title: American Academy of Sleep Medicine (AASM) Position Paper for the Use of Telemedicine for the Diagnosis and Treatment of Sleep Disorders.
abstract: The American Academy of Sleep Medicine's (AASM) Taskforce on Sleep Telemedicine supports telemedicine as a means of advancing patient health by improving access to the expertise of Board-Certified Sleep Medicine Specialists. However, such access improvement needs to be anchored in attention to quality and value in diagnosing and treating sleep disorders. Telemedicine is also useful to promote professionalism through patient care coordination and communication between other specialties and sleep medicine. Many of the principles and key concepts adopted here are based on U.S. industry standards, with special consideration given to the body of work by the American Telemedicine Association (http://www.americantelemed.org/), and abide by standards endorsed by the American Medical Association (http://www.ama-assn.org/). Practitioners who wish to integrate sleep telemedicine into their practice should have a clear understanding of the salient issues, key terminology, and the following recommendations from the AASM. The Taskforce recommends the following: • Clinical care standards for telemedicine services should mirror those of live office visits, including all aspects of diagnosis and treatment decisions as would be reasonably expected in traditional office-based encounters. • Clinical judgment should be exercised when determining the scope and extent of telemedicine applications in the diagnosis and treatment of specific patients and sleep disorders. • Live Interactive Telemedicine for sleep disorders, if utilized in a manner consistent with the principles outlined in this document, should be recognized and reimbursed in a manner competitive or comparable with traditional in-person visits. • Roles, expectations, and responsibilities of providers involved in the delivery of sleep telemedicine should be defined, including those at originating sites and distant sites. • The practice of telemedicine should aim to promote a care model in which sleep specialists, patients, primary care providers, and other members of the healthcare team aim to improve the value of healthcare delivery in a coordinated fashion. • Appropriate technical standards should be upheld throughout the telemedicine care delivery process, at both the originating and distant sites, and specifically meet the standards set forth by the Health Insurance Portability and Accountability Act (HIPAA). • Methods that aim to improve the utility of telemedicine exist and should be explored, including the utilization of patient presenters, local resources and providers, adjunct testing, and add-on technologies. • Quality Assurance processes should be in place for telemedicine care delivery models that aim to capture process measures, patient outcomes, and patient/provider experiences with the model(s) employed. • Time for data management, quality processes, and other aspects of care delivery related to telemedicine encounters should be recognized in value-based care delivery models. • The use of telemedicine services and its equipment should adhere to strict professional and ethical standards so as not to violate the intent of the telemedicine interaction while aiming to improve overall patient access, quality, and/or value of care. • When billing for telemedicine services, it is recommended that patients, providers, and others rendering services understand payor reimbursements, and that there be financial transparency throughout the process. • Telemedicine utilization for sleep medicine is likely to rapidly expand, as are broader telehealth applications in general; further research into the impact and outcomes of these are needed. This document serves as a resource by defining issues and terminology and explaining recommendations. However, it is not intended to supersede regulatory or credentialing recommendations and guidelines. It is intended to support and be consistent with professional and ethical standards of the profession.
authors.affiliation: Carolinas HealthCare System, Charlotte, NC.
authors.forename: Jaspal
authors.initials: J
authors.lastname: Singh
authors.affiliation: Wayne State University, Detroit, MI.
authors.forename: M Safwan
authors.initials: MS
authors.lastname: Badr
authors.affiliation: The VirtualEngine, LLC, St. Louis, MO.
authors.forename: Wendy
authors.initials: W
authors.lastname: Diebert
authors.affiliation: Welltrinsic, Darien, IL.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Epstein
authors.affiliation: Kaiser Permanente, Fontana, CA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Carolinas HealthCare System, Charlotte, NC.
authors.forename: Valerie
authors.initials: V
authors.lastname: Karres
authors.affiliation: North Dakota Center for Sleep, Fargo, ND.
authors.forename: Seema
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Carolinas HealthCare System, Charlotte, NC.
authors.forename: K Nicole
authors.initials: KN
authors.lastname: Mims
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Affifa
authors.initials: A
authors.lastname: Shamim-Uzzaman
authors.affiliation: Carolinas HealthCare System, Charlotte, NC.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kirsch
authors.affiliation: American Academy of Sleep Medicine, Darien, IL.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Heald
authors.affiliation: American Academy of Sleep Medicine, Darien, IL.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McCann
mesh_terms: D000047:Academies and Institutes; D006801:Humans; D056508:Sleep Medicine Specialty; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine; D014481:United States
keywords: position paper; telemedicine