Real-Time Remote MonitoringReal time supervision of intraoperative monitoring during orthopaedic and neurosurgical procedures has been the proposed standard of care since the beginning of intraoperative monitoring. Unfortunately, the need for monitoring rapidly outpaced the profession’s ability to provide certified technologists to provide the service and neurophysiologists to supervise them. This resulted in technologists being thrust into roles that they may not have been adequately prepared or trained for with little or no education and no supervision for them while they participated in the intraoperative care of patients during high risk surgeries. Neurophysiologists to supervise the technologists are rare as well with less than two hundred (200) board certified neurophysiologists in the world. Three major organizations, the American Electroencephalographic Society, the American Academy of Neurologists, and the American Society of Electrodiagnostic Technologists have all written position statements regarding the role of technologists, neurophysiologists, and supervision. Briefly they state that the monitoring “team” must be under the direct supervision of a trained clinical neurophysiologist and that the neurophysiologist be physically present or present by means of real-time remote mechanism.
The advantages of this real time remote monitoring are numerous. Whereas previously, if a technologist identified data that was considered questionable, they were required to “describe” the data to the surgeon who was then responsible for interpreting the description or sending for a neurophysiologist if one was available. Real time remote monitoring provides a neurophysiologist to instantaneously interpret and consult with the surgical team. The increase in the professionalism of the intraoperative monitoring team will result in an immediate reduction in the medical/legal liability as well. The neurophysiologist is always available for pre-operative planning of the surgery to assure that the monitoring modalities that might be required are available. Modern electrodiagnostic monitoring systems allow for real time remote monitoring or may be easily adapted so any existing system currently in use may continue to be utilized with no additional equipment purchases necessary. Neurophysiology Inc has been providing intraoperative monitoring services for many years and, as a group, has over thirty five (35) years of monitoring experience. As many different hospital settings may require customizing the monitoring programs, Neurophysiology Inc is capable of adapting their services to meet the hospital’s needs. The basic real time remote program
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With the advent of the internet and secure transmission of data, the technology exists whereby the intraoperative monitoring data may be instantaneously transmitted to a remote location. Communication between the technologist and neurophysiologist currently includes text messaging via the monitoring system and telephone conversation. In the very near future live video and voice will be added to the system to allow even more effective communication between the monitoring team and the surgical staff.