transfer sleep studies from the bedside to the sleep lab. Technicians can monitor and respond to problems, yet the patient is still under the immediate supervision of skilled nurses.

Wireless Not Flawless:

But, anyone who has ever lost a connection on a cell phone knows that wireless technology is not yet flawless. If a PSG study is interrupted several times through the night, since typically the amount of PSG data being transmitted is so large, even brief lapses can disrupt acquisition, annoy sleep techs and may affect data interpretation.

Workarounds:

Wireless systems work by transmitting data via electromagnetic waves at a defined frequency. With so much congestion in the 2.4 GHz band (the most commonly used, from Wireless Local Area Network to microwave ovens), the probability of losing data due to radio frequency interference increases. In order to enhance their immunity to interference, most wireless devices operate in a pseudo-random fashion, a strategy known as “hopping“. Because this signal is not stationary, the approach works well for small and intermittent transmissions, like browsing the internet. Sleep studies however, have large data files that are continuously streaming for hours, which make the process of data recovery more difficult if not impossible. One potential way to mitigate this problem is to simultaneously store the PSG data in memory inside the bed-side unit and use the transmitted data only for basic patient status check and to confirm electrode connections.

Our next post:
Questions that you should definitely be asking your potential equipment supplier if your sleep lab is considering going wireless.

This post draws on the experience of several experts at CleveMed and is an adaptation from “Wireless Polysomnography” as seen in Sleep Diagnosis and Therapy, June⁄ July 2006.