Here - ASET

IN THIS ISSUE
BRIEFINGS FROM THE BOARD 3
TECHNICAL TIPS 6
INTEREST SECTIONS 8
GOVERNMENTAL AFFAIRS AND ADVOCACY 24
CONNECTIONS CORNER 25
NEW MEMBERS 28
ASETnews
Summer 2013
SUMMER 2013
VOLUME 37, NUMBER 2
ASET OFFICERS
BOARD OF TRUSTEES
PRESIDENT
Judy Ahn-Ewing, R. EEG/EP T., CNIM, CLTM, FASET, BA
St. John Providence Health System
Detroit, MI
jahnewing@tir.com
Susan Agostini, R. EEG/EP T., CLTM
Banner Good Samaritan Medical Center
Phoenix, AZ
TJ Amdurs, R. EEG T., MS
University of Pittsburgh Medical Center
Pittsburgh, PA
PRESIDENT ELECT
Brian Markley, R. EEG/EP T., R.NCS.T., BS
The Neurology Center, PA
Silver Spring, MD
bam@neurologycenter.com
Sara Batson, R. EEG/EP T., RPSGT, CNIM, CLTM
Jacksonville, FL
Scott Blodgett, R. EEG T., RPSGT, RST, MBA
ResMed Corporation
Rochester, NY
SECRETARY/TREASURER
Pat Smith, R. EEG T., AA
Child Neurology Center of Orlando, PA
Orlando, FL
psmith016@yahoo.com
Marcia Davidson, R. EEG/EP T., RPSGT, CNIM, RET, RN
St. Mary’s Hospital
Madison, WI
Ryan Lau, R. EEG/EP T., CNIM, CLTM, MS
Indiana University Health
Indianapolis, IN
Cheryl Plummer, R. EEG T., CLTM, BS
University of Pittsburgh Medical Center
Pittsburgh, PA
Christine Scott, R. EEG/EP T., CLTM, MA
Massachusetts General Hospital
Boston, MA
Cherie Young, R. EEG T., CNIM
Children’s Hospital
New Orleans, LA
2
BRIEFINGS FROM THE BOARD
BYLAWS AMENDMENTS TO BE VOTED ON AT ANNUAL BUSINESS MEETING
T
hree proposed amendments to the ASET Bylaws will be placed before the membership for a vote at the 2013 Annual
Business Meeting of the Society. The business meeting will be held on Friday, August 2, 2013 from noon to 2 p.m. at
the Peppermill Resort Spa Casino. The business meeting is being held in conjunction with the 2013 ASET Annual
Conference.
Per Article18, Section 2 of the ASET Bylaws, proposed amendments which fall within the following criteria require a full vote
of the membership in order to be adopted: (a) Materially and adversely affect the members’ rights as to voting, dissolution,
or transfer; (b) Effect a re-definition or cancellation of all or part of the membership categories; (c) Authorize a new class of
membership; (d) Increase or extend the terms of trustees; (e) Allow a trustee to hold office by designation or selection rather
than by election of the membership, other than the provisions of Article IX, Section 10; and (f) Authorize cumulative voting.
Business to be discussed that requires a vote of the membership
is as follows.
the ASET bylaws are amended by the membership to create
the additional position on the ASET board. Per the Chapter
Affiliate program approved by the board, nomination,
election and term of office of the Council chair is to be timed
with the nomination, election, and term of office of the ASET
president-elect and secretary-treasurer. The following two
proposed resolutions call for amending the bylaws to create
a position on the ASET Board of Trustees for the Chapter
Presidents Council chair and to set the term of office for the
new position.
A. Resolutions to amend ASET Bylaws to add a position to
the Board of Trustees and to set the term of office for that
new position
Background: The Chapter Affiliate program approved by
the ASET Board of Trustees at its July 31, 2012 meeting,
and unanimously endorsed by presidents of local, state and
regional neurodiagnostic societies present at the August 3,
2012 Society Presidents Roundtable meeting, specifies that
when ten entities have been chartered as ASET Chapters
under the program, a Chapter Presidents Council will be
formed. The Chapter Presidents Council comprises each
Chapter president. Each Council member will have full
voting rights on matters brought before the Council. The
Chapter Presidents Council will be empowered to request
and receive reports from its members, advise the ASET
Board of Trustees on matters pertaining to areas of common
interest, and initiate proposals for consideration by the ASET
Board of Trustees.
RESOLVED: That Article 9, Board of Trustees, Section 1, be
amended as follows:
Section 1. Number and Composition of Board of Trustees
The ASET voting Board of Trustees shall be composed of
up to 13 14 trustees, including 9 trustees elected at-large,
1 trustee who shall have been elected from and by the
Chapter Presidents Council as the chair of the Chapter
Presidents Council, and the officers including the president,
president-elect, secretary/treasurer and the immediate past
president. The immediate past president shall serve a term
of one year following their term as president. The decrease
from 16 trustees as of July 2007 will go into effect through the
process of attrition by board vacancies or resignations and
future board elections. Beginning in 2008, 3 at-large trustees
will be elected each year. After July 2007, board vacancies
will only be filled to maintain the minimum of 3 elected atlarge members per board term.
The chair of the Chapter Presidents Council is to be elected
from among and by the Council and will serve for a term of
two years, with eligibility for re-election for a second term.
Under the Chapter Affiliate program, it is prescribed that
the duly elected Chapter Presidents Council Chair serve as a
full voting member of the ASET Board of Trustees providing
3
BRIEFINGS FROM THE BOARD continued
RESOLVED: That Article 9, Board of Trustees, Section 2, be
amended as follows:
Section 2. Terms of the Board of Trustees
new subsection e. The Board of Trustee member elected
from and by the Chapter Presidents Council shall be
elected for a two-year term and may succeed him or herself
for one consecutive term. He/she will be ineligible to again
serve for three years upon their expired term. Term of
office shall coincide with the term served by the Society
president.
Key: Bold text represents new language proposed; text
stricken through represents language proposed to be deleted.
Note: The language in Article 9, Section 1, is proposed to
be deleted since transition instructions for downsizing the
board are now in full effect.
B. Resolution to Amend Bylaws to extend voting rights of
Institutional Members
the unanimous opinion that it is time to grant Institutional
employee members the right to vote rather than continue to
disenfranchise this large segment of the member population.
Approval of the following proposed Bylaws amendment
would extend voting rights to all Institutional members
rather than continuing to restrict it to just the Institution’s
Voting Representative/Primary Billing Contact.
Background: ASET’s Institutional member class is for health
care delivery organizations and educational institutions that
employ or educate neurodiagnostic technologists. Included
in the Institutional member annual dues is the ability to
sign up a voting representative/primary billing contact, and
up to four employees as members. Institutional members
may sign up additional employees under their Institutional
membership for a nominal add-on fee. All employees
enrolled under the Institution’s membership are directly
entitled to all member programs, services and privileges,
including the right to serve on ASET committees and task
forces. However, only the employee designated as the Voting
Representative/Primary Billing Contact has the right to
vote in Society elections and on Society matters, and no
Institutional member is eligible to serve as a trustee or officer
of the Society.
RESOLVED: That Article 5, Members, Section 2f, be
amended as follows:
Section 2f. Institutional: Any health care delivery or
educational institution which employs or educates
neurodiagnostic technologists may become an Institutional
member. Institutional members in good standing shall be
entitled to all membership privileges, including the right
to vote by the primary representative as designated by the
institution and to serve on committees, but shall not be
eligible to serve as a trustee or officer.
Key: Bold text represents new language proposed; text
stricken through represents language proposed to be deleted.
Over the past four years the number of Institutional members
has grown consistently and currently comprises more than 25
percent of the ASET member population. Given that one of
the five critical goals adopted by the ASET Board of Trustees
for the period 2012 – 2015 is that “practitioners become
active ‘owners’ of ASET,” and given that one of the strongest
tools to create a sense of ownership is member engagement
through, for examples, volunteerism, Interest Section
participation, manuscript submissions for the journal, and
participation in elections, the ASET Board of Trustees is of
Voting members who are present at the annual business
meeting will constitute a quorum for the transaction of
business. All Active, Associate, Student, Lifetime, and
Emeritus members, and designated voting representatives/
primary billing contacts of Institutional members, in good
standing of the Society attending the meeting will constitute
the voting body.
4
2013 ELECTION RESULTS
Ballots for the 2013 election for officers and trustees have been counted and the election results ratified.
Newly elected officers are:
President-Elect:
Cheryl Plummer, BS, R. EEG T., CLTM
Supervisor, Neurodiagnostics
Presbyterian-Shadyside Hospital
University of Pittsburgh Medical Center
Pittsburgh, PA
Secretary-Treasurer:
Patricia Smith, AA, R. EEG T.
EEG Technologist
Child Neurology Center of Orlando, P.A.
Orlando, FL
Newly elected as trustees for three year-year terms are:
Vicki Sexton, BS, R. EEG/EP T., R.NCS.T., CNCT, CLTM
EEG Technical Coordinator
Hospital of the University of Pennsylvania
Philadelphia, PA
Jennifer L. Walcoff, R. EEG T., CNIM
Epilepsy Coordinator, Lead Technologist, IOM Monitor
Johnson City Medical Center
Mountain States Health Alliance
Johnson City, TN
Note: Jennifer Walcoff, R. EEG T., CNIM, and Liberty Simmons, BS, R. EEG T., R.NCS.T., CNCT, CNIM, CLTM,
won the vote count to fill the two upcoming trustee vacancies on the board. However, circumstances have prevented
Liberty Simmons from being able to fulfill the required travel obligations of trustee this year. Therefore, Vicki Sexton,
BS, R. EEG/EP T., R.NCS.T., CNCT, CLTM, as the recipient of the next highest vote count, has been duly elected.
5
TECHNICAL TIPS
Kathryn Hansen, R. EEG T., BS, CPC
Healthcare Consultant
Integration Consultants
Lexington, Kentucky
R
eimbursement challenges have tested our program’s profitability in the past, and 2013 is
no exception. This year there are additional factors which will impact clinical and financial
practices: the expanding influences with Accountable Care Organizations, the 2013 Office
of Inspector General (OIG) Work Plan, the implementation of ICD-10-CM code changes. As well,
Medicare has published many program updates for us to review and consider as we proceed with
submitting billing claims for 2013.
The 2013 Medicare Physician Fee Schedule is fairly consistent with 2012, and may be reviewed
on your regional MAC’s website. A significant change effective January 1, 2013 is the increase of
Medicare Part B deductible to $147 from $140 for 2012. This will have an impact on our patients
and us as providers, since collection of the deductible is required prior to the payment from CMS
and third party payers is forthcoming.
A key Medicare change for us to target, which will have an impact on future reimbursement, is the
previously voluntary outcome reporting – Physician Quality Reporting System.
In 2013, the reporting of outcomes is important for all physicians, specialists included. This is
the baseline year for reporting key indicators, which are clustered into measurement groups, and
reported to CMS on claims filed for Medicare Part B patient encounters. A defined number of
patient claims are required to be reported, and this sets the provisions for future years. So, what is
the implication for providers?
