Patient-centered care model in IONM: a review and commentary

Both remote monitoring and nearby/available care models depend on waveform telemetry (a limited form of telemedicine) during intraoperative neurophysiological monitoring (IONM). These dominant models neither mandate preoperative patient contact nor assume co-practitioner collegiality. This review and commentary argues in favor of a routine, normative relationship between the patient and the IONM physician/professional (IONM-P). Similarly, normal collegial relations should be established and maintained over time between the IONM-P and fellow co-practitioners (the proceduralist and the anesthesiologist). This professional practice "upgrade" places the IONM-P in a much stronger bioethical position among peers (and third party reviewers of the field and its practices). This "upgrade" also improves the likelihood that correct context-driven decisions will be made by the co-practitioners (IONM-P, proceduralist, and anesthesiologist) during complex multimodality monitoring. Most current models of IONM can be accommodated by readily available telemedicine-mediated videoconferencing. Several lines of argument are used to support this "patient-centered care model" of IONM.