ResMed S9 wireless modem

[jps1012]

Depends on which S9 you have. If your machine has the word "Escape" in the name, then the only data you will have is how many hours you have used it each night (compliance data). Using software is pointless.

If you have one that does NOT have that word, then yes, there are two software programs you can use to view the data, SleepyHead and ResScan.

Thanks! Do those use the SD card or the wireless modem?

[RonWessels]

You will use the SD card. In addition to the software, you will need a card reader for the SD card. Don't be fooled into buying an overpriced CPAP-specific card reader. Any flash card reader that reads SD cards will do. You should be able to pick one up at your local electronics store for not too much $$. If you aren't too familiar with the various flash card formats, simply take the flash card with you when you buy the reader. If it fits into the reader, the reader will read it.

[jps1012]

You will use the SD card. In addition to the software, you will need a card reader for the SD card. Don't be fooled into buying an overpriced CPAP-specific card reader. Any flash card reader that reads SD cards will do. You should be able to pick one up at your local electronics store for not too much $$. If you aren't too familiar with the various flash card formats, simply take the flash card with you when you buy the reader. If it fits into the reader, the reader will read it.

awesome thanks

[dduttonnc]

The modem .. IF you have one ... is NOT for resmed to collect data.. that would be a MASSIVE HIPPA violation as NONE of us have given resmed permission to collect data in ANY WAY SHAPE OR FORM

I work in the medical industry, and I have to know HIPPA forwards and backwards...

Also the modem is RX (Transmit only). So new settings can NOT be uploaded to it.


IF you have a modem, it's used in 1 of 2 ways

1) If the machine is given to you by your DR, the modem transmits the data DIRECTLY to your DR, or to a data collection service he or she uses. Then your Dr can analyze your sleep data and have your bring your machine in from time to time

2) If your DR works with a home health care company (here in Charlotte, NC it's called Healthy @ Home). The data is collected by Healthy @ Home, and you give THEM permission to collect the data.. for THEIR techs to analyze it AND to pass it on to your DR. The reason why techs need to look at the data is (how much air is the mask leaking? 60L/min is a huge leak..either your facemask is not on right, not tight enough, or you need another size.. also in the data is your AHI score , Total AI, and Central AI scores).. you want them as close to 0 as possible.. If your s9 doesn't show this... look below and access the admin menu and turn SLEEP QUALITY ON (gives the machine permission to show the patient some basic sleep data)

That's IT... this is MEDICAL data.. and it just can't be collected for "compliance" reasons without your permission. I have the best Blue Cross Blue Shield money can buy... and they don't want ANYTHING to do with the data

Once you get a cpap machine, IT'S YOURS

I didn't like my settings... to strong.. I woke up with a distended belly and spent hrs burping up air.

I complained to my DR and healthy @ home.. they never could get the settings right.. so I set them myself

EASY: hold down the settings button (lower button with 2 check marks) and push the round wheel down at once.. and boom.. you get the clinician setup menu where you can change ANYTHING

I have a s9 auto set (APAP machine vs CPAP - although you can put this thing into just CPAP mode), and mine was set to not allow the ramp higher than 20 min.. 15-20 pressure .. too much.. it was blowing the mask off... i had to make it so tight my nose started bleeding after a week

I have a BAD case.. so I DO need a setting of 20 now and then... I resolved this by setting the MIN pressure down from 15 to 11 and a max of 20... with a starting ramp pressure of 8. And changed the max ramp limit to 45 mins as it takes me 30-45min to fall asleep

So when I press the on button (actually I don't need to as I put the machine in auto start/stop mode)... it starts me at 8 and over 45 mins slowly brings me up to 11... then as I'm sleeping the machine will use 11 to 20 depending on how bad my apnea events are

One thing people don't realize.

Yes you DO need an Rx to get a machine, mask, humidifier, and power backup unit.. any other accessories (heated tube, nasal padding to prevent what's happening to my nose) You do NOT need a Rx... but once you GET that machine.. YOU OWN IT... there is NO LAWS.. NO REGULATIONS saying that you CAN NOT change the settings! They don't exist in any federal or state form. (although many Drs or tech companies that set you up will try to strike fear into you to the contrary)

Now if your DR has a company set it up for you THAT company and techs legally need a new RX to change it... but YOU DO NOT

The ONLY exception to this is if the machine is being RENTED/LEASED to you (which is some what common)... but then you'd be signing something that you agree not to mess with the machine...It's good because as it gets outdated, your insurance will pay for you to rent a new one... bad because you can't tweak the machine itself w/o pissing off the company that rented it to you

I requested that I buy mine and my ins paid 100% (I already hit my 500$ dedcutable and 1500 out of pocket expenses earlier this year getting diagnosed with apnea)... so ALL my medical bills are 100% paid for the rest of the year... so anything I've ever suspected wrong with me is being taken care of... but it turns out 90% of all these other issues are tied back to my apnea!