Provisions outlined in the final Accountable Care Act include implementation of the physician
value-based payment modifier for provider practices. Developed by CMS in 2006, the voluntary
pay for reporting program is the next step of the pay for performance models and pilots we have
heard about the past few years. For physicians billing sleep medicine codes, the American Academy
of Sleep Medicine (AASM) has contracted with a provider to record the value-based modifiers,
called the Physician Quality Reporting System (PQRS.) It is a fairly easy process to report the PQRS
codes, and many approved electronic medical records have the indicators included in the measure
groups for reporting integrated in their templates. Data may be reported directly to CMS through
the submission of the claim. As well, reporting may be performed through an approved vendor or
through a registry, such as the one available through the AASM.
Of importance for sleep medicine providers, is documenting the Physician Quality Reporting
Indicators (PQRI), which list four indicators to measure clinical effectiveness for sleep apnea:
• Assessment of Sleep Symptoms: Percentage of visits for patients aged 18 years and older
with a diagnosis of obstructive sleep apnea that includes documentation of an assessment of
symptoms, including presence or absence of snoring and daytime sleepiness
• Severity Assessment at Initial Diagnosis: Percentage of patients aged 18 years and older with a
diagnosis of obstructive sleep apnea who had an apnea hypopnea index (AHI) or a respiratory
disturbance index (RDI) measured at the time of initial diagnosis
• Positive Airway Pressure Therapy Prescribed: Percentage of patients aged 18 years and older
with a diagnosis of moderate or severe obstructive sleep apnea who were prescribed positive
airway pressure therapy
6
TECHNICAL TIPS
A PROACTIVE APPROACH TO REIMBURSEMENT
TECHNICAL TIPS continued
•
Assessment of Adherence to Positive Airway Pressure
Therapy: Percentage of visits for patients aged 18 years
and older with a diagnosis of obstructive sleep apnea
who were prescribed positive airway pressure therapy
who had documentation that adherence to positive
airway pressure therapy was objectively measured.
Critical to reporting the indices is the fact that 2013 is a
provider’s benchmark year and this impacts revenue for
years to come. The reporting of outcome indices through
the Physician Quality Reporting System involves all of us
working with physicians in a medical practice providing
diagnosis and therapy for sleep apnea. Documentation of the
therapy outcomes is a responsibility for all
of us who work with our physicians seeing
the patients in clinic. It is critical we take
Providers who have not
time to review this process and establish a
successfully reported
plan for integrating.
PQRS measures in
Physicians participating in the
program and reporting for year
2012 and 2013 are eligible to receive
a 0.5% financial incentive payment
on all total estimated charges for
2013 will incur a 1.5%
Medicare Physician Fee Schedule
With the changing landscape for clinical
negative adjustment
covered services furnished during
providers, there are other opportunities to
with the 2015 Medicare
the respective (2012 or 2013)
consider in the face of all these changes.
Part B reimbursements.
reporting period. Providers who
Collaboration with third party payers,
have not successfully reported
the patient, your referral network, and
PQRS measures in 2013 will incur
the community will boost reimbursement
a 1.5% negative adjustment with the 2015 Medicare Part for services. Integrating monitoring of testing outcomes is
B reimbursements. The negative adjustment will increase needed to ensure effective therapies and patient adherence
to 2% for 2016 and 2017 thereafter. The provider must with therapy. Our focus is changing: we are now transitioning
elect to report at least one measure group, as listed above, from performing volume to documenting the value of our
or at least three individual measures listed in one group to patient encounters. This is a patient-centric care continuum,
obtain the incentive. There is a provision for retrospective with savings realized through efficient care, improved
reporting with 2012 outcome indicators, which will benefit access to care, and better care coordination. It requires
the provider’s value-based profile for subsequent years.
a partnership with our primary care network and other
specialists to effectively manage our patient’s care plan. For
To be specific, if a provider elects to report a measure group, most healthcare providers, this was an overarching reason
which for sleep apnea includes four individual measures, the to become a healthcare provider. Therefore, have the many
provider must report all four outcomes for at least 20 eligible changes we are experiencing within healthcare taking us
patients, and of these eligible patients, at least eleven must be back to our personal commitment and mission?
Medicare Part B fee schedule claims submitted patients.
If the provider elects to report at least three individual
measures, they must submit outcome measures for 80%
of Medicare Part B patients eligible for each measure. For
larger practices, incremental reporting requirements are
tiered based on the number of practitioners in the practice.
Physicians may choose to report indicators in another
measure group, such as those measurement groups in the
pulmonary and neurology standards. Only one measurement
group needs to be reported by the physician.
In reviewing the individual measures, they capture data
that is routinely reported by dedicated clinical providers,
when completing the history and physical, as well as when
documenting the clinical changes during a follow-up visit.
Therefore, this is a financial incentive that is available to
all who are already documenting the information in our
patient’s medical record. Why not develop the process to
report to obtain the incentive each year?
SAVE THE DATE
SATURDAY, AUGUST 3, 2013
ASET ANNUAL CONFERENCE
RENO, NV
CPT CODING
WORKSHOP
with Kathryn Hansen
7
INTEREST SECTION BRIEFINGS
INTEREST SECTION COORDINATOR
Margaret Hawkins, R. EEG/EP T., CNIM, CLTM
Wausau, WI
margaret.hawkins@ministryhealth.org
WELCOME FROM THE INTEREST SECTION COORDINATOR
By Margaret Hawkins, R. EEG/EP T., CNIM, CLTM
INTEREST SECTION LEADERS
T
he Executive, Education, and Publication offices of ASET have
recently received an increased number of inquiries regarding dealing
with handling/preparing for/surviving healthcare reform and its
various ramifications. Many techs are concerned that they as professional
and direct providers of health services are getting lost in bottom lines,
productivity reports, and efficacy studies. They are wondering how to
maintain respect within their institutions and be acknowledged for the
unique role they play in caring for neurological patients. So we decided
to put that topic out to our team of Special Interest authors at this time.
You will notice some common themes—We will always do our best, “every
patient, every time”, no matter the outside pressures; doing more with less;
continuing to learn; obtaining credentials; etc…
By reading their articles you will discover that no matter how change in
the healthcare environment in your personal realm is playing out, you
are not alone. Our facility just last week dramatically decreased its staff
by eliminating some positions entirely and significantly reducing existing
hours for other positions. I was caught in this “workforce re-alignment”
and I will assure you, it is a bitter pill to swallow—financially, emotionally,
professionally. Mostly I have decided that I will rely on my worth as a solid
and skilled technologist, a dependable employee, and a strong patient
advocate to get me through this current wave of change and uncertainty…
Acute/Critical Care Neurodiagnostics
By Sara Batson, R. EEG/EP T., CNIM, CLTM, RPSGT
Well the topic of discussion for this newsletter is how do we
prove our worth? As technologists, do we need to prove our worth? As
long as we do our job and keep the patient’s safety in mind as well as
perform a good quality test then that should be all that matters. Right?
I have heard techs say “A tech is as good as the test they
run.” I think every one of us works hard towards recording a
quality EEG to the best of our ability every time under whatever
the circumstances may be. We strive to be the best tech we can be.
Most people have never heard of a Neurodiagnostic Technologist,
let alone know what one is and what job function they perform unless
they have had an EEG or they know someone who has. Truth of it is, I
didn’t know what one was before entering this profession in my 30s. My
family only knows what Neurodiagnostic Technologists do because of
me being in this profession; otherwise sadly neither I nor they would
have a clue about this field. We as techs perform many different types of
modalities in several arenas within the healthcare field. Yet everyone in
this field feels at one time or another that they have gone unrecognized as
a tech performing the job duties. Plus, I think we have all wondered not
just when will EEG become recognized but when will others in and out of
health care see and understand how worthy EEG is to the medical field.
8
ACUTE/CRITICAL CARE
NEURODIAGNOSTICS
Sara Batson, R. EEG/EP T., RPSGT, CNIM, CLTM
Jacksonville, FL
endtech_2007@yahoo.com
Erika Diaz, R. EEG T., CLTM
Chicago, IL
ediaz@nmh.org
AMBULATORY MONITORING
Jennifer Carlile, R. EEG T.
Cleveland, OH
carlileja@aol.com
CLINICAL EEG
Keith Davidson, R. EP T., BA
Mankato, MN
davidson.keith@mayo.edu
Petra Davidson, R. EEG/EP T., BS
Mankato, MN
davidson.petra@mayo.edu
COMPUTERS IN THE WORKPLACE
TJ Amdurs, R. EEG T., MS
Pittsburgh, PA
amdurstj@upmc.edu
CPT® CODES
Lynn Bragg, R. EEG/EP T.
Canton, OH
lmbragg54@yahoo.com
Kristina Port, R. EEG/EP T., RPSGT, MPH
Novelty, OH
kaport@prodigy.net
DEPARTMENT MANAGERS
Stephanie Jordan, R. EEG/EP T., CNIM, CLTM
Seattle, WA
Stephanie.Jordan@swedish.org
Pat Lordeon, R. EEG T.
Pittsburgh, PA
patricia.lordeon@chp.edu
EPILEPSY MONITORING
Susan Agostini, R. EEG/EP T., CLTM
Phoenix, AZ
Susan.agostini@bannerhealth.com
Cheryl Plummer, R. EEG T., CLTM, BS
Pittsburgh, PA
Plum1960@hotmail.com
INTRAOPERATIVE NEUROMONITORING
Jeff Balzer, PhD, FASNM, DABNM
Pittsburgh, PA
balzerjr@upmc.edu
Ryan Lau, R. EEG/EP T., CNIM, CLTM, MS
Indianapolis, IN
Rlau2@iuhealth.org
Justin Silverstein, CNIM, R.NCS.T., CNCT, MS
Deer Park, NY
Wiredneuro@gmail.com
MAGNETOENCEPHALOGRAPHY
Hisako Fujiwara, R. EEG/EP T., CLTM, RPSGT
Cincinnati, OH
Hisako.fujiwara@cchmc.org
JP Lowe, R. EEG/EP T., CNIM, CLTM
Summit, NJ
James.lowe@atlantichealth.org
NERVE CONDUCTION STUDIES
Dorothy J. Gaiter, R. EEG T., R.NCS.T., CNCT,
FASET, MHA
Birmingham, AL
get@gaiterelectrodiagnostic.com
Jerry Morris, R.NCS.T., CNCT, MS
Shreveport, LA
Jmorris09@suddenlink.net
NEURODIAGNOSTIC EDUCATION
Mary Feltman, R. EEG T., MEd
Hewitt, TX
mfeltman@concorde.edu
Mark Ryland, R. EP T., RPSGT, R.NCS.T., CNCT,
AuD
Parma, OH
mark.ryland@tri-c.edu
Acute/Critical Care Neurodiagnostics...Continued
When a patient is thought to be having a seizure, who do they
call? Not the Ghostbusters, that’s for sure. It is us, the Neurodiagnostic
Tech to the rescue. When a patient is experiencing altered mental status,
who do they call? Us. When a patient in ICU will not wake up, who do
they call? Us. And even sometimes depending on the facility and the
doctors, when a patient has an episode of syncope or headaches, who do
they call? You guessed it right, us. And when a child regardless of age may
be acting out and exhibiting bizarre behavior for the first time ever, guess
who gets called regardless of the day or time? Yep, you are right again.
