title: Impact of Sleep Telemedicine Protocol in Management of Sleep Apnea: A 5-Year VA Experience.
abstract: There is growing evidence that demonstrates an important role for telemedicine technologies in enhancing healthcare delivery. A comprehensive sleep telemedicine protocol was implemented at the Veterans Administration Medical Center (VAMC), Milwaukee, WI, in 2008 in an effort to improve access to sleep specialty care. The telemedicine protocol relied heavily on sleep specialist interventions based on chart review (electronic consult [e-consult]). This was done in response to long wait time for sleep clinic visits as well as delayed sleep study appointments. Since 2008 all consults are screened by sleep service to determine the next step in intervention. Based on chart review, the following steps are undertaken: (1) eligibility for portable versus in-lab sleep study is determined, and a sleep study order is placed accordingly, (2) positive airway pressure (PAP) therapy is prescribed for confirmed sleep apnea, and (3) need for in-person evaluation in the sleep clinic is determined, and the visit is scheduled. This study summarizes the 5-year trend in various aspects of access to sleep care after implementation of sleep telemedicine protocol at the Milwaukee VAMC.
  
  
  
  This is a retrospective system efficiency study. The electronic medical record was interrogated 5 years after starting the sleep telemedicine protocol to study annual trends in the following outcomes: (1) interval between sleep consult and prescription of PAP equipment, (2) total sleep consults, and (3) sleep clinic wait time.
  
  
  
  Two part-time sleep physicians provided sleep-related care at the Milwaukee VAMC between 2008 and 2012. During this period, the interval between sleep consult and PAP prescription decreased from ≥60 days to ≤7 days. This occurred in spite of an increase in total sleep consults and sleep studies. There was also a significant increase in data downloads, indicating overall improved follow-up. There was no change in clinic wait time of ≥60 days.
  
  
  
  Implementation of a sleep telemedicine protocol at the Milwaukee VAMC was associated with increased efficiency of sleep services. Timeliness of sleep management interventions for sleep apnea improved in spite of the increased volume of service.
authors.affiliation: 1 Division of Pulmonary Medicine, Clement J. Zablocki VA Medical Center , Milwaukee, Wisconsin.
authors.forename: Mirza M
authors.initials: MM
authors.lastname: Baig
authors.affiliation: 1 Division of Pulmonary Medicine, Clement J. Zablocki VA Medical Center , Milwaukee, Wisconsin.|2 Division of Pulmonary Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin.
authors.forename: Andrea
authors.initials: A
authors.lastname: Antonescu-Turcu
authors.affiliation: 1 Division of Pulmonary Medicine, Clement J. Zablocki VA Medical Center , Milwaukee, Wisconsin.|2 Division of Pulmonary Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin.
authors.forename: Kavita
authors.initials: K
authors.lastname: Ratarasarn
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment; D014481:United States; D014493:United States Department of Veterans Affairs; D014850:Waiting Lists
keywords: Veterans Administration Medical Center; access; electronic consult; sleep apnea; telemedicine