ResMed and Post-Acute: A Constant Technology Evolution

ResMed COO Rob Douglas on his company’s 30-year anniversary and how it has participated in the growth and adoption of new care technologies in post-acute health.

This year, sleep therapy equipment and technology company ResMed is celebrating its 30th anniversary, and during those three decades, the company has sat at the epicenter of a increasingly high-tech response to an ever-growing population of people with sleep apnea.

For example, ResMed recently released a study that found that approximately 170 million people across North and South America have sleep apnea, a number that reveals sleep apnea is more common in the Americas than previously thought. And, a related ResMed study found that cloud-connectable PAP devices that enable remote monitoring and patient self-monitoring generate higher-than-average adherence rates in patients.

I recently met with Rob Douglas, president and chief operating officer of ResMed, to discuss its new study; how sleep therapy technology has evolved; how cloud-connected systems for patient monitoring and data sharing are improving care; how technology is helping expand out-of-hospital care; and how the post-acute technology landscape might take shape in the near future.


HMEB: ResMed is celebrating its 30-year anniversary. Maybe you could describe the company's digital evolution that’s happened during that time.

Rob Douglas: You know, some people think 30 years is old for a company, but for us we still think we're just getting started. Particularly because all that time we've had this focus on sleep apnea and later on COPD, and these are both two chronic conditions that are severely under-recognized, particularly sleep apnea, and particularly undertreated. And we think there's still big opportunity in that.

For many years we were a company that focused on improving the physical products and the performance of the treatments, and how we could make life easier for patients, and for providers in terms of dealing with the condition and staying on the treatment and all of that. And we had lots of mechanical engineers, and electric engineers building products. And our sort of big challenge as we worked through this was just getting recognition and awareness of sleep apnea being an important thing that needed to be treated.


HMEB: Very true; super under-diagnosed.

Douglas: Absolutely. And you know I've been with the company a bit over 18 years and when I first joined, we were still on this mission around creating awareness.

Whereas now, I think we've made great progress — ResMed, the industry as a whole, and all of the providers. And people know about sleep apnea and they know it's something that should be treated. We're not done on that awareness campaign. I don't think that health systems really appreciate the consequences and the cost of untreated sleep apnea. If they did appreciate it more they'd probably support the diagnosis and treatment of patients more collectively.

But all through the time I've been in the company, we've been experimenting with connectivity and teaching about ways to make these products more effective and more usable. We always knew with the CPAP machines that we basically had a computer on the bedside table. And as technology improved and we're able to get better connectivity, we test and trial lots of ways of getting the information about how well the patients were working with the machine into a central place where we could provide it back to people so that we could take action on that.

It wasn't until we introduced the AirSense 10 (a bit more than four years ago now), where we integrated a coms chip into the into the device, and we made this data collection really transparent to the patient and to the providers. And we were able to really effectively get all that information and package it up and provide it back to workflows for HME providers, but also app data for patients. And we quickly showed that if these coms systems and the data was being used, we got much better outcomes in terms of patients sticking on treatment.


HMEB: And that's kind of brings us to now. We now live in this realm of connected care and remote patient monitoring. Let's take a level set on today's reality. Are patients, providers and referral sources starting to adopt this new approach to care and using information to improve care?

Douglas: Absolutely. I mean, you know early on when we did this, we did a number of studies, and we have published studies showing that just turning the system on and using its automated features would take short-term compliance rates from somewhere in the low 60s percent to somewhere in the high 80s percent range. That if you think about it, that's a huge difference. That's a more significant outcome than you'll get from almost any other intervention.

We've also published data showing you similar improvements if the patients are signed up onto the MyAir app. That app can support the patient, it can also give tips and show videos and provide advice for routine problems. We saw similar improvements to that. So, it's had a huge impact.

Our future areas of what we're starting to look at longer term compliance, because if you want the health benefits of having your sleep apnea treated, you really need to stick with it over the longer term. And we're starting to use this data to publish information. We could do observational studies on lots of patients — when we have approval to use the data, that is — that show that getting a patient, for example, onto a good resupply program will improve the adherence rates one year out after initial set up by similar amounts to what I mentioned in those earlier studies. We did one study that showed patients on resupply would be at one year adherence rate around 84 percent, verses patients not on resupply who had one year adherence around 66 percent.


HMEB: So, right there, we're seeing data being used to direct effect. What, have been other elements of ResMed’s technological evolution besides remote patient monitoring?

Douglas: It's all part of that transition to being a tech-driven medical device company. And really a software tech company; we've been investing in other business in terms of software as a service business. And one of the big investments obviously of interest to your readers was our investment in Brightree.

HMEB: Certainly.