It is that faithful EEG tech woken up in the middle of the night with the
pager going off or the phone ringing. Let’s not forget the ever faithful
call for the EEG tech to come in for the patient with a history of seizures
that the doctor wants to discharge in the evening or on the weekend. So
as EEG techs in the healthcare environment we should get recognition
and we should be considered as worthy as any other healthcare provider.
As far as maintaining and gaining recognition, I think that goes
along with performing a good quality test. When a tech takes pride in
what they do, then others around them see that. They gain recognition
for their hard work and the quality they produce. They maintain it by
repeating it every time they perform their job. So I hope each and every one
of you keeps up the great work you are doing. You are being recognized!
Ambulatory Monitoring
By Jennifer Carlile, R. EEG T.
The theme for this newsletter is how do we maintain and gain
recognition, how do we prove our worth? In my opinion, we prove our worth
every day by doing the best of our ability on every patient. To maintain and
gain recognition I like to think of this as a daily stream of communicating
with the physicians. I can honestly say that at least once a day I speak directly
with a physician or their nurse manager regarding results of an Ambulatory
EEG (AEEG) study. Not only communicating results, also discussing the
need for extra testing and possible need for medication. Bringing all of
these items to the physician’s attention proves our worth; it proves that we
offer quality next to none and most importantly care about each patient. I
have a case study that I would like to present displaying the significance or
“worth” of Ambulatory EEG.
Case 1: 24-year-old male who is on no medications at the time of
the 7-day AEEG. The AEEG was obtained with video which was extremely
helpful but for this article, I am unable to show video associated with each
event. Patient presents with daily episodes of staring, loss of consciousness,
and generalized body shaking that usually cluster up to a minute. He has an
aura of lights around him going dim prior to staring. The patient is amnestic
of event; has aphasia, is fatigued, and complains of severe headaches, after
the event. These episodes began 4 years ago after being shot in the head with
a taser gun. The patient was fooling around with friends when the taser was
accidently discharged, striking the patient on the right posterior region of
his head. PMH: ADHD, bipolar disorder, and schizophrenia. Prior routine
EEG and CT scan were normal.
9
NEUROFEEDBACK
Bill Coslett, CNIM, PhD, BCIA, EEG-C
Lake Worth, FL
wecoslett@bellsouth.net
Ambulatory Monitoring...Continued
Background Rhythms:
Riki Rager, R. EEG T., FASET, BS
Nashville, TN
Riki.rager@vanderbilt.edu
NEW TECHNOLOGIES & RESEARCH
Andrew Ehrenberg, R. EEG T., CNIM, BS
Atlanta, GA
Andrew.ehrenberg@gmail.com
Marco Moreno, R. EEG T., MS
Fenton, MO
Marco.moreno@carefusion.com
PEDIATRICS & NEONATOLOGY
Shelly Gregory, R. EEG T.
Snohomish, WA
Michelle.gregory@seattlechildrens.org
Melanie Sewkarran, R. EEG T., CLTM
St. Louis, MO
Mkf3975@bjc.org
This patient had 9 recorded seizures and the patient’s girlfriend pressed
the event marker identifying all 9 seizures. Please note: the patient did not
have any interictal discharges and all of the documented seizures were
identical to the one illustrated below:
Seizure 8 out of 9:
POLYSOMNOGRAPHY/SLEEP
TECHNOLOGY
Scott Blodgett, R. EEG T., RPSGT, MBA
Rochester, NY
scott.blodgett@resmed.com
Kathryn Johnson, R. EEG/EP T., RPSGT, FASET
Huntington, WV
Kathy.johnson@st-marys.org
10
Ambulatory Monitoring...Continued
ASET poster sessions visually present
information on a variety of topics - from
original study or research, to evaluation of a
method, device or protocol, to offering a report
on an uncommon clinical case. Poster authors
will be on hand to discuss their findings or
data with attendees in an informal venue.
Here is a list of posters for the upcoming
ASET Annual Conference in Reno, NV
August 1 - 2, 2013
Reducing the Incidence of Skin Breakdown in
Neurotelemetry Patients
Sara L. Brown, MPH; Mark E. Canner; Josh T. East;
Ryan R. Lau, R. EEG/EP T., CNIM, CLTM, MS
Overview of Using T1/T2 and 10–10 Subtemporal
Electrode Chains for Localizing EEG Abnormalities
Susan Feravich, R. EEG T., CLTM, BS; Crystal
Keller, R. EEG T., CLTM, BA
Annals for the Anal Sphincter with Sacral Surgery
for Tarlov Cysts
Cyndi Miller, R. EEG T., CNIM, R.NCS.T.; Frank
Feigenbaum, MD
Magnetoencephalography and its Application to
Epilepsy Surgery
Daphne Hart, R. EEG T., BA; Joseph Manuel
Camerone, R. EP T.
Asystole in the LTM Unit: What Would You Do?
Stephanie Jordan, R. EEG/EP T., CNIM, CLTM
Role of Neurophysiologic Intraoperative Monitoring
in Hybrid Approach to Thoracoabdominal Aortic
Aneurysm Repair
Emily B. Kale, CNIM, BS; Aatif M. Husain, MD
Intracranial EEG and Cortical Mapping: Seizure
Spread through Mesial Tracks
Crystal M. Keller, R. EEG T., CLTM, BA
Critical Role of Intraoperative Neurophysiologic
Monitoring (IONM) in the Early Detection of
Cerebrovascular Ischemia in the Endovascular Suite:
Case Report
Dru Sigman, CNIM, BA; Eric Jones, R. EEG/EP T.,
CNIM, CLTM, BS
11
The Brain Team: A Case Review
Kristin Siebenlist, R. EEG/EP T., RPSGT, RST, BA;
Ryan R. Lau, R. EEG/EP T., CNIM, CLTM, MS;
Sara L. Brown, MPH
Ambulatory Monitoring...Continued
Poster Presentations...Continued
The Establishment of Normal Average Value Ranges
for Clinical Testing of Somatosensory Evoked
Potentials
Jennifer A. Thomas, R. EP T., BA; Jim Leuck, R. EP
T., CNIM, BA; Ryan R. Lau, R. EEG/EP T., CNIM,
CLTM, MS; Sabrina L. Faust, R. EEG/EP T., CNIM,
CLTM; Omkar Markand, MD
Protracted Post-Ictal Trismus
Muhammad Umair Khan, MD, A. Janati, MD;
N. Alghassab, MD
Lennox-Gastaut Syndrome Associated with
Dysgenesis of the Corpus Callosum
Muhammad Umair Khan, MD; A. B. Janati, MD;
N. Alghassab, MD; M. I. Alzeir, MD; M. Sammour,
MD
Do It Yourself: Building a Neurodiagnostic
Society….It’s Easier than You Think!
Kathy Johnson, R. EEG/EP T., RPSGT, FASET
Botox® for Spasmodic Torticollis: A Case Study
Kathy Johnson, R. EEG/EP T., RPSGT, FASET; Ijaz
Ahmad, MD
What is CTE?
Heidi Scott, R. EEG/EP T., CNIM, CNCT
The Use of EEG in Deep Brain Stimulation for
Parkinson’s Disease
Sara L. Brown, MPH; Shelley A. Wolfe, R. EEG/
EP T., CNIM, CLTM; Leonid L. Rubchinsky PhD;
Robert M. Worth, PhD, MD; Ryan R. Lau, R. EEG/
EP T., CNIM, CLTM, MS
A I D E T® and Patient Satisfaction Scores
Jodi Burhenn, R. EEG/EP T., CNIM, CLTM, RPSGT;
Marti Sherrill, R. EEG/EP T., CNIM, CLTM, BA;
Bonnie Merkel, R. EEG T.; Ryan R. Lau, R. EEG/
EP T., CNIM, CLTM, MS
Ambulatory Monitoring...Continued
12
I would also like to point out that this is
toward the end of the 7-day monitoring
period. Please note the quality of the
tracing. For those who do not believe a
“quality tracing” can be obtained through
home monitoring, I would like to disagree
and “prove our worth.”
Clinical EEG
“key identifiers”, you are beginning the bedside exam. When
you ask them to turn their head or hold their head up for
head measurement, you are doing even more of the bedside
exam. Hyperventilation and mental activation incorporate
more of the exam. If a patient is comatose, we have been
trained to perform auditory, tactile, and noxious stimulation
to arouse a patient. We also perform Babinski reflex test, ask
them to squeeze our hands, and perform photic stimulation.
Many times on an inpatient test we are present when the
neurologist or mid-level for neurology performs an exam.
Pay attention to these exams, they will teach you a lot about
your patient.
I have “cured” a lot of unresponsive patients by simply
doing an EEG. You color on their head and they tighten
their facial muscles. Scrub on their head with a cotton tip
applicator, they grimace. Start the strobe light, eye blinking.
Pay attention to each little clue. They may not pull away from
painful stimulation but do they grimace, blink more rapidly,
tighten their jaw? These are signs of responsiveness. We can
help reduce further unnecessary testing by proving that these
patients are actually awake.
Reduced inpatient hospitalizations: We can help
reduce inpatient hospitalizations. We can educate physicians
from all backgrounds and our nursing staff to look for
uncommon signs of seizures. As we perform bedside testing,
educate your nursing staff that Grandma Genevieve is not
going to stiffen, jerk, and drool. She most likely will have
hallucinations, possibly trouble speaking and the words
coming out of her mouth are going to be out of context. This
could mean nonconvulsive status epilepticus. Every confused
elderly patient is not necessarily demented.
Every patient that has strange behavioral outbursts
and seems “crazy” doesn’t need to be in behavioral health,
frontal lobe seizures cause these same behaviors and often
go undiagnosed because of their bizarre symptoms. Believe
it or not, many medical professionals still believe that most
seizures are shaking, jerking, and foaming at the mouth. We
must not be doing our job to fully educate other staff.
Attending grand rounds, family medicine staff
meetings, and brown bag lunches can be great places to
start with education. These are special opportunities for
us and our neurologists to give a five to ten minute talk on
the usefulness of EEG. It is also important to dispel rumors
about what EEG can do. We do not need to increase pointless
EEGs. We want to increase our worth.
By helping to increase awareness of seizure
symptoms to the staff that routinely see non-neurological
admissions, we can increase the ability to catch seizures and
nonconvulsive status epilepticus earlier and therefore reduce
inpatient hospitalizations. It is also important at this point
to stress that an outpatient EEG is appropriate and in what
situations a patient can wait to have an outpatient EEG rather
than staying in the hospital a day longer.
By Petra Davidson, R. EEG/EP T., BS and
Keith Davidson, R. EP T., BA
Estimating Our Worth
First, let us start this off by wishing summer a quick
arrival. It has not really started here in Minnesota yet. We are
having high temperatures this week in the mid 50s. It does
make for fantastic trips to the zoo. You haven’t really seen
animals until it is cooler, then they are so beautifully active
and you can really appreciate the Como Zoo and realize its
worth is so much more than the price of admission.
Our task this newsletter is to demonstrate our worth
with the current healthcare changes. First, it is important to
define the current healthcare changes. The Affordable Care
Act, the president’s healthcare reform, states its purpose is to
bring every American citizen affordable health care. Agree
with it or not, it is already in motion. The nuts and bolts
of this program mean that every facility will have to focus
on necessary testing, reduce inpatient hospitalizations, and
help patients to understand routine maintenance is much
more important than recovery efforts after damage has been
sustained. We as EEG technologists have an important role
in this program.