I've only had this machine 2 weeks, and I already feel 15 yrs younger!

Lastly you can press and hold the 2 small buttons at once for a more detailed reports and read only view of the all settings

[jaycee]

The modem .. IF you have one ... is NOT for resmed to collect data.. that would be a MASSIVE HIPPA violation as NONE of us have given resmed permission to collect data in ANY WAY SHAPE OR FORM

I work in the medical industry, and I have to know HIPPA forwards and backwards...

Also the modem is RX (Transmit only). So new settings can NOT be uploaded to it.


IF you have a modem, it's used in 1 of 2 ways

1) If the machine is given to you by your DR, the modem transmits the data DIRECTLY to your DR, or to a data collection service he or she uses. Then your Dr can analyze your sleep data and have your bring your machine in from time to time

2) If your DR works with a home health care company (here in Charlotte, NC it's called Healthy @ Home). The data is collected by Healthy @ Home, and you give THEM permission to collect the data.. for THEIR techs to analyze it AND to pass it on to your DR. The reason why techs need to look at the data is (how much air is the mask leaking? 60L/min is a huge leak..either your facemask is not on right, not tight enough, or you need another size.. also in the data is your AHI score , Total AI, and Central AI scores).. you want them as close to 0 as possible.. If your s9 doesn't show this... look below and access the admin menu and turn SLEEP QUALITY ON (gives the machine permission to show the patient some basic sleep data)

That's IT... this is MEDICAL data.. and it just can't be collected for "compliance" reasons without your permission. I have the best Blue Cross Blue Shield money can buy... and they don't want ANYTHING to do with the data

Once you get a cpap machine, IT'S YOURS

I didn't like my settings... to strong.. I woke up with a distended belly and spent hrs burping up air.

I complained to my DR and healthy @ home.. they never could get the settings right.. so I set them myself

EASY: hold down the settings button (lower button with 2 check marks) and push the round wheel down at once.. and boom.. you get the clinician setup menu where you can change ANYTHING

I have a s9 auto set (APAP machine vs CPAP - although you can put this thing into just CPAP mode), and mine was set to not allow the ramp higher than 20 min.. 15-20 pressure .. too much.. it was blowing the mask off... i had to make it so tight my nose started bleeding after a week

I have a BAD case.. so I DO need a setting of 20 now and then... I resolved this by setting the MIN pressure down from 15 to 11 and a max of 20... with a starting ramp pressure of 8. And changed the max ramp limit to 45 mins as it takes me 30-45min to fall asleep

So when I press the on button (actually I don't need to as I put the machine in auto start/stop mode)... it starts me at 8 and over 45 mins slowly brings me up to 11... then as I'm sleeping the machine will use 11 to 20 depending on how bad my apnea events are

One thing people don't realize.

Yes you DO need an Rx to get a machine, mask, humidifier, and power backup unit.. any other accessories (heated tube, nasal padding to prevent what's happening to my nose) You do NOT need a Rx... but once you GET that machine.. YOU OWN IT... there is NO LAWS.. NO REGULATIONS saying that you CAN NOT change the settings! They don't exist in any federal or state form. (although many Drs or tech companies that set you up will try to strike fear into you to the contrary)

Now if your DR has a company set it up for you THAT company and techs legally need a new RX to change it... but YOU DO NOT

The ONLY exception to this is if the machine is being RENTED/LEASED to you (which is some what common)... but then you'd be signing something that you agree not to mess with the machine...It's good because as it gets outdated, your insurance will pay for you to rent a new one... bad because you can't tweak the machine itself w/o pissing off the company that rented it to you

I requested that I buy mine and my ins paid 100% (I already hit my 500$ dedcutable and 1500 out of pocket expenses earlier this year getting diagnosed with apnea)... so ALL my medical bills are 100% paid for the rest of the year... so anything I've ever suspected wrong with me is being taken care of... but it turns out 90% of all these other issues are tied back to my apnea!

I've only had this machine 2 weeks, and I already feel 15 yrs younger!

Lastly you can press and hold the 2 small buttons at once for a more detailed reports and read only view of the all settings

The modem works both ways. I can upload changes to settings via the modem (when I have an order from the doctor to do so). Upon receiving the order I call that patient and let them know the change that the doctor ordered. Then I make the change and it is sent to the modem.