Douglas: Brightree can have really positive impact to the business operations of the HME providers and can greatly improve efficiencies. And you know, we're able to think about ways how these connected care devices that I've mentioned sort of improving workflows. We can actually really integrate these information flows with the workflows within Brightree as well and make things all that much more efficient in terms of managing the patients, keeping them on treatment, making sure that we've got the really good documentation trial and making sure that can be robust in the face of audits and things like that.


HMEB: Brightree has been so aggressive when it comes to driving data interoperability and data sharing between different entities in the healthcare continuum. So, where do you think that's going to take us? How's that going to play out?

Douglas: Care provided outside of hospitals has got to be a better place than providing it inside the hospital. But you've got to do it well, and you've got to manage it well and you've got to have transparency about what's going on. And you want care providers talking to patients, not filling in forms all the time.

So these technology software systems, I think, can make a huge difference in raising the quality of care and in fact, increasing the accountability. I think the connected care on devices and you know, some of the systems that Brightree have around visit verification and all those types of things, we can actually make the treatments be much more accountable, and I think that will lead to better outcomes. And the better outcomes will be good for the patients, good for the payers and good for the industry as well.


HMEB: How do wearable health devices factor into this? Can the data collected by wearables be factored into the more immediate care data being reported by CPAP machines, for example? I'm wondering if at some point we might get to a point where people have sort of a portfolio of healthcare metrics that are interconnected?

Douglas: There are lots of aspects to that question, but the whole issue of patients’ concern for their own wellbeing and health, if that increases we think that will be important for health systems to use that data. And there's a huge increase in concern and interest about having some metrics and monitoring around your sleep, and increasing understanding of the impact on sleep on all of your life.

Now, the thing with measuring sleep is that it's not an easy thing to do. And that's consequently why we have polysomnography, which is a pretty sophisticated way of tracking sleep. The wearables, they're really good. The watches and that type of thing actually based on movement or oximetry and that type of thing. We have a joint venture that we put some of our technology in called SleepScore Labs, and it's actually a non-contact monitor of your sleep. It actually effectively uses sonar out of a high-end phone to track your sleep in great detail, and gives you a report of how well you're sleeping. Definitely not a diagnostic tool; these are consumer tools and we have to be aware of the issue of consumer awareness about sleep to make sure we drive the right questions to be asked, so that people know when they should be going to consult a doctor and get into the health system.

But the whole issue around this linkage to other health conditions we think it's really important. In fact one of our investments that we've talked about is a joint venture with Verily, that's a subsidiary of Alphabet. If you think about the types of data that we have in our system, and that's our patients' data that we are the guardians of and have to preserve and look after very carefully. And when we have approval to use it in studies, we can. And we've actually published some great studies with very large number of patients in the,.

But it's very specific around sleep and sleep apnea. And as you say, people's lives have a lot of other things going on and also their health care utilization. Verily has access to other data or studies around what's going on in people's life. In particular they're doing a study called Baseline where they're looking at all of the health parameters of around 10,000 people, many of whom will have sleep apnea, by the way. And we think that by having partnerships with our very deep data with other organizations like Verily that have broader data, we can actually start learning a lot about what types of things actually make a difference to people's sleep and their life and how well they sleep. We can also learn a lot about what sort of benefit do they get from these out-of-hospital treatments, like sleep apnea or eventually for COPD, and what sort of difference based on people's other healthcare utilization — all the trajectory of their health. And having partnerships in this connected world is really important.


HMEB: Putting my “blue sky” thinking a little bit back in check and diving back down towards ground level, what are the next steps in ResMed's evolution, technologically? Is it more the remote patient monitoring? Is it expanding this to other types of care? Where are we going?

Douglas: We take a view that there's some big trends in the health system that will play out over the next five to eight years. Some of those trends really is just sort of continued involvement with technology and, how data and information flows through it. We think there'll be continued trend to looking for out-of-hospital care settings, particularly in the disease states that we treat. There'll be continued strong patient inflows of awareness and recognition. And that under-diagnosis starts to get addressed.

And that will come with the attendant cost concerns. We see in that set of big trends a big opportunity in what we call integrated care models. And in a sense, this is where devices will need to be able to interact with information systems and that are working in conjunction with healthcare professionals and care providers and patients, through the whole system.

We still have huge opportunity in the terrible fact that there are so many untreated sleep apnea patients around. And also in the terrible fact that COPD is still such a significant condition And around the world and is sort of undertreated, as well. We'll continue to invest in fast businesses. We'll continue to invest in making our treatments easier and more comfortable and more effective for patients to use; we've got a very large R&D program going on and focusing on that. And we'll continue to, where appropriate, use the information that we're able to collect to make the case that these treatments for chronic diseases out of the hospital can be really cost effective and very, really improve the quality of life of patients, as well.

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