Unnecessary Testing: First to reduce unnecessary
testing, a provider must perform a thorough bedside
evaluation and take a diligent history. A physician I worked
beside in Kansas City, who has since retired, often gave lunch
lectures. He was a neurologist, although his main focus was
always treating patients in general. He really believed in
excellent medical care. In order to provide excellent medical
care, every physician must listen and hear each patient as
an individual; the physician must ask thoughtful questions
about the patient’s symptoms and realize that the patient may
not realize all of the related symptoms to a diagnosis. It is
the physician’s job to educate the patient and the patient’s job
to educate the physician on their history and current health
problems.
This brilliant man was always learning. He took the
time to listen and learn from everyone he worked around.
He seemed to touch everyone’s life when he brushed by. He
gave multiple lectures about the components of a bedside
exam. He felt that while diagnostic imaging and testing had
its place, it should not be used until the thorough bedside
exam had been fully exhausted. The patient is paying for this
thorough exam in their consultation fee, give them their full
worth.
As a technologist, we can perform a thorough
bedside exam very efficiently while talking to the patient
and setting up their EEG. It is an easy process once you learn
how. You may not realize this now, but every time you enter a
room, visually assess the patient, say hello and ask them their
13
Clinical EEG...Continued
Routine Maintenance vs. Recovery Efforts: As many due to a trickle-down effect. Due to governmental demands,
of you know, routine maintenance on a vehicle, home, and administrators are now more than ever cutting operating
EEG equipment saves thousands of dollars in the long run. budgets and demanding more frequent reconciliation of
Routine maintenance with our bodies is no different. Part worked hours per Key Volume Indicator (KVI). It requires
of the current healthcare initiative is to increase routine an understanding and self-driven motivation to succeed
checkups of our various body systems. Through education in today’s fiscal environment. I feel that patients do not
of the public as a whole, patients can
equate competency with quality. The
be taught that routine visits to their Each of us can add more and
patient typically does not know what
physicians when problems do not exist
the “alphabet soup” of credentials
more
worth
to
our
testing
when
can help prevent problems in the future.
following our names stands for. The
Patients with epilepsy do we educate others, listen to our
“patient experience” consists primarily
not need an EEG every year. If their patients, and take the time to
of us smiling and providing a safe
seizures increase, often the first jump in learn more about the testing we
experience. They want to feel that we
treatment is imaging. An EEG is much offer every day.
are going to treat them well and be in
less expensive, much more sensitive to
good hands. We have to appropriately
cortical dysfunction and much safer.
acknowledge them when we greet
Educating primary care physicians
them, introduce ourselves with our
who treat patients with epilepsy about routine EEG would credentials and how long we have been in the field(s). We
probably save hundreds, if not thousands of dollars each year need to explain what we are going to do and tell them how
in imaging costs.
long it is going to take. Finally, we should thank them for
Developing a standard of care for a patient with choosing our hospital, lab, or office. This all goes a long way
epilepsy to have an EEG, perhaps every five years, might give in driving quality and recognition. The “inner drive” equates
a better baseline for their cortical function than waiting until to attaining the education needed to have the credentials
they have problems.
behind our name. Now being good at what we do and
Summary: According to Merriam Webster’s providing a great “patient experience” are things we need to
dictionary worth can be defined as simply monetary or let people know.
material value. Simply speaking the worth of an EEG One way to notably enhance the promotion of your
outweighs the worth of imaging, we are far cheaper. However, departments and/or yourself is to take advantage of social
when we partner with imaging in necessary patients, our media. Daily life has been impacted significantly by it and
worth is driven much higher. Worth can also be defined as has overwhelmingly changed how we interact with each
being at the fullest extent of one’s ability. Every day, with every other. Anywhere from:
patient, you should feel challenged to be at your maximum 1. News from business, family and friends on Facebook and
worth. Make every EEG count every time. Pay attention to
Twitter, and groups that you follow for traditional news.
the small clues that may really add that extra insight for the 2. Advertisements for departments that do not have much
interpreting physician. Take the few extra seconds to study
money in their budget to spend can reach a multitude of
how the patient responds to questions of self, location, and
people through social media.
time. Each of us can add more and more worth to our testing 3. I read an article a while ago that stated: The amount of
when we educate others, listen to our patients, and take the
time that is spent meeting and staying in touch with
time to learn more about the testing we offer every day.
colleagues has almost tripled in the last year.
Have a fabulous summer. Don’t ever stop learning. 4. It seems that people share more about their feelings. I
Never stop offering your full worth to each patient and each
have noticed this on Facebook a multitude of times.
physician you encounter, no matter what the circumstance.
Although, it seems that sometimes it is a little much.
5. It is possible to influence many people depending on
how many people follow you on Twitter or how many
Computers in the Workplace
friends you have on Facebook. It expands your audience.
By TJ Amdurs, R. EEG T., MS
It is much faster to reach people by posting something
on Facebook than it is to call each person. It is faster than
The first thing that came to mind when thinking
email in regards to when people read it.
how to maintain and gain recognition and prove our worth So computer software can make a big difference in
in this new healthcare environment that we face today is: how we market our services and the social media products
“inner-drive”. It is becoming harder to prove your worth can provide a vehicle for your department to do so.
14
CPT® Coding
When you put all this into perspective, it seems like a
combination overload of narcissism and chutzpah. How does
one compete in a world of hyperbole and self-absorption?
How do we prove our worth?
The basic answer is one of metrics. In the world
of health care, our worth is judged everyday by our scores
on Press Ganey®, our statistics and productivity, our
accreditation (or lack of), our credentialing (or lack of), and
of course, our performance reviews. But those are only part
of the picture.
One cannot perform well on such a quantitative
metric scale without having a healthy sense of self-worth.
Think about the last day you had where everything seemed
to go wrong: you woke up in a bad mood, you missed a
seizure when reviewing an ambulatory EEG, your second
patient was less than cordial and said something unpleasant
to you, your last patient of the day wouldn’t fall asleep for
you and you know they will have to come back for a repeat
test, and the computer crashed when you were doing the
day’s billing. How would you rate the quality of your work on
this particular day? If you are like the rest of us, you would
probably say you hadn’t done your best.
It’s important to realize that your values, your self
esteem, your loyalty to others, your trustworthiness, your
compassion, and your ability to accept responsibility for your
actions….all of these and more contribute to how others
perceive you. And in a judgmental world such as we live in
today, perception quickly becomes reality.
When do we do our best work? When we feel we are
equal to a challenge, mentally strong, efficient, and upbeat,
then our actions are more likely to mimic our feelings. So,
it is just as important to bring a set of positive values to the
table as it is a set of good metrics. Unfortunately, there are no
ways to factor good attitude into a productivity report. But,
don’t ever think that attitude isn’t noticed….by your peers,
your patients, or your boss.
Sometimes it is just as simple as doing an honest
day’s work for an honest day’s pay. If you think you’ve done a
good job, then you have. Work with feeling. Feel good about
your work. Then you will have done a worthwhile job.
By Lynn Bragg, R. EEG/EP T.
With all the recent and upcoming changes to health
care one could be easily overwhelmed. In our field there are
few, if any, shortcuts to provide “quantity over quality.”
I remember when our lab got our first 18 channel
EEG machine. Immediately I was asked if the studies would
be shorter since there was more recorded on each page.
My reply was that that would not meet the recommended
guidelines and therefore if audited would not be reimbursed.
It is imperative that we record all our studies to
the best of our ability and according to the recommended
guidelines. If we keep this practice up, our lab’s integrity stays
intact and our reimbursements will continue to be at the
highest allowed by insurance providers. It is also important
for techs to have some knowledge of reimbursements for
specific studies coded in their lab and know which ones will
reimburse at a higher amount. Doctors often don’t think of
this when ordering, and recording for several minutes more
can bring in a little extra reimbursement.
It would not surprise me that there will be more
reductions in reimbursement for health care and that we will
see an increase in studies to make up for lost revenue. I have
already spoken to several technologists who are experiencing
this already in their labs.
The overall healthcare change along with the shortage
of registered technologists is going to be a huge hurdle for
neurodiagnostics. It has been discussed that in the next 10
years or so nearly 47% of the registered techs working now
will be retiring. That is a significant number of techs and if
it becomes mandatory for neurodiagnostic labs to have a
registered tech for reimbursement imagine the scramble to
fill these vacancies.
A neurodiagnostic technologist who performs each
study as if it were on a family member will always have the
greatest respect and lab integrity.
Department Managers
By Pat Lordeon, R. EEG T.
By Stephanie Jordan, R. EEG/EP T., CNIM, CLTM
Today’s society is one of “instant gratification”
and “self-entitlement.” We want it faster, bigger, better, and
sooner. We want the services we utilize to cater to us, court
us, and tell us why they can do it better than everyone else
and why we will be better for letting them do it. We want
them to give us 500 million reasons why we should buy their
product, go to their store, consider their option, or choose
them. We want recognition of our importance in the scheme
of things, and recognition for our achievements (real or
imagined). We want everyone to see how magnificent we are
at being us.
In order to maintain and gain recognition in the
new healthcare environment I believe that now, more than
ever, teamwork and communication skills are essential to
prove our worth to our employers, our co-workers, and our
patients. With a system wide focus on both quality patient
care and productivity, national accreditation for our labs and
credentialing of our staff must be encouraged and maintained.
Staff must feel supported and recognized in their efforts to
achieve the goals of credentialing for themselves, their team
members, and their lab.
15
respect and trust in our abilities to take care of the patients
and be part of their team is crucial. Educate the hospital
staff and the community physicians on the importance of
Neurodiagnostic services and their clinical indications. Stress
the importance of early diagnosis and treatment of seizures,
and its emergencies such as nonconvulsive status epilepticus.
Most important, the impact that the procedures have in
better patient outcomes. Promote our services and programs
during Neurodiagnostic week, career fairs, and in any other
community activity that offers the opportunity to showcase
what we do. Visibility brings credibility and credibility brings
trust!
Accountability – By holding ourselves accountable
while displaying professionalism and expertise with every
patient encounter. We need to find every opportunity to do
the right thing consistently, day in and day out. Accountability
happens when we take ownership of our department and
the services we provide. Our patients deserve the best of
us. Every time that we are interacting with our patients and
hospital staff we need to remember that we are representing
our department. Our department speaks through each one
of us. When we hold ourselves accountable we are constantly
looking for better ways to do things.
Learning – By keeping up with new trends in the
field, by attending educational activities and every learning
opportunity that can enhance and strengthen our knowledge.
By obtaining national credentials in a modality or modalities
of interest. By sharing knowledge with peers and colleagues.
We have chosen to work in health care, and by doing so we
are committed to continuing education. Learning better ways
to do things, and creating efficient workflows, processes,
policies and procedures play a role in achieving better patient
outcomes.
Uniqueness – By putting a unique, personal print
to every procedure we perform. A positive encounter with
patients and hospital staff by adding that special touch
that makes us who we are, going above and beyond what’s
expected of us will set a high standard of care/service that
will be hard to match! This is what I like to call “my seal of
approval – My “Susan’s guaranteed quality service.” Whether
it is a “thank you” note to the patients, or the “VI3’s – Very
Important 3” things that patients feel are important to them,
come up with ideas that will make your team and your
department unique!
