Philosophy of a Sleep Scoring Innovator

As president and CEO of Sleep Strategies, Natalie Morin aims to bring consistent quality to the business of sleep scoring.

There was a time when sleep study scoring was only outsourced as a last-minute measure to deal with staffing shortages. But what began as a reactive business practice is now a flourishing business model that hospitals and private sleep facilities have embraced in an effort to streamline operations. In fact, several industry authorities claim this is quickly becoming the preferred method for sleep laboratories to have their sleep studies scored.

Natalie Morin, president & CEO of Sleep Strategies agrees— and with her company’s track record, it’s easy to understand why. As one of the industry’s top female executives, Morin has built a company that has influenced a market sector.

Sleep Strategies was the first sleep scoring firm to establish a quality assurance department devoted to overseeing the sleep studies it is commissioned to analyze. Early on, Sleep Strategies decided to exclusively staff only clinically experienced registered technologists. In contrast, competitors were downloading the bulk of their studies to under-trained or off-shore technologists. “The blatant use of unskilled, unregistered, untrained individuals performing the scoring of sleep studies is prevalent,” says Morin. “I have witnessed sleep studies being scored by inexperienced foreign physicians, by front- office receptionists, and even by high school students. It is imperative that scoring not be viewed as a tedious task but as the most important clinical element to correctly diagnosing a patient with a sleep disorder.” What these shrewd moves amount to is an ability to make guarantees. With several layers of scrutiny and accountability built into Sleep Strategies’ processes, Morin’s organization has sufficient grounds to assure clients about the accuracy of the tests they’ve been entrusted with.

Trust, transparency, and due diligence are guiding principles in Morin’s corporate philosophy. “We see ourselves as an extension of each of our client’s sleep laboratories,” explains Morin. “Cost cutting is perhaps the main factor when laboratories and hospitals engage with a scoring service like ours. However, the benefits extend far beyond dollar figures. Once a partnering laboratory has the confidence that we’ll perform as if we were one of their own, they gain an ability to improve productivity, increase volume and heighten efficiency in a way they never could without major additional infrastructure.”

Morin has dedicated customer service agents, a top notch team of RPSGT technologists, FAASM physicians, quality assurance personnel and a technical support division to guide customers through Sleep Strategies’ HIPAA-compliant data transfer system. Ultimately, Morin suspects that it’s her firm’s extended focus on patient and employee concerns that gives her a competitive advantage.

A recent internal audit regarding Sleep Strategies’ hiring practices revealed that two out of every ten registered technologists who apply to the company pass the first round of pre-employment testing. From those two, only one tends to be offered a position with the firm. “I want our staff to know that when they say they work for Sleep Strategies that means they’re the best of the best,” says Morin. “Applicants might have previous experience as laboratory managers or sleep scoring veterans, but if they don’t measure up to our standards, we won’t take a chance on them.”

Along with the prestige associated with working for Sleep Strategies, staff receives continuous training and education opportunities along with performance recognition and rewards for outstanding achievements. Morin can afford to be so selective because there is no shortage of applicants.


With much of the sleep scoring industry still unregulated, hospitals and laboratories need to carefully choose a potential scoring vendor. Morin stresses the importance of steering clear of vendors that use key phrases like “no service agreement,” “cheapest rates in America,” and “you pick the price.” Several sleep scoring firms attract clients with bargain pricing underwritten by the use of unregistered technologists with no clinical or sleep medicine experience.

Morin recommends reference and background checks. She says, “It’s not unreasonable to draw up RFPs requesting at least three references which will be called.” Beyond client references, industry contacts are valuable legitimizing sources. These could include software companies and industry associations that have a history with the potential vendor. Looking at trade publications to see if a company is getting media coverage or investing in advertising is another good way to vet. Several of the off-shore outfits or freelance scorers run fly-by-night operations, meaning they tend not to remain in business or under the same name for long. An established history, says Morin, is an indication of brand investment which often— although, not always—signifies an investment in client care.


During the economic crisis, Morin and her executive team managed to grow Sleep Strategies at a time when other companies were paring back. She did this by expanding services into a parallel sector—the home care industry and portable monitoring sectors—and by extending its European reach. “It is gratifying to enjoy growth and success during what should be a time of economic uncertainty,” explains Morin. “Having a positive revenue stream is great for us, but we hope our success provides hope that stability of the sleep scoring industry is possible in even the most uncertain times.”