The data is for 2 purposes, compliance information to provide for insurance as well as your AHI/Leak/etc if your machine has that information. The data is uploaded into a database. Your DME (if that is who set you up with the machine) adds you to that database. They also add your doctor (some doctors/sleep labs use this database and some don't). When you do downloads via the SD card, it is also uploaded to this database.

Your "best" BCBS insurance REQUIRES compliance data, both on new users and replacement machines (at least they do in my state). They have a special BCBS form just for that reason.

I've set up thousands of CPAP machines (in the U.S.) and only a small fraction of those are purchase machines. Most are "rent to own". The purchase price is divided by a number of monthly payments (10-15 depending on the insurance).

Your DME would gladly do all purchase machines and not have to worry about compliance. It is your insurance company that is the bad guy here, not your DME. The modem allows the patient to NOT have to come into the office to have their compliance checked. Once you meet your compliance requirements, we call and you can pop your modem back in the mail to us (with the free postage envelope we provide). The modem also allows us to identify patients that are having problems so we have time to get those problems fixed soon and get the patient compliant.

Modems with CPAPs are a GOOD thing. It benefits the patient, the DME and your doctor.

[dduttonnc]

I must have a different modem. My modem say RX ONLY on it and when I asked then to upload settings, they said I had a one way modem and had to
Bring it back in

Bcbs can NOT see my data as I have not signed forms allowing them to

Ins comps can not look at anyone's med records unless given explicit permission to do so

Bcbs of nc only req a sleep study, a Drs RX. Then they BUY (not rent) the machine for me. My machine was 800$ and about 175$ for the h5i

So this sucker belongs to me. Bcbs paid 100% and I get new accessories as they wear out

[robysue]

The modem works both ways. I can upload changes to settings via the modem (when I have an order from the doctor to do so). Upon receiving the order I call that patient and let them know the change that the doctor ordered. Then I make the change and it is sent to the modem.

Pardon me for saying it, but this part of the modem set up scares the bejesus out of me. And here's why: I do NOT want you and the doc deciding to change my pressure without MY knowledge. And permission. And guess who you left out in your writing about this scenario? Me--the patient.

I know: You'll say the doc should tell me that the script is going to be changed. But what if the doc looks at the wirelessly transmitted data and never talks to me about about it? What if he just decides to fax you the script and you change it and neither of you bothers to contact me?

Here's the thing: The modem takes ME the patient out of the loop of knowing what's going on. It lets you and the doc look at and ACT on my data without the requirement that somebody takes the time to talk directly with ME about the proposed change in my medical care BEFORE it happens.

And if I wind up NOT doing well on the new settings? I'm clueless about what's changed because no-one bothered to tell me, the patient, that a pressure change was ordered and sent to my machine.

And if I'm knowledgeable enough to know how to check my settings (and SET them as well), when I discover the change and set it back to settings that I can sleep with? You can spy on me and change it back, again without my permission or explicit knowledge.

Yes, I know I'm painting a dark scenario. But its just that I've seen too many examples of DMEs and docs who don't listen to the patient at all ...

Your DME would gladly do all purchase machines and not have to worry about compliance. It is your insurance company that is the bad guy here, not your DME. The modem allows the patient to NOT have to come into the office to have their compliance checked.

My compliance and my hubby's compliance was checked by putting the SD card into a mailing envelop and dropping it in the mail. The DME did call hubby to remind him that they needed to see the SD card. But no office trip to either the DME or doc was needed for our compliance checks.

That said: A follow-up face-to-face office with a new PAPer is NOT a bad thing. Too many newbies face a long list of what they think are bizarre problems all by themselves and they're very reluctant to call either the DME or the sleep doc to actually talk about them. It helps to have SOMEBODY to talk to face-to-face about this weird alien who has moved into your bedroom. And eliminating the need for an office visit or a phone call reduces the built-in opportunities for a shy patient who's in trouble to get some necessary feedback to help turn things around.

Once you meet your compliance requirements, we call and you can pop your modem back in the mail to us (with the free postage envelope we provide). The modem also allows us to identify patients that are having problems so we have time to get those problems fixed soon and get the patient compliant.

Only thing is: You can't fix a problem that you don't understand. And playing phone-tag is highly inefficient from the patient's point of view. We absolutely HATE having to stick close to the phone hoping for a call back. And even with cells, we have our lives too, and getting the call back in the middle of a meeting just is not convenient for us.