Extraordinary – patient experience! How? It’s
simple. Remember that it is all about patient’s perception.
Create that connection with your patient that will allow for
them to trust you and your work. Maintain transparency,
professionalism, a caring demeanor, and most importantly
pay attention to details. A patient-centered approach to
everything we do will allow us to make better choices and act
in the best interest of our patients!
Department Managers...Continued
As a manager you can show support in many ways:
1. Communication – Check in with each individual to
gain an understanding of their perception of the work
environment. Listen to their ideas and suggestions for
improving the lab. When an employee feels heard their
job satisfaction and efficiency goes up. You may come
away with a new idea that benefits the entire team and
may increase productivity. Encourage and support them
in achieving ABRET credentialing which benefits their
career and the team unit at the same time.
2. Recognition – It has been proven that recognizing
employees for a job well done increases employee
satisfaction, productivity, and job retention. It also
encourages a friendly competitiveness between
employees to perform well. When you acknowledge an
employee for a great performance you are encouraging
and reinforcing that higher level of performance for the
future.
3. Set a team goal – Setting a team goal and allowing every
team member to own a piece of the accomplishment
allows them to feel productive and supported by each
other. This will have a trickle-down effect as they continue
to support each other in the daily tasks of the lab. This
can be as simple as a team goal for employee attendance
or as grand as achieving ABRET lab accreditation.
When we recognize the worth of our team we
achieve the same for ourselves, our staff, and our healthcare
institutions.
Epilepsy Monitoring
By Susan Agostini, R. EEG/EP T., CLTM
We want to be part of the neuro patient’s work up,
and we want to prove that our studies provide important
information that can potentially impact the patient’s care and
outcome. There are some basic thing we should be doing that
I feel would help us in gaining the recognition and worth that
we strive for. The quality of our services is measured not only
by the great technical job we do but also by the patient’s and
hospital staff ’s perception of their experience with us.
Value is defined by Google as: “The regard that
something is held to deserve; the importance or preciousness of
something.”
The following VALUE acronym conveys the way I
have always felt about the delivery and focus of our services:
Visibility – We need to be visible in the community
and our hospital, by educating others of the services that we
provide and the importance of our procedures in the patient’s
work up, diagnosis, and treatment. Gaining the hospital staff
16
Epilepsy Monitoring...Continued
One thing that is clear in the intraoperative monitoring
(IOM) field is that regardless of how our performance or
“worth” is measured in the eyes of regulators and payers, our
sights should be set on excellence, perception, and outcomes.
Let me begin with excellence. As an individual
who has had the opportunity to review the quality of IOM
across the country, I can definitively say that our field
remains inconsistent and lacks standardization with regards
to who performs the monitoring, how we perform the
monitoring, and how we interpret and communicate our
findings to the surgical team. Despite detailed technical
guidelines with regards to how IOM should be performed,
tremendous inter- and cross-institutional variability exists.
These glaring inconsistencies result in a paradox for both
credentialing (The Joint Commission) and reimbursement
agencies (CMS). It is difficult for them to assay how the field
is performing or, for that matter, the direction the field is
heading without a consistent approach to how IOM is being
performed on a daily basis. Some general inconsistencies
that I have observed include simple deficiencies like the
absence of IOM policy and procedure manuals. Specific
examples range from the lack of an accepted definition of
“continuous” monitoring as it refers to how often data are
collected to “CNIM eligible” technologists monitoring cases
on their own. These seemingly insignificant inconsistencies
add up to glaring voids in performance and impede the
excellence that our field has to strive to reach and maintain
in order to be consistent and provide superior patient care.
While guidelines and peer reviewed literature can be our
guide, it is the establishment of expectations on the part of
the hospitals, administrators, and risk managers that will
drive the excellence. Without a fundamental understanding
of how IOM is being performed or what the qualifications of
the personnel are, a demand for compliance to standards will
never occur. This will leave our field with a level of culpability
with regards to how we do our jobs and ultimately, what the
value of the service is to the consumer, namely, the patient.
We need to send our message of IOM excellence and how
we achieve it to the people enlisting our services so that
accountability is demanded on a daily basis.
Perception of the IOM service and team, as well as the
healthcare system as a whole has always been an important
and underrated aspect of patient care. Recently, this aspect
of service delivery has become an important metric of
reimbursement. Patient satisfaction measures are being
tracked, recorded, and utilized to define the performance
of healthcare providers and institutions. As a testament
to the importance of these metrics, particularly since they
will now drive reimbursement, many institutions have
turned to national organizations to assist them in gathering
and analyzing these data. For example, Press Ganey®,
an organization that we use, helps healthcare providers
understand and improve the entire patient care experience
from admission to discharge. What we have learned is that in
order to improve the experience that a patient has at our
By Cheryl Plummer, R. EEG T., CLTM, BS
I hope this article finds all of you enjoying your
Summer. The theme of this Interest Section edition is “In
this new healthcare environment how do we maintain and
gain recognition, how do we prove our worth?” Well, I have
thought about this long and hard and I think that how we
do this is by promoting ourselves and our services. We are
entering into an era in which we will have to continue doing
more with less. We must make sound economical choices
when choosing what to buy for capital equipment. We must
evaluate where we can increase our services to provide better
access to our consumers. In the Long-term Monitoring Unit,
one way to make it more convenient for our customers is to
offer admissions on several days of the week.
In this regard, offering ambulatory EEG over the
weekend is a very nice service
to people who work during
the week. It is very difficult
for patients to take off from
work to have testing done
so one way to increase our
numbers is to increase our
hours of operation. Several
years ago at the hospital in
which I work, we decided to expand our hours to having the
lab open 24 hours/7 days a week. Economically, this change
made more sense because the amount of overtime was
astronomical and employees were called in to the hospital
several times a night. This has been a very successful change
and has enabled us to increase our procedures and staff.
I think that we all have to look around at our places of
employment and try to see where we can make changes, even
small ones, which may result in cost savings. Even something
as small as being diligent about how much cream or collodion
we use could provide a cost savings when looking at it over a
prolonged period of time. We can try to prioritize our work
load so that we complete studies on patients who are waiting
to be discharged in a timely manner.
We have to be our own champions. We can make
changes even in our departments regardless of how small
or large. One thing we cannot afford to do in this changing
environment is to not be an active participant in healthcare
reform. Don’t be afraid to make suggestions about cost saving
initiatives. Hope to see you all in Reno.
Intraoperative Neuromonitoring
By Jeff Balzer, PhD, FASNM, DABNM
Excellence, Perception and Outcomes: Determining the
Value of IOM
Healthcare performance metrics and reimbursement
are critically related and rapidly changing. Not only are they
changing, they are often difficult to estimate or understand.
17
base tumors, to microvascular decompression, to idiopathic
scoliosis. Moreover, our publications have included our
methods, our approaches, our service delivery model, and our
expectations with regards to the IOM and the specific cases
being performed. Without these data, our field will always be
susceptible to the conjecture of payers with the default being
to lessen the value of the IOM service. Of course, the quality
of the outcomes data is intimately related to the first point
that I made above, consistency, and excellence of the manner
in which we collect the data in the first place.
In closing, the value of IOM is measured by job
performance and the guidelines and structure we adhere
to, the degree to which we care for our patients and their
families, and the ability for our field to demonstrate
medical necessity in the face of a shrinking reimbursement
environment. Striving for excellence in the IOM field is no
longer an option; it’s an essential aspect of all facets of our
work in and out of the operating room.
Intraoperative Neuromonitoring...Continued
health system, we need to recognize and understand the
relationships that exist between clinical, safety, satisfaction,
and financial measures. This primarily occurs via patient
feedback concerning their experience during their hospital
stay. This patient oriented satisfaction initiative is exquisitely
important such that our institution has instituted a systemwide program called “Nice Matters”. This is a one-hour
program that all caregivers attend. The importance of making
the patient and family comfortable and satisfied during their
visit is explained. The program goes on to stress the potential
ramifications of compliance or lack thereof and how to
improve how we interact. From a personal perspective, I can
tell you that how we interact with our patients and families
really does pay clinical dividends.
We recently were performing an awake craniotomy
on a 66-year-old woman with a left temporal glioblastoma
multiforme (GBM). While pre-operative language testing
is part of our normal routine, the interaction with the
patient and their family before surgery, particularly if
conditions dictate seeing them in the holding area, is of the
utmost importance to surgical success and patient comfort
and satisfaction. After our testing in the holding area, our
patient, and her family, were completely comfortable with
the procedure, understood exactly what was going to occur
before during and after surgery, and were clearly prepared to
make the best of a frightening situation. This was all in the
face of a very significant baseline clinical deficit in the form
of expressive aphasia. Our pre-operative interaction was
invaluable clinically and the procedure went beautifully. Not
only that, our patient took the time to reach out to our team
the next day to let us know that she could not have gotten
through it without us. Situations like this one or simply
stopping in a hall and asking if someone needs directions or
help getting to an appointment not only will be critiqued by
payers in the future but is always the best policy for successful
and excellent patient care and compassion.
IOM outcome data are another metric of major
importance for creating benchmarks for medical necessity and
ultimately reimbursement. The IOM field has been remiss in
putting forth a concerted effort to establish definitive medical
necessity for the services that we provide. While prospective,
randomized trial data are generally difficult to obtain in any
medical discipline, the IOM field needs to do a better job of
collecting, analyzing, and publishing the data that we record
in surgeries every day. We can start by publishing our policies,
procedures, alarm criteria, and outcomes as they relate to the
sensitivity and specificity of the IOM data. Despite estimated
tens of thousands of IOM cases being performed each year,
the field’s publication record, in general, does not reflect this
volume. In an effort to further establish IOM’s worth, our
group at UPMC has continued to publish our large series of
IOM experiences. Our data have exemplified the sensitivity
and specificity of IOM in procedures ranging from skull
Magnetoencephalography
By Hisako Fujiwara, R. EEG/EP T., CLTM, RPSGT
Life is a continuous learning process - no limits for the new
technology.
No matter what kind of neurodiagnostic testing you
are performing clinically, you must know what you are doing
and what you are looking at. You might ask “Why do we need
to know what we are doing in terms of the concept of the
study since we, as technicians cannot interpret the data that
we get from patients, and even as technologists, cannot give
the final interpretation?” and might say “I’ll just do the basic
task and give the data to the physician.” But, if you do not
know exactly what you are doing, you are not providing the
best care and service to your patients. In fact, you should be
able to answer the patient’s and family’s questions regarding
the basics of the study in order to make them comfortable to
participate in the test.
Even though the EEG field is well known and in
clinical use for more than 80 years since its discovery in
1929 by Dr. Hans Berger, the field remains very much in
need of improvement with new evidence-based discoveries
through clinical research. MEG by comparison is a fairly new
technology; many patients and families do not know what it
is. Some people even tell me MEG is similar to MRI, because
of the shared word “magnetic.” As MEG technologists, we
should be able to explain what it is, how it works, how it differs
from EEG and MRI, why it needs to be done for them, and
what happens during the test. At Cincinnati Children’s we
provide as much information about MEG as possible to the
parents and patients the day before the MEG study. It usually
takes us about 15 to 45 minutes to explain the procedure and
answer questions (listening to their concerns is also a key
18
point here). I believe this pre-study discussion makes them
more comfortable during the MEG study and can improve
the quality of the clinical data as we then have the cooperation
of the patient and family. Since MEG is a newer technology, there are many
research articles continuously coming out in both clinical
research and pure research. Reading some of these articles is
one of the great ways to gain more knowledge of MEG along
with technical skills. After that, discuss with physicians,
researchers, and other technologists to get their thoughts.
