Choosing your Sleep Recording and Analysis System: How to Get the Most out of it now and in the Future – Paul Schmitz

Choosing your Sleep Recording and Analysis System: How to Get the Most Out of It Now and in the Future

The medical field is filled with equipment from stethoscopes, pumps and BP machines to sophisticated EEG recorders and sleep recording equipment. Over the last 20 years computers have entered society at a staggering pace. Computers have had a major impact in everyday life and they have migrated into the area of medical equipment. When purchasing a Sleep Diagnostic System, a thorough investigation and evaluation by the right people in order to optimize functionality now and in the future needs to be conducted.

What to Consider When Evaluating Medical Equipment for Purchase?
In the past, as now, equipment should be evaluated from the perspective of how a particular hospital, doctor’s office or testing facility operates. The needs of the patient, nurse, technologist and physician should be considered. Different vendors should be contacted to see whether they qualify within the basic requirements. Then qualified vendors are compared within the framework of options, service, support and upgrades. Price could be a barrier to purchasing the highest rated equipment but the investigative process should be the same; the equipment with the highest rating within the budget is purchased. These days another perspective needs to be considered. This perspective may be the most important because it modifies the scale of all the other considerations. It is the systems administrator, local area network (LAN) manager or whoever the organization uses to evaluate computers within the organization. Why? Because medical equipment has changed from the stand alone system manufactured for one purpose to a computer-based system. Today’s sleep recording and analysis systems are no different; they are designed around a personal computer as the core. This core is purchased with the latest operating system, hard drive and memory. Like all other personal computers, as time goes on, its basic functions become outdated and no longer supported within the global network of computer systems in general. Typically, a personal computer gives about four years of service until it becomes outdated either due to a hardware or software changes in the general computer environment. Because of this general change, a total replacement or upgrade of the core may be needed. Here is an example; Windows NT is no longer supported by Microsoft, the network administrators of your organization are updating the infrastructure and the network upgrade requires Windows XP or greater, yet the hardware at the core of the sleep system cannot support Windows XP. Unlike in the past with stand-alone amplifiers and systems that operated for several years without requiring an upgrade, the present day systems are dependant on a computer at the core which is integrated with other systems. This presents a disadvantage to the new design, however there are numerous advantages as well and virtually all vendors have migrated to this new design. In other words, you do not have an option. Third-party vendor’s offer only limited support. Because of this, someone who understands computers from all aspects should be consulted prior to purchase. Someone with expertise in computers will ask the questions to help make better decisions on aspects including networking, automatic reporting and archiving. Other issues to consider include upgrades to operating systems, software and hardware integration, data security, the database data storage and access.

Another example relates to data storage and retrieval. The Webster dictionary defines archiving as a repository or collection especially of information. Most people will ask the vendor “Does the equipment archive the patient data or study?” Answer: “Yes”. The next question usually is “Can I get the study back if I need it?” Answer: “Yes, we can save as many of studies as you like and we have a database that can save as many as 16,000 patient records that will show you where the study is located. You can save it for years and pull it back when you need it. It is up to you and you can make the system work anyway you would like.” This usually ends the discussion with the medical person satisfied that the system will archive what they need and it is retrievable forever. They are satisfied and excited. However, you might have purchased, a piece of equipment that stores each patient on a separate CD and logs the patient in an Excel spreadsheet that specifies patient “Smith” is located on CD – “325-C” and the study can only be read on a computer with the appropriate software version 4.2. Some basic problems now arise such as room where to store the CD’s, implementation of a manual system for labeling the CD, CD retrieval and so on. Other issues such as how to migrate the data from a CD to another medium when it comes time (remember that pediatric data should be saved for 18 years), can the study be de-identified after coding for research, is the database searchable for particular needs, should be considered. These details seem mundane but are important for the proper selection of a system, or at least clarification of expectations. Imagine now a system that stores your patient data on a server computer located in a fire protected computer operations center with a hot spare backup across town that will automatically take over if the original is corrupted. The data is retrievable by name, date or study type and comes with an attached link to the report, wave forms, and video, and the study is readable on any computer in your organization. It takes the right questions by the right people who understand the issues and concepts in order to identify some of the outlying questions medical personal do not know to ask. Clarification of the expectations by the right person who understands how to qualify the answers properly insures the equipment is purchased that should satisfy almost all requirements. The answer that suits the needs of everyone usually is somewhere in between expectations and what can be delivered. Expectations are limited to what we know. The computer person’s understanding opens up options that many people did not even know existed and they help manage expectations of what the system can and cannot provide.

Who Should You Ask for Advice in This Area?
Do some research, find the people in the organization who understand computer systems, educate them on the medical-sleep side at a generic level and how the equipment needs to function in your environment. Ask the computer expert to talk with the vendor before choices are made. If you do not have the resources within your organization, talk to someone outside the organization who understands business applications in the computer environment. Do not rely on a buddy of yours who is able to get the wireless home network to work. Home and business applications and networks are as different as apples and oranges. The medical personnel can make the right decision with respect to how the equipment functions on the patient and data usefulness sides, but in the end after the patient is gone the technologist/nurse/physician is left with the data to read and interpret. If the data cannot move from place to place or is tough to retrieve or manipulate, then it makes patient care harder. Take the time to do this home work and allow the people who deal with computers to help make a decision; in the end the final product will be better than anticipated or dreamt about.

Paul Schmitz
Associate Director Neurodiagnostics
Vanderbilt University Medical Center
Nashville, TN

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