HST: Is anyone HOME?


It’s official: home sleep testing (HST) has become a fixture in bedrooms across North America. What was once considered a fleeting trend is now the diagnostic darling of patients and insurers alike. Where industry leaders were once divided on the notion of portable sleep studies most have come to agree that this cost effective method of testing is not only a legitimate, but also a necessary, tactic in the diagnosis of OSA (Obstructive Sleep Apnea).

By most accounts, HST is here to stay. But even in the bedroom, the marriage of clinical and business priorities sometimes produces conflict. The challenge lies in making sure patient care isn’t overlooked amid the ever-arising opportunities of a new market.

Initially, many physicians were opposed to HST due to the significant decrease in reimbursement they were likely to receive and the initial question of this method’s effectiveness. Now most stakeholders see this new testing domain as a boon. Insurers are on the hook for dramatically lower payouts—so much so that they’ve mandated hometesting as the primary line of defence against OSA before more intensive lab-testing will be approved for coverage. Medical Companies are rushing to market new and improved home sleep test devices. Even dental and personal wellness sectors are jumping on the home sleep testing bandwagon.

Most are rejoicing the integration of this new business model with good reason. Even patients have reason to celebrate—seemingly. Certainly, patients benefit from remaining in the comfort of their own home as they take steps toward getting a better night’s rest. But are their health needs ultimately and adequately served by home-testing? And how might we ensure that they are? President and CEO of Sleep Strategies Inc., Natalie Morin, answers these crucial questions with a few of her own, “Who is scoring these home sleep tests? And are they qualified to do so?”

The issue Morin raises is one of quality assurance. Along with the growth promised to countless peripheral sectors, HST also sees sleep testing companies with little or no clinical background trying to cash in on its popularity. The problem is not a new one. The validity of sleep testing has always been plagued by flyby-night operations that disregard industry quality standards and opt not to employ RPSGTs (Registered Polysomnographic Technologist) and the DABSM (Diplomats of American Board of Sleep Medicine) as the crucial keepers of diagnostic accuracy they are. The difference with home-testing is one of scale. In its rise to prominence, HST reawakens long-standing concerns related to the governance of scoring and interpretation and places defenders of the sleep industry’s integrity back at ground zero as they attempt to educate related parties on the importance of accurate test results.

Lesson number one in this educational process? The validity of home-testing depends on RPSGT and DABSM for their specialized expertise in scoring and interpretating the data from the HSTs. Only these designations can ensure the effectiveness of the entire testing process and quality experts agree that any perceived cost savings associated with HST are undermined by misdiagnoses made by under-qualified practitioners. This is a recommendation made repeatedly by the AASM (American Academy of Sleep Medicine), but many newcomers to home sleep testing are choosing to ignore the advice.

With the recent proliferation of home sleep tests, Morin feels that “we need to ensure that revenue potential doesn’t take precedence over patient care. In order for this form of testing to remain a valid option we need to collectively agree as an industry that proper standards are being implemented. I have personally seen patient’s data being reported on after the sole use of automatic scoring without any expert review. The reality is that many companies have serious blind spots when it comes the most crucial phase of testing—analysis.”


As the popularity of this new service increases so too will industry guidelines and standards. There are rumblings within the industry in terms of what is needed to ensure patients undergoing
HST receive industry-recognized services. To be clear, this means studies being scored by an RPSGT and interpreted by a DABSM .

“We cannot allow a short-sighted, moneymaking mentality to set the tone for a burgeoning sector. Sleep care is first and foremost a medical service and as a result, proper ethics have to dictate what would otherwise be savvy business decisions,” explains Morin. She adds, “For the record, there are many HST companies that offer unparalleled service. From beginning to end the patient is first and foremost in all they do. But it’s our role as industry watchers to ensure these companies lead the pack.”

Declaring the need for increased accountability is one thing. But accuracy, reliability and consistency are as much about a systematic approach to quality as they are about any one company’s individual sense of duty. Ensuring effective testing involves adopting a structural approach to diagnoses made up of processes and frameworks with safeguards to guarantee quality. The HST industry has evolved dramatically over the past few years. And as it matures into a more solidified entity, many are recognizing that these processes and frameworks need to be sought externally.

Quite likely, this is why the benefits of engaging a third-party scoring firm for HST are being recognized and appreciated by a wide range of stakeholders—not only homecare companies, but hospitals and labs as well. As the home sleep study industry grows, it may just need to rely on the supporting infrastructure of industry specialists.

Certainly, cost savings are a motivating factor. Hospitals are looking for ways to trim costs and physical spaces as well as labor are at a premium. HST is a godsend in terms of bed space—hometesting guarantees every patient is bound to have one. But HST combined with a scoring service makes for a dream team of cost-effective, modern diagnostic approaches. For the majority of hospitals, a scoring service such as Morin’s own Sleep Strategies allows them to focus on their daily operations without hiring additional staff or resources, all the while ensuring that quality and patient care are uncompromised.

As for patients, not to mention sleep labs, the importance of quality cannot be overemphasized. “You might never know that a sleep study has been incorrectly scored–until it’s too late, until a patient realizes they’ve been misdiagnosed,” Morin emphasizes. She says that quality scoring should never be rushed or timed against a stopwatch.”Rushing this process sends the message that costefficiency is more important than patient care,” she explains. “This is definitely not the message anyone wants to send.” Employing a reputable and industry-recognized scoring service is not only an excellent way to ensure the efficient scoring of data, but also a way to gain access to experts, thus decreasing time and increasing efficiencies. And this, says Morin, means the needs of patients are being recognized, met and respected.

So while cost savings is admittedly a motivator to making sleep scoring outsourcing a permanent fixture in the HST landscape; clearly, it is far from the primary benefit. Sleep scoring companies are a way to ensure the accuracy and efficiency of test results become a stable variable. But by no means are all scoring companies created equal.


Trust, transparency, and due diligence are guiding principles in Morin’s corporate philosophy. With much of the home sleep industry still unregulated, hospitals, homecare and healthcare providers need to carefully implement a scoring option into their business or choose a potential scoring vendor. Several sleep scoring firms attract clients with bargain pricing underwritten by the use of unregistered technologists with no clinical or sleep medicine experience.

In contrast, Sleep Strategies’ approach to success is simple: manual scoring performed by an industry-recognized RPSGT, delivered on time, every time. Morin recommends HST companies consider these features as the baseline for the safe selection of a scoring partner. But beyond that, she describes her own companies’ obsessive quality habits. “Our QA department is continually reviewing our techs to ensure that they’re meeting both our own as well as clients’ specific scoring standards. In fact, many of our client’s studies are scored by two registered techs to ensure
unwavering quality.”

As the home-testing sector evolves, regulation will help protect clients’ and patients’ interests. While home sleep testing is changing rapidly, its management and standardization is slow. But recent attention to this business practice is promising. “We’re watching an industry come of age and it’s just now confronting the necessary rules and regulations that will help it successfully mature,” says Morin. I’ve witnessed the birth of HST over the past decade and have followed closely the key players in this diagnostic concept. I believe that like any industry evolution improvements are key. We need to change with the times. But one thing that should never change is the ethical obligation we have to our patients.”



Natalie Morin is President and CEO of Sleep Strategies Inc. an award winning, industry recognized leader in sleep scoring services. For more information on Sleep Strategies, visit www.sleepstrategies.com.

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