Beyond the Brick and Mortar: – Robin Palmer Update: Beyond the Brick and Mortar

Thanks to a small army of available scorers, sleep labs looking to outsource sleep scoring functions can now benefit from expanded access to talented technicians.

A new business model takes time to absorb, and while the founder of acknowledges that some misconceptions still persist, the Delaware-based company continues its mission to revamp sleep scoring beyond traditional geographic boundaries. According to Robin Palmer, co-founder of of, the concept is actually simple, despite the high-tech trappings.

In short, the Web site facilitates the outsourcing of scoring for sleep studies, fostering a direct connection between sleep labs and scorers in one virtual location. As the site has evolved, so too has the number of available scorers. “Our biggest focus has been building up the database of scorers,” says Palmer, who also maintains an office in Ontario, Canada. “Without the scorers, we don’t have a product, and now we have between 500 to 600 available scorers. After some marketing efforts, we are seeing more scorers come in just by word of mouth.”

One of the pesky misconceptions that Palmer hopes to address is the question of quality. Some companies still believe that outsourcing amounts to reduced reliability. “On average, our scorers have 10 or more years of experience, so it is really the exact opposite,” enthuses Palmer. “We have a rating system, and once you do a job you are going to get rated. Most scorers are in there looking for more work. If they do a bad job, they will get a low rating, and it will be difficult to find work again. This is something completely new for sleep laboratories. It’s not scary, but it is not known, and it is still not part of the culture.”

Cultural transformation is a tall order, and Palmer is adamant that his goal is instead to merely boost the existing culture, making things easier for sleep labs and scorers alike. “We certainly do not believe we are hurting the industry, and we don’t necessarily see people using this 100% of the time,” adds Palmer. “But when sleep labs need extra help, we are there, and you don’t have to pay overhead for our help. We don’t see it taking jobs away from people who are already working in labs, and we don’t even want that. There are enough scoring jobs out there that are backlogged, and we are looking to help out with that backlog of scoring. For small labs that want to get started, it will make sense. If they do not have access to good scoring, they can use us and get that good scoring.”

For those sleep labs who are still intimidated or somewhat confused, Palmer came up with an explanation that can fit on the back of a cocktail napkin. The procedure goes like this:

1. log in to and post your sleep studies for outsourcing;
2. scoring technicians view and bid on jobs;
3. receive bids from scoring technicians;
4. accept a bid, send study to scorer, and place payment for escrow;
5. outsourced scorer scores study and sends it back to you; and
6. payment is automatically released from escrow to score.

Whether you call it OutScoring or outsourcing, the concept is designed as a web-based service and platform to get the scoring done in a timely fashion, and without regard to who happens to live close by. “We saw a lot of crazy things such as putting studies on CD and running them across town,” says Palmer with a chuckle. “SleepScore is a marketplace source where technicians can come in, create a profile, and look for work.”

It’s free to make a request, and money (via PayPal) only changes hands after bids for services are fielded and ultimately accepted. “You can communicate with the bidders, see who has bid on the job, and communicate with that scorer,” says Palmer. “As soon as sleep labs accept that bid, we really encourage them to communicate with that scorer. Ratings are done by whoever is submitting the studies for review.”

Technicians who wish to score can come in, create a profile, and ultimately be rated by the lab after services are rendered. A lab that accepts a bid first places the money aside until it is time to release the funds to the scorer’s account. Palmer is confident that the end result will be to improve overall patient care, increase access to traditional technologists, and decrease backlogs that are destined to only get worse in the coming years.

Sleep laboratories are ultimately no different than other health care facilities that must occasionally cut back on services. US Bureau of Labor and Statistics and a CMS study suggest that 90% of all facilities employing health care workers will have inadequate staffing levels by the year 2030, primarily due to the massive influx of baby boomers. In short, sleep labs will likely need some help.

For those who wish to start a lab, Palmer views SleepScore. com as a place to work with scorers, reduce overhead, and increase patients. The rating system, he says, will let sleep labs know who is good and who can’t be trusted.

Despite the lack of legal language, Palmer characterizes the agreement as a contract of sorts. “If you’re a scorer and you bid and are accepted, you are bound by contract between yourself and that lab,” says Palmer. “They have a duty of care—a contract between that scorer and that sleep center. You agree to terms that are put up for auction.”

A New Perspective

When developing the idea for SleepScore, they noticed two critical items in the industry that when combined, had the potential to solve a need in the market to reduce backlog. First, outsourcing was establishing itself as a valid option. And with anticipated demand, sleep lab officials would ultimately face debilitating capacity constraints.

Finally, when scorers obtained one universal designation allowing them to score for labs regardless of geography, it meant the work could in essence be performed by anyone, anywhere, anytime. “We had seen what labs were doing to overcome access issues to scoring techs, and it seemed to us that there had to be a simpler solution,” says Palmer. “The only issue facing the industry was a middle layer solution provider that could coordinate efficient matching of skills and delivery of files and results, and provide an unlimited supply of service providers. The team at SleepScore comes from various backgrounds and disciplines outside the sleep industry. We are idea developers, technology creators, and investors. Much like any other idea that we have worked on, SleepScore became a mashup of various concepts rolled into one final idea.”

Palmer calls SleepScore an instant “on” solution for both labs and scoring providers in that there is nothing to learn, buy, or download for those who wish to try. The entire solution is web based, and there is no charge to create a profile and participate. “We have been compared to Ebay,, and,” says Palmer. “These are all auction sites or sites that match need and demand. We are similar to auction sites in that services are bid on, but that is where the analogy ends. Effectively, the services these sites provide ends when a match is made; consequently, unlike these sites, we provide delivery of the products—in this case a medical record, and corresponding results. The core of what we do is enabling labs and scoring technicians to find each other. We provide the conduit for the two sides to connect, negotiate a fair price, and provide the means for this work to be transferred. Of course a safe environment and easy e-commerce is vital to make this happen.”

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