Apply or add to your MEG study, if appropriate.
A community of MEG technology has just begun at
ASET. We hope this will also be one of the sources to gain
knowledge of MEG and help a technologist, who is new to
MEG, learn about MEG from ‘A to Z’ in the near future. I
think that in the current MEG world, we need to maintain
current skills and techniques and move forward to gain more
knowledge and even to discover new findings. There is no
limitation for life as a continuous learning process!
Search for techniques to cut cost of clinical supplies
and learn to work smarter, not harder, by working with other
departments in your area. Share and solicit ideas from other
team members in your department on how work can flow
more efficiently, without jeopardizing quality patient care.
Proving one’s worth in the Neurodiagnostic field is
(in my opinion) to have the flexibility and physical ability
to prevail and move forward. For every negative comment,
strive to give a positive response in this new healthcare
environment, and one can maintain and gain recognition
with a professional attitude in knowing that your work makes
a positive difference in the lives of not only patients, but
everyone that has contact with you in this new environment
of healthcare.
In ASET’s Statement of Professional Code of Ethics
http://www.aset.org/i4a/pages/index.cfm?pageid=3520, the
first statement of this code is, “Act in the best interest of
the patient, keeping the health and safety of the patient in
mind at all times.” – a code to live by daily in our healthcare
profession of Neurodiagnostics.
Nerve Conduction Studies
Neurodiagnostic Education
It is a bit of a quandary when one thinks about how
the new healthcare environment affects the Neurodiagnostic
field. Being in the field for over 30 years and having
experienced working in a healthcare facility to physicians’
clinics and private practices, there has been a continued focus
on quality patient care. With that said, the other crucial point
being cost: the good, bad, and ugly of how one maintains the
same standard of quality care with a great deal less for some
areas in health care (e.g., NCS/EMG).
Patients expect excellent and competent service
from all healthcare professionals. Nonetheless, it comes at
a sacrifice with such drastic cuts in reimbursements, some
techs are working longer hours with less staff than before and
an increase in the number of patients having procedures as
well. This is due in part to various clinics no longer accepting
certain types of healthcare insurance, which makes for more
outpatients procedures in hospitals and other physician
clinics.
Do any of you remember the days when DRGs
(Diagnostic Related Groups) first started? It was sheer
pandemonium back then, and the changes would forever
affect patient care as we knew it. Since that time, healthcare
coverage has continued to spiral out of control. Yet, we must
maintain professionalism, with a positive attitude, stand out
above the crowd in going with the flow of change in this new
environment of health care, and let our work ethic speak
for us through continued education, high performance, and
demonstration of what it means to be a leader and team
player.
Recognition: according to Webster it means the
act of identifying somebody or something on the basis of a
past sighting or experience; appreciation of the value of an
achievement; acknowledgement of the existence or validity
of something. When I was in sixth grade, one of my classmates
passed away unexpectedly five days before Christmas. I
remember asking my mom “Why my classmate when the lady
across the street was old and senile?” My mom proceeded to
explain to me that God must have had a reason and we just
are not supposed to know the why just yet. Six months later,
the neighbor lady was in the hospital and died. My mom
again reminded me that at least her family got to spend a
little more time with her.
None of this still seems to make any sense, but it does
remind me regularly to always treat every patient the way you
would want your family to be treated. Most important….this
might be the last time for any patient. Can I make it pleasant?
It makes me feel good when I have successfully completed
a difficult study and found an answer for the neurologist. I
know that this is my job, but neurology people especially feel
good about abnormal studies. Now I realize I probably will
not get the pat on the back from the neurologist, but I know
that deep inside me, I realize that I did a great job.
But let us go back to the issue of recognition. Since
I didn’t get kudos from the neurologist and/or the patient,
when will my time come? Am I wrong in wanting some
recognition? Remember back in elementary school when
you were acknowledged for misbehaving, or talking in class?
Magnetoencephalography...Continued
By Dorothy Gaiter, R. EEG T., R.NCS.T., CNCT, FASET, MHA
By Mary Feltman, R. EEG T., MEd
19
of Neurodiagnostics is not for everyone; and not everyone
should be allowed to do what we do. I don’t mean that in a
snobby elitist manner, but the last person I want conducting
a neurodiagnostic procedure on me or someone I care about
is what I call a “paycheck collector”; the person who goes into
work every day simply to receive a paycheck. If we are more
concerned about retention and completion for everyone, we
will be producing “paycheck collectors”.
So, we walk a fine line between retention (and
completion) while keeping the bar high enough to assure
we are graduating competent entry level technologists.
The line maybe thin, but I refuse to allow “just anyone” to
complete unless they have at least reached the standards.
We do have the advantage of accreditation standards, which
administrators do understand, so appropriate attrition will
happen. And, as I said before, that’s a good thing.
Neurodiagnostic Education...Continued
Now maybe that was the wrong type of recognition, but it
still happened. Just simply walking down the hall and making
that personal hello to a co-worker with saying their name
goes a long way in giving them recognition. How about that
mailed thank-you note for the birthday gift? I guess even a
thank-you emailed shows you took the time to recognize that
someone made you feel special.
The simple saying of “please and thank-you” goes
a long way in feeling appreciated and recognized. How
about that cranky nurse in the ICU? The last time you had
to perform a study on her patient, did she help you get the
patient in position and maybe hold the head? Or come do
an extra suction right before you started? Did you bother to
thank her after you were done? Did you help her reposition
the patient after the study? Did you clean up the room when
you were all done? You know recognizing someone else
for their job, can and does make you feel good about the
teamwork you both just completed.
I belong to Toastmasters, which is an international
organization for the betterment of communication and
leadership skills. One very important portion of each
meeting is the evaluation process. We use something called
the sandwich method. This means a positive comment, then
a learning comment, followed by another positive comment.
Sometimes simply acknowledging the person for standing
in front of the club is huge. We continue to come back to
the meetings because we want to improve. We appreciate the
evaluation and hope to always learn some new idea, thought,
or trick to improve the next speech we give. The other
important element of Toastmasters is the fact that we shake
hands with each transition of a speaker. The feel of another
person’s hand and that smile, have often helped even the best
speaker to settle the butterflies and get them to fly in motion.
Don’t let the word recognition make you think about
awards and big trophies. A smile and a nice hello sometimes
are the only good things some people experience in a day.
Make it your new habit to recognize someone everyday…
because what goes around comes around. Your turn for
recognition is just around the corner.
Neurofeedback
By Bill Coslett, CNIM, BCIA, EEG-C, PhD
Choosing the right neurofeedback practitioner!
Frank Duffy, MD, professor and pediatric
neurologist at Harvard Medical School stated in an editorial
in the January 2000 issue of the Journal of Clinical EEG
that the present research is suggesting that neurofeedback
should play a major therapeutic role in the many different
areas. In his opinion he stated that “…if any medication had
demonstrated such a wide spectrum of efficacy would be
universally accepted and widely used. It [Neurofeedback] is
a field to be taken very seriously by all.”
Some pretty strong words spoken in January of 2000.
Neurofeedback (NF) practitioners have been aware of that
fact a long time before the “Decade of the Brain” (1990s).
Today, the field stands on firm foundations. Strong researchers
like Barry Sternman and Joel Lubar have provided strong
empirical data and studies that have given NF creditability
in the treatment of ADHD as well as epilepsy. Recently the
Academy of Pediatrics recognized the efficacy of NF. Over
30 years of solid scientific research has shown the NF is
an evidence based treatment for ADHD. Neurofeedback
should no longer be considered “only experimental” or
quasi scientific as defined by many insurance companies.
The scientific research done by Lubar, and many others have
consistently demonstrated the efficacy of NF.
So how does one go about finding a neurofeedback
practitioner? That is the focus of this article. I would like
to discuss three guiding factors when choosing the right
therapist. The therapist must be licensed by a regulating
board or agency. Secondly, the therapist must show
experience in the field that you are looking for (i.e., ADHD,
peak performance training, substance abuse), and lastly they
should possess a strong background in the area you want to
work.
By Mark Ryland, R. EP T., RPSGT, R.NCS.T., CNCT, AuD
Just as the medical and Allied Health Career field is
shifting to increased patient satisfaction, so to the world of
academia is also shifting focus. Funding for public colleges
(and particularly Community colleges) is now going to be
tied to completion, rather than bringing people in the door.
And that isn’t such a bad notion, but being an instructor in
an Allied Health Career Program (the red-headed stepchild
of the academic world) the notion of completion rings
a slightly different tune. A word college administrators
do not like to hear is “attrition”. But in Health Careers,
attrition is not always a bad thing. What we do in the world
20
and training to optimize your chances for successful training.
Match the therapist with the condition/reason for training.
Be very wary of franchise operations that use one size fits all
approaches. I have found one particular franchise operations
in my area offering neurofeedback training that did not
provide any scientific backed treatments – very dangerous
and reflects poorly on the field.
The last consideration takes into account the
therapist’s experience. How many cases has the therapist
done in the area you want to work? A therapist may have
expertise in treating ADHD but have no clue as how to train
someone in optimal performances. Experienced therapists
have learned to combine the art with the science. By
examining the therapist credentials you will still only have
a partial understanding of how good the treatment will be.
Truly the best source of understanding will come from word
of mouth. By speaking to past clients about their experiences
some light may be shed on how treatment might go for you.
Just be careful, most referrals to old clients are going to reflect
more on when treatment went well, not when it did not help.
The field of neurofeedback is developing at
an accelerated pace. More and more practitioners are
incorporating neurofeedback in their practices. Be vigilant
when selecting the therapist with whom you choose to work.
By following some very basic considerations, you will have a
very positive experience with neurofeedback.
Neurofeedback...Continued
The first place to look for a NF practitioner is your
computer. Begin your search with two specific sites. The
first is the Association for Applied Psychophysiology and
Biofeedback (AAPB) www.aapb.org. This organization has
a long history of Biofeedback and Neurofeedback training.
They provide a forum for discussion, encourage research, and
promote biofeedback. This group of clinicians and incredible
researchers has been providing profession meetings since
1969. The second major source is the International Society of
Neuronal Regulation (ISNR) www.isnr.org. ISNR is a nonprofit member organization for those professionals pursing
research and promotion of self-regulation and brain activity
for healthier functioning. Their website, like AAPB, has
a membership directory as well section for locating a NF
practitioner.
It must be clearly stated that not all therapists or
practitioners or for that matter therapeutic approaches are
right for you. Like any other professions there will be some
practitioners that are more competent than others and some
that have less clinical expertise. Personalities may clash
which may not ensure the most benefit to you. There are basic
requirements that need to be met when you are selecting an
effective NF therapist.
First, the clinician needs to be licensed professionally.
The person should possess a license in psychology, medicine,
social work, or other health related field. The license should
be in the areas that you want to work. The therapist needs to
be fully registered, licensed, or registered by a department
of Profession regulation. Be careful of those individuals
with “certification or registration” only. Be aware of who
is certifying these individuals. The reason that you need to
be vigilant is the therapist will have “something to lose” if
found in violation of ethical or standard of practice methods.