But her desire to see an entire industry improve goes beyond mere well-wishing, Sleep Strategies educates hospital administrators and CEOs on the concept of sleep scoring services and the benefits that come with incorporating this business model. “More important than a healthy company is a healthy sector. I’m as interested in raising Sleep Strategies’ profile as I am in elevating the entire sleep scoring industry overall.” So far, Morin’s plan seems to be working. While many companies are laying off employees or closing their doors, Sleep Strategies is initiating an aggressive hiring campaign.


While questionable off-shore firms or discount scorers still plague pockets of the industry, these companies are destined to die out with sector growth. The most successful companies in this space—the one’s with the largest volumes and the most recognition—are those that place quality first. With the AASM having recently made strong recommendations concerning the use of registered sleep technologists—especially in terms of portable testing—there’s a growing need for reputable scoring companies.

The reality, says Morin, is that our society continues to lose sleep. Whether it is stress, depression or obesity, the demand for sleep studies continues to grow. The marketplace has become saturated with several software companies, but Morin believes that “we’ll see more company takeovers like the one by Embla with Sandman software.” And while sleep scoring firms continue to grow, hospitals are perpetually in search of areas to save. “My prediction is that the task of analyzing patient sleep studies will, by default, move from being performed in-house to scoring service companies where specialization and time savings are key factors for hospitals looking to address backlogs and budget cuts,” Morin adds.


It’s no secret that healthcare departments are, by default, expected to find creative ways to accomplish their goals on miniscule budgets—same goes for sleep laboratories. However, when budget cuts occur, quality and patient care may begin to suffer. How can a sleep laboratory ensure the quality of patient sleep studies is never compromised?

Regulations are a necessary start, but to truly claim you have a rigorous quality assurance system, it takes a little more than a piece of paper in your policies and procedures manual that says you do. Here are just some of the points for your sleep laboratory to consider regarding the quality assurance of your scored sleep studies:

  • Insist on registered technologists. Only these specially trained and BRPT tested, highly experienced professionals can guarantee an accurate interpretation of data. Self Audit. Randomly select client files and review to ensure internal standards are being met.
  • Review technologists. Even the experts can fall into bad habits – perform peer observations to maintain scoring consistency.
  • Understand the latest guidelines. AASM and HIPAA enforce a base level of service delivery.
  • Hire a professional scoring service to ensure quality standards are never compromised. Most scoring companies offer flexible engagement options—full-time, part-time or per-project arrangements to establish the optimal method for cutting operating costs and increasing productivity.


Autoscoring is and always will be a hot topic in sleep medicine. The debate has, in essence, polarized clinicians and corporations, with each having sound arguments. Physicians and technologists question the frequency of use of such software, while the corporate world sees it as the future of sleep medicine.

After personally testing several auto scoring software programs, Morin is reluctant to dismiss them entirely. However, she feels that “it’s nowhere near the point of matching gold standard analysis performed by a registered technologist. It will take years to fine-tune this technology to the point that it will play any significant role in the daily operations of sleep facilities.” The consensus between Morin and her cohorts seems to be that no matter how advanced autoscoring software becomes, it can never replace the role of a registered scoring technologist.

Any sleep laboratory that is using autoscoring to diagnose patients without having trained technologists thoroughly review and ensure its accuracy could be placing their patients’ well-being in jeopardy. Any sleep study—whether it is Level 1, 2 or 3—needs to be scored by a registered technologist. “If the concept of auto-scoring is brought to the table as a tool to assist technologists then it will gain much more validity within the marketplace. But the reality is that many of these companies are marketing it as a turnkey alternative to technologist scoring,” Morin explains, fearing the rise of misdiagnosis rates should autoscoring become the sole method of analysis.


Sleep Strategies conducts business in countries all around the globe. It is engaged in every aspect of the sleep scoring process, including analysis, quality assurance, accreditation, and education.

The initiatives and standards Morin has put in place have helped define a sector and ease the infrastructure woes of industry partners. The health of a sleep laboratory’s patients and the reputation of a sector still in formation depend on accuracy and integrity. From the alleviation of sleep study backlogs to a significant reduction in costs for hospitals and labs, sleep record outsourcing is becoming the preferred method of sleep study analysis.

As the scoring sector evolves, regulation will help protect client and patient interests. Change is slow but recent modifications to scoring rules and BRPT re-qualification processes are 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.

With unprecedented growth over the last two years Sleep Strategies remains at the top of its game. While Morin is delighted that the company is continuing to expand, her main goal is to elevate the sleep scoring industry as a whole and raise the bar for standards to ensure that a promising sector is not undermined by opportunistic scoring practices. She finishes by saying, “I’m interested in partnering with hospitals, laboratories, software and pharmaceutical companies and even competitors to cultivate business practices that establish a gold standard we can all work towards.”

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