A follow up appointment is really a good idea. For the rare newbie like my hubby who has no troubles at all, it may seem like a bit of a nuisance. But for someone like me who had a laundry list of problems, in person follow-up appointments are critical. And please understand, no one looking at my data would have identified me as someone who was in trouble: I was fully compliant in the sense of using the damn machine every single night, all night long; my leak data was superb; and my treated AHI was between 0.5 and 1.0. And yet I was a walking zombie with a growing case of CPAP-induced insomnia; people at work were concerned about my rapid decline once I *started* PAP therapy----I was visibly exhausted and unable to do even routine tasks at my job as a college professor. But if hubby hadn't seen fit to intervene and start demanding that folks at both the DME and sleep doc's office start talking with me (in person), I'm not sure I would have gotten the help I so badly needed.

Modems with CPAPs are a GOOD thing. It benefits the patient, the DME and your doctor.

A modem only helps the patient IF the DME and the doc KEEP the patient in the loop. And that means figuring out a way of getting all the data you're gathering through that modem TO the patient on a regular basis regardless of whether the data seem to indicate whether things are going well or not.

Moreover, a modem can't create data that the machine doesn't record in the first place. And modem-equipped bricks are NOT in the patient's best interest, but supplying modem-equipped bricks is in the DME's short-term financial interest: The machine is cheaper AND with the modem, there's even less chance that someone at the DME will have to speak face-to-face with the PAPer in question.

[jaycee]

I must have a different modem. My modem say RX ONLY on it and when I asked then to upload settings, they said I had a one way modem and had to
Bring it back in

Bcbs can NOT see my data as I have not signed forms allowing them to

Ins comps can not look at anyone's med records unless given explicit permission to do so

Bcbs of nc only req a sleep study, a Drs RX. Then they BUY (not rent) the machine for me. My machine was 800$ and about 175$ for the h5i

So this sucker belongs to me. Bcbs paid 100% and I get new accessories as they wear out

All the Resmed modems I've used say RX only and I can assure you they work both ways.

BCBS in my state requires all patients to sign the BCBS compliance form or they will deny the claim. They used to buy PAPs and as a DME, we loved that. Less time/effort/expense on our part.

We use a general compliance form that authorizes us to send their compliance data to their insurance. You don't get a rental machine without completing the paperwork. Most insurances will stop paying after the 90 day mark if you don't provide them proof that the patient is "compliant" (usually 30 day stretch, 4+ hours 70% of the time).

[archangle]

The S9 and PRS1 wireless modems do work both ways. From a technical standpoint, whoever is in control on the other end can change your pressure settings, as well as look at some of your data.

They can also do this via the SD card or smart card for machines so equipped. In the old days, you'd send them the data card via mail or in person, and they'd give you one back, which might or might not have new pressure settings.

The wireless modems work with the cell phone system. Cell phones don't work everywhere, so sometimes, the wireless bit doesn't work. (wink, wink). If the wireless modem doesn't work, the SD card can be used to get the compliance data. If the SD card is missing or damaged, the compliance data is still in the machine. You can insert a SD card, and the data will be sent to the card, which can then be read with the software. If the SD card still doesn't work, you can read the compliance info directly off the display of the machine. On the PRS1 machines, there's even some checksum information where the patient can read the DME or doctor the information over the phone and they can get compliance verification.

Summary: Unless you've gone into the clinician menu and erased the data, or the machine failed, they can get compliance data if you bring them the machine. Whether they're smart enough to know that is another question.

Re: HIPAA vs. CPAP Manufacturer

Let's call CPAPCO the person who runs the data collection service used by your wireless modem. CPAPCO may be the manufacturer or some other company.

Your doctor is authorized to see your data. Your doctor can share this authorization with various other medical professionals. For instance, the billing department, his nurses, medical facilities involved in your care, etc. CPAPCO runs the data collection service that gathers data on behalf of the doctor. i.e. CPAPCO controls the computers on the other end of the cell phone line. CPAPCO does certain types of analysis on this data in order to format it and display it to the doctor.

There are restrictions on what CPAPCO and even your doctor's office can do with this data, but I'm not sure exactly where the boundaries lie. I doubt the boundaries are policed that well, either for company authorized "snooping" or unauthorized snooping.

I think in many cases, CPAPCO may be allowed to do things with your data as long as they "anonymize" the data by removing your personal information.

Re: HIPAA vs. Insurance

You agree to let your insurance company see at least some of your medical information when you apply for insurance. There may be some restrictions on what data they can see, but I don't think there are many restrictions. A doctor (or pseudo doctor*) has to make most of the medical decisions, but the insurance company has quite a bit of leeway to say "We're not going to pay for procedure X for this patient. We need to see the patient's records before we'll approve this. We will pay for procedure Y."