Practice review boards can monitor the quality of the
treatment and ensure accountability. A licensed practitioner
will follow acceptable procedures and ethical treatments of
their clients. It is essential to inquire about what professional
liability insurance is carried by the practitioner. I believe at the
very least, a potential therapist should possess certification
through the Biofeedback Certification International Alliance
(BCIA). The most importance issue here is that those
clinicians working with you are accountable.
Secondly, the clinician should have considerable
experience in the field that you are working in. For example,
you should have a counselor with a strong background in
drug and alcohol if you want to use neurofeedback in the
substance abuse issues. As Duffy pointed out, NF has a wide
spectrum of efficacies. It has been used in medical conditions
as well as those conditions in psychological or mental health
issues. NF has been successfully used in sports psychology,
musical training, and generalized brain sharpening. It is
important to find the therapist with the right background
By Guest Author: Eileen Hayes, R. EEG T.
In this new healthcare environment how do we
maintain and gain recognition, how do we prove our worth?
The healthcare environment is changing due to many factors
but the most critical and immediate challenge is financial.
Many different approaches are being taken in order to
ease the new financial burden. The results include reduction
of full-time equivalents (FTEs) either by eliminating a
position, decreasing a full time position to part time or
reducing overall full time 40 hour positions to 36 to 38 hours.
Hospitals are reducing the number of upper management
levels. Hiring freezes are becoming more commonplace by
employers and generally overtime is forbidden. Another
approach being employed in the area of compensation is the
temporary ceasing of vacation accrual.
These changes we are experiencing are difficult
and in some cases, life changing. In order to survive these
uncertain times it is important that all involved maintain
a positive attitude that includes the understanding that we
are all in this together. This is the time when we can prove
our worth every single day. Our first and most important
responsibility is to our patient. Assuring that every patient
gets the very best care we can provide everyday will go a long
way in reconciling within ourselves the changes we are facing
during these challenging times.
21
•
New electrode application techniques are being
developed that have the potential to improve our
efficiency by making electrodes easier to apply or that
allow electrodes to stay attached for imaging studies –
preventing repeated reapplication of electrodes.
• Digital Analysis software comes in many flavors and
depending on your circumstances, it may help to become
more efficient in managing huge amounts of data. Spike
and Seizure detection and EEG trending, when used
appropriately, have the potential to efficiently sift through
tremendous amounts of data. These techniques may not
be particularly helpful for a standard EEG or a longterm study that is continuously attended by a competent
technologist, but when long-term studies are unattended
for significant amounts of time, the techniques can be
quite useful and cost efficient.
These are just some of the technology advances
that are currently available for assisting us in our mission
to reduce medical errors and to maintain high quality and
efficient patient care. As the upcoming round of health care
reform is implemented, we all need to look for opportunities
to innovate and develop new technologies that can be
brought to reality by healthcare facilities and by industry.
Neurofeedback...Continued
If you are unaware of the actual budgetary restraints
your department may be under…ask. There are many ways
in which we can each contribute in order to ease the current
burdens. For example if you are involved in ordering supplies
for your department start thinking in the short term.
Although it is easier to order paste every 3 or 4 months, when
you do that you are spending money from a limited monthly
supply budget for paste to sit on a shelf. Inventory control is
a sure way to save your department money. Start thinking
about your department budget like you do your household
budget and you will be amazed at the inventive ways you and
your peers will come up with to cut cost.
I have lived through many different cycles in my
forty plus years of working in healthcare. What I can assure
you of is that change has always been a constant. There will
always be situations that you can control and many situations
you have no control over. If every evening on your way home
from work you are sure that you did your very best for your
patient, your co-worker, and your employer you have proven
your worth!
New Technologies and Research
By Marco Moreno, R. EEG T, MS
Pediatrics and Neonatology
By Shelley Gregory, R. EEG T.
With every new iteration of healthcare reform there
is a constant push to reduce cost – to do more with less –
to work smarter, not harder. In addition to cutting costs,
healthcare facilities will be penalized for poor quality care,
medical errors, for readmissions to the hospital, etc.
How do we leverage technology to deal with these
upcoming pressures?
• Archiving data files to a server for permanent storage
rather than burning CDs or DVDs may save a great deal
of time for your lab. While burning these storage discs
gives you the comfort of knowing that you have access
to the data within your lab, it also requires a significant
amount of time to create the discs, while exposing you
to the potential that someone may walk off with patient
data.
• Automated report generation allows you to import a
significant amount of clinical data into patient reports.
Whether it’s an EMG report or a cortical mapping
report, the ability of the system to create reports with a
significant amount of clinical information will save time
and prevent transcription errors.
• HL-7 interfaces allow your EEG equipment to tie into
your Medical Records system to retrieve admitting
information and can save a significant amount of tech
time and reduce transcription errors that can create
even more work. Importing patient demographics and
exporting patient reports can potentially save a great
deal of work and rework.
As I have mentioned over the years, working with
children is not easy and you deal not just with the individual
but, in fact, the whole family. “Family Centered Care” is
the term that our hospital calls it. Seattle Children’s EEG
Technologists strive to produce the best quality studies every
day on a very difficult population, whether it is an EEG on
a 23-week gestation neonate or a medically compromised
seizure patient that needs extra care in achieving the study,
we do it. Once that is accomplished, the rest usually falls
into place. Below is the way that everyone from staff and
my administrator to the CEO go about our work at Seattle
Children’s. It reflects a home with everything from the walls
and basement to the roof. Patients and families are the
most important aspect and without them the rest would
not happen. So providing quality EEGs in a safe manner by
someone who is truly engaged makes for a happy home.
We also have a Family Experience Survey (FES) that
we use to gage how departments are perceived by families
that have gone through various clinics. These questions vary
from cultural respect during their visit from the provider to
does this provider seem to know the important information
about your child’s medical history? It helps me understand
what the families feel are important when they come for the
EEG. Families have choices as to where they want to go to
have services and quality, safety and good experiences can go
a long ways. It’s kind of like taking your EEG Boards, if you
22
Pediatrics and Neurology...Continued
didn’t do well in one of the sections you are sent a form that
points out your score and areas of improvement. Trust me, I
have been there are a few times.
As the EEG Supervisor, it is my job to keep my team
informed of the results from the Family Experience Survey.
My Director sends the report via email to our Vice President
as well as the Director of the Neurology Department and
myself so that we are all kept in the loop as to how we are doing
compared to the hospital’s scores and are now comparing
ourselves to nationwide Children’s hospitals. There is also
monetary incentive for us on a yearly basis if we meet our
goals in the EEG Lab as well as the hospital goals. Don’t get
me wrong, we will always provide the highest quality studies
but being acknowledged for a job well done with a bonus is a
great perk.
One last item, I really feel that as a supervisor, it is my
responsibility to lead and teach my team on an ongoing basis.
Now, whether that is showing via hands-on by performing
an EEG on a challenging patient or sitting down with my
team members in a one to one check-in I really believe that is
imperative.
Polysomnography/Sleep Technologies
By Scott Blodgett, R. EEG T., RPSGT, RST, MBA
Hello colleagues! I hope this finds you well, enjoying
the summer months, and finding time to relax. This edition’s
focus is about gaining and maintaining recognition in the
new healthcare environment. In sleep, we certainly have
a unique opportunity in this area, especially amidst the
challenges our industry is facing.
Most people outside of our specialty believe that the
role of the sleep technologist in the care continuum is limited;
this mainly because our patients are asleep. The reality is that
it’s quite the opposite! Sure, Polysomnographic Technologists
record bio-physiological sleep data while patients are asleep,
but we also provide an important role in patient education.
With that in mind, let’s consider a few important points
keeping the patient in focus.
From our first encounter with the patient, how many
of us realize that the patient has had little to no education
about why they are being tested or why it’s important? I see
our primary job in this evolving healthcare environment as
just that – patient advocate and educator. Continuing on
this thought, how many of us find ourselves explaining to
the patient why they’re back in our lab for PAP titration and
what we’ll be doing while they’re in our care? We explain
procedures, comfort patients, and perform titrations using
state of the art equipment, all while the world and our
patients sleep…
Our role as educators and advocates can also continue
after the patient’s stay(s) in our laboratory. Technologists
23
can play an important role with coordinating care after the
providers have ordered the appropriate therapy. I see our role
on the team as the “jack of all trades”. We spend the most,
and let me emphasize this point, the most, patient contact
hours of any other provider on our team. We’re not only
recording Polysomnographic data at night, we’re working in
the daytime clinics running MSLTs, MWTs, and assisting the
providers with mask fittings and compliance downloads.
With that said, and considering the robust service
offerings we can provide, it’s important that we are properly
trained and credentialed to do so. In fact, the key to gaining
and maintaining recognition is all about education and
credentialing; it proves our competence. However, our initial
training and credentialing is only the first step. Continuing
education is a must not only to reinforce our existing skill
sets, but also to stay cutting edge. Circling-back to the patient,
it’s always a good idea to let them know your credentials.
I highly recommend proudly displaying you credentials
and continuing education prominently in your lab. It helps
your patient to feel comfortable with your level of training
and skills while reminding you that education is a lifelong
journey, not just an event.
Thank you for your time and dedication to our field
and have a wonderful summer!
GOVERNMENTAL AFFAIRS AND ADVOCACY
By Bradley A. Hix, Governmental & Grassroots Advocacy Manager
ASET Who Do You Know Program:
I
n politics it often comes down to who you know. Personal relationships can open
doors that otherwise would not be opened and provide access to legislators and
staff. Personal relationships make it easier to schedule a meeting, get a return
call or have your point of view considered. The old saying “It’s not what you know,
it’s who you know” is so true. Sometimes something as simple as a relationship
with a college friend can get a bill scheduled for a hearing. Legislators are just like
us. They like to do favors for people they know and trust. Politics is based upon
relationships and leveraging our relationships will help ASET shape legislation and
regulations that impact our profession and the well-being of patients.
As part of achieving our governmental advocacy goals we have created the “Who Do You Know” program. The Who Do
You Know Program is ASET’s tactic to build a more effective grassroots organization and builds on our Point of Contact
Handbook on enhancing relationships with legislators.
If you have a relationship with your State Senator or State Representative or members of their staff, you are well positioned
to influence the legislative process. Even if you do not have a relationship with a legislator or a staff member you might know
someone who does. Do you have a politically active member of your family or a friend who would be willing to introduce you
to a legislator? Is your neighbor a business associate of a legislator? Think of the people you know who may know someone
who is a legislator or staff member.
During the upcoming ASET Annual Conference in Reno we will be collecting information to build a database of the political
relationships our members have with legislators and staff. Drop by the Grassroots Watering Hole in the Exhibit Hall to learn
more about the program. ASET staff and members of the Governmental Advocacy Committee will be on hand to help you
fill out a “Who Do You Know” form or you may also fax it to 816-931-1145 after you return home. If you will not be in Reno
you can submit the form by visiting http://www.aset.org/i4a/pages/index.cfm?pageid=4028.
Want to become involved, but don’t know your legislator personally? Pick up a copy of the Point of Contact Handbook at the
Grassroots Watering Hole or download it from the ASET website http://www.aset.org/i4a/pages/index.cfm?pageid=3997.