*pseudo doctor - For some things, I think "physician's assistants," or even nurses may be able to prescribe drugs or order treatments. Even if they can't legally do so, I think quite a few doctors have some "non-doctor" who essentially writes prescriptions and the doctor rubber stamps them. Sometimes the doctor may be "responsible," but he never even sees the prescription with his name and signature on it.

Re: Changing pressure

I think that legally, the pressure changes require a doctor or pseudo-doctor's prescription. Technically, I think someone else in the system actually pushes the button, but legally has to follow the official prescription. Of course, even if the human side is all done according to the process, the technology can go wrong. And the human side can make a typo or other mistakes.

BTW, I think it's actually a doctor's "order," not a "prescription," and there are some legal fine points of distinction. It may be written on a "prescription" form in many cases.

Re: Wireless data

Looking at this ResMed tutorial, it looks like the wireless data is ONLY compliance, pressure and AHI. Maybe that's only for some particular version of wireless data collection. It indicate AHI, HI, AI, OAI, CAI, and UAI. No info on when during the night these events occur, or on event duration. No waveforms.

www . resmed.com/us/products/easycare_online/easycare-online.html?nc=clinicians

[robysue]

Resmed currently has TWO web-based pieces of software for looking at data generated by S9 machines.

SleepSeeker
The web-based software that Resmed is marketing towards patients is called SleepSeeker, but it provides NOTHING that's not available directly from the machine's LCD report. Here's a typical screen shot that I found on another forum of what SleepSeeker reports look like:



That's LESS info that you get off the S9's LCD in the long Sleep Quality Report: The AHI on the long Sleep Quality Report is broken down into AHI, AI, and CAI, from which you can easily compute the OAI and HI if desired.

It also bothers the mathematician in me that the leak number is not labeled. I'd assume that it's the 95% leak rate, but it sure would be nice if they told you that.

Moreover, I'm told that in order to sign up for SleepSeeker, you have to give Resmed a lot of personal information. So you give up some significant privacy and gain nothing as a patient if you choose to use SleepSeeker.


EasyCare Online
The web-based software aimed at DMEs and clinics is called EasyCare Online. The EasyCare Online web based tutorial clearly indicates that two types of therapy reports can be generated using EasyCare Online.

EasyCare Online Therapy Report
The Therapy Report can be generated from the data sent by the wireless modem attached to an S9 Elite or an S9 AutoSet (or an S9 Escape Auto I suppose). Or the data can be uploaded from the SD card from the machine. In either case, the information in an EasyCare Online Therapy Report is pretty limited for a "therapy report" in my opinion. I just re-listened to the on-line training guide and captured these two screen shots of what the EasyCare Online Therapy Report looks like:





You'll notice there's not much here that's not on the SleepSeeker screen shot. The AHI is broken down AI and HI by day, but on any individual day, there's no way to tell how much of that AI is CAI vs. OAI. And those numbers off to the left seem to be averages for the entire viewing period---i.e. summary numbers.

If this is what Resmed wants the DMEs and docs to buy into for the data needed to properly assess the efficacy of a patient's PAP therapy, it's a step backwards in my opinion. And the potential for finding a way to prevent us, the patients, from seeing anything that's not on SleepSeeker is pretty high; all it will take is convincing the DMEs to treat "SD card compatible" as an "optional add-on module" for patients in remote locations where there is no cell phone coverage...


EasyCare Online Detailed Data Report
Right now Resmed also allows the DME to generate Detailed Data reports from inside EasyCare Online as well as the Therapy Reports. However, according to the tutorial, the data needed to generate a Detailed Data report must be uploaded into EasyCare Online through the SD card; you can't generate a detailed data report with the data that is transmitted by the wireless modem. (And Detailed Data reports are limited to S9 Elite and S9 AutoSet machines; no surprise there.)

As what does a Detailed Data report look like? Well, the short answer is it looks a lot like a Rescan Detailed Data report minus the wave flow data, the numbers on top of the apnea flags that tell you how long each apnea lasted, and the other more esoteric graphs for snoring and flow limitation that are shown in standard Resscan reports if I recall correctly. Here are screen shots from the tutorial showing what a Detailed Data report contains:







It seems clear to me from browsing the Resmed web pages aimed at clinicians and DMEs, that Resmed is really pushing EasyCare Online as the replacement for ResScan. They're telling DMEs and clinics that they won't have to do any software maintenance if they switch over to EasyCare Online. And yes, EasyCare Online does use cloud storage techniques for storing the actual patient data. The data is stored on secure servers (for HIPAA reasons no doubt). But what that means in the long run is that it will become easier and easier to lock the patients completely out of seeing any of the data that Resmed (and their true customers, the DMEs) do not want us to see.