This handbook will provide you the information you need to build long lasting relationships with your legislators and their
staff. In the handbook you will learn tips on how to correspond, meet with, and telephone elected officials. Developing
relationships with legislators and staff is easier than you might think. If you do not have an existing relationship, reach out to
your legislators and establish relationships that will help protect our profession.
The purpose of the governmental advocacy program is to protect the scope of practice for neurodiagnostics. In addition, the
ASET Board of Trustees adopted the critical goal of introducing licensure for neurodiagnostic professionals at the state level
no later than 2015. We need your help achieving these goals. Get started today by participating in our Who Do You Know
program.
Legislative Update:
Currently the majority of State legislative bodies are not in session. There are 15 State legislative bodies that have yet to
adjourn for the year. The Governmental Advocacy Committee has been busy reviewing hundreds of bills and regulations and
has identified a few that directly impact the neurodiagnostic profession. For the most up to date information on the issues we
are tracking please, visit the Neurodiagnostic Legislative & Regulatory Action Center under the Advocacy tab of the ASET
website.
24
CONNECTIONS CORNER
Interviews Connecting Members
“Fun, Spiritual, Encouraging, Visionary, ASET Member”
By Sarah Dolezilek, Marketing & Communications Manager
Petra Nicole Davidson, R. EEG/EP T., BS
Neurophysiology Technologist
Mayo Clinic Health System
Mankato, MN
Sometimes in life, you don’t know what, how or when something will make such an impression on you that it changes
the direction you were headed in. Enter Petra Nicole Davidson, a young, fun, spiritual, encouraging visionary in the
neurodiagnostic field. Her co-workers have even coined a phrase in her honor. Instead of hard-working, she is Petraworking! Petra’s journey into the field may be similar to yours; however her reasons for staying are fantastic. Sometimes,
just being in the right place at the right time and doing what you believe in, is enough to change your life. I hope you enjoy
reading Petra’s story!
My interview with Petra was done on June 16, 2013 via a phone conversation. My intention with this interview and the
ones to follow in this new section of the newsletter is for you to learn more about the amazing individuals who make up the
neurodiagnostic profession, who live and breathe it every day. The profession would not be where it is today without these
remarkable, hard-working, intelligent, believers.
ASET: How did you first learn of the field of neurodiagnostics and what drew you to it?
Petra: I graduated with a Bachelor’s Degree in Biology from Southwest Missouri State
University, with an initial intention to attend medical school. I shadowed physicians in
many fields and quickly discovered that I really wanted hands on medical care with more
hands on and less paperwork. I surveyed the local hospitals in Springfield, Missouri and
stumbled upon a position as an entry level EEG technologist. A gentleman named Bruce
Maggard, the senior lab technologist, interviewed me for the job. He had spent the previous
twenty years performing EEGs and training new college graduates only to see them move
on to another field. He tried his best to scare me off by telling me all the gory, gruesome
details of the job. Bodily fluids, head traumas, a near drowning, hypothermia patients, and
deceased patients were all included on his list. The more he tried to scare me off the more
intriguing it got. I asked him if I had to use any sharp objects or change anyone’s soiled
pants. He said no, so I said I was in! He sat me down with Niedermeyer, lovingly called Petra Davidson (left) with her
Nieder-Monster because of the size of the text book. I studied it harder than I had ever husband and fellow technologist,
studied before. Neurology and neurophysiology is so fascinating. I saw my first EEG with Keith Davidson (2012)
Bruce about one week later and was completely hooked! I loved taking care of patients; I
knew I had a huge passion for it.
ASET: Tell me how you first got involved with ASET
Petra: I told Bruce I wanted to learn more about EEG and get an in-depth
knowledge. He told me about the ASET Annual Conference and I researched all
the information I could from the internet and talked my boss into allowing me
to attend the conference in Indianapolis in May of 2000. I got to the conference
and was hooked! The enthusiasm and vigor that people had at the conference
and the way they presented the education got me hooked on being a part of this
organization, and it gave me a little more insight as to what I could possibly
do in the future as far as education. It was years after that that I became truly
involved with ASET.
25
“ASET seems to be one
of the few organizations
where they want to listen to
what new techs are doing.”
CONNECTIONS CORNER continued
ASET: What was your first impression of the Society?
Petra: ASET seemed to be made up of technologists at the
time who were primarily OJT’s who had found this career
almost by accident, which made it intriguing to me. The
Society itself seemed to be one of openness, where you
could feel free to ask a question no matter how silly it was,
and someone would help you find the answer. I never felt
uncomfortable. Shortly after joining I met Lucy Sullivan at
a meeting; she really helped increase my involvement. She
roped me into ASET pretty quick. Everyone is so helpful,
occasionally when I am feeling stumped I go into the forum
and post a question and I always get great feedback and quick
responses.
thought wow that was really cool, this must mean something.
So I go around to hookup her EEG and it doesn’t look good.
I asked my supervisor to look at it and he says she probably
isn’t going to make it. The Intracranial Pressure (ICP)
monitor was scary and the sutures were frightening. Her
grandmother came in while I was recording the study and
I was honest and said I was skilled at doing the test but did
not know anything about reading it yet. She just asked me
if I would pray for her granddaughter when I got home that
evening. I said absolutely.
My supervisor Bruce took a look at the EEG and said that
she was not going to make it. I said
I don’t know I think she will. I know
you know more about EEG but she
is young and you said young brains
are resilient. He said, well there are
rare exceptions, but I don’t think she
is going to make it. I replied, I get a
feeling that she will, I think her faith
will make her well. He said, oh yeah
that’s right; you’re a praying person,
aren’t ya? I said, yes, give her a week.
ASET: What has surprised you most
about working with the ASET Board
and being on Committees and task
forces?
Petra: How well collaboration
works when it is done correctly. The
openness of the teams to discuss ideas
is amazing. ASET seems to be one of
the few organizations were they want
to listen to what new techs are doing. They keep an open
mind and there is a great transfer of information.
ASET: Can you give me an example?
Petra: Absolutely! Right now, I’m working on the Standards
and Practices committee, as a team we have been able to
come up with great educational standards/requirements. The
collaboration goes back and forth so you can agree on one
point, and not another and the team is able to give feedback.
Together we all have agreed on the minimal educational
guidelines, that really none of us had to go through when
we were training, but it is the direction that we want to see
ASET go.
“It was then I knew this was
my career... I will remember
it for the rest of my life.”
I went on about my daily tasks and put that to the back burner.
One week later, Bruce greeted me at the door and said that
I was never going to guess who was up walking around in
Physical Therapy. I said who? He told me that it was her. I
just smiled and thanked him for telling me. I knew she was.
Six months later, she came back to have an outpatient EEG.
When I called her name her eyes got huge, and she closed
her eyes tightly and asked for me to repeat her name and
say that “I was going to pray for her”. I did what she asked.
She opened her eyes and said, “it was you, you did my test
in the hospital and you prayed for me.” We hugged!! She
remembered my voice.
ASET: What’s your first fond memory of working in the
Neurodiagnostic field?
Petra: My first fond memory of working in the
Neurodiagnostic field was doing an EEG on a child who
had been in a motor vehicle accident. This child was the
only survivor of the accident. She was in a coma. There were
posters all over her ICU room about prayers being offered
up on her behalf. I quietly in my head said a prayer for her
before I started placing wires on her head. I didn’t realize it
at the time, but I did speak the prayer out loud, although
quietly, it was out loud, and I’ll get to that in a minute. For
some reason… you know I’ve always heard people say they
have heard God talk to them, and I think, yeah sure alright.
But I remember distinctly hearing God tell me she would
be okay in a week. I really hadn’t heard his voice before so I
It was then I knew that this was my career. I had only been
testing for about six months at the time. I will remember it
for the rest of my life.
Because of this one situation, I am able to fondly remember
to talk to patients in that situation and am able to tell
family members to do the same, and help them feel more
comfortable when their loved one is in a coma. I could have
just gone in there and thrown the wires on and did the test,
but it wouldn’t have had the same impression on me, or her.
It makes me really think how instrumental the tests that we
do are.
26
CONNECTIONS CORNER continued
ASET: What are you most proud of in your professional life?
Petra: Successfully performing EEGs on Autistic and
developmentally delayed children who could not get them
completed elsewhere with sedation. They either weren’t able
to do the test or were so terrified because of how they had
been given to them before. I was able to find ways to calm
them and ease their mind, so they actually enjoyed coming
in for their EEG. That’s what I am most proud of, being able
to give them that opportunity. I have done this multiple times
with sedation, playing is instrumental. I love those kids.
Right now, it has been imaging and imaging doesn’t tell about
brain function. We need to help the providers see the value
of EEG. Right now the big push from physicians is imaging,
imaging, imaging; they want a MRI, CT, and Ultrasound.
They don’t want to order the EEG, which I don’t understand;
our test is the cheapest by far, no side effects, and there is
no one I cannot do it on. Patients have to be screened very
heavily before they can have a MRI or CT, not all patients can
have one. Even if they can, you cannot look at brain function
on either of those tests, you have to have those wires on that
patients head to see that their brain is functioning electrically.
It is so unique and so helpful.
ASET: Tell me about someone who has influenced your
decision to work in Neurodiagnostics?
Petra: Three people have really made a difference in
my professional life. Jeremy Slater, MD, was the first
neurologist from which I had the distinct pleasure to learn
Neurodiagnostics. He is amazing. He loves his profession,
his patients, and is constantly striving to learn more. He is
one of the few neurologists that will grab a second set of
leads to help me hook up a patient when I was called in to
do multiple EEGs on a late night. He is still my friend and
colleague. I can bounce questions off of him and he still says
he learns from me. Bruce Maggard, the technologist who
trained me. He taught me to stand up for myself. He would
say; “Yes, you are a tech, but you are not just a tech, you are
doing a very important job that most other people can’t step
in and do”. Lastly, there is Dr. Andrew
Reedes, he blows me away how much
he continues to learn; he calls himself a
“simple country neurologist”.
ASET: Is there anyone (living or deceased) in the
Neurodiagnostic field that you would like to talk to?
Petra: Hans Berger definitely. He was thought of as crazy in
his time, but he was a genius. We use his technology every
day. I would love to sit with him and ask him how he got
started and how he thought to put electrodes on the head.
Also one of my neurologists who I work with every day, Dr.
Andrew Reedes, he has been a mentor of mine for 12 years.
And even though he is an extremely well trained neurologist,
he comes to me and asks me questions, he values my opinion.
He asks me what do I see, etc… so sitting down and taking to
him about how he got into neurophysiology would be really
neat.
ASET: Last question; if you had
$30,000 to donate to ASET or the ASET
Foundation, what would you wish it be
used for?
Petra: Two things; I would have to split it
between marketing the value of our tests
to providers and Education. I would send
more techs to the conferences and have
it used specifically for technologists that can’t usually attend;
to give them the opportunity to build on the collaboration
and connection that you receive at the meetings.
“We need to help the
providers see the
value of EEG. “
ASET: What is the best piece of advice
that you have ever received?
Petra: Never stop learning. Especially
with neurodiagnostics, the field itself
constantly changes. What we know about EEG now is
different from when I started 14 years ago. If it changes
that quickly, we need to participate in the webinars, go to
conferences and talk to our fellow colleagues; it is through
this research and innovation that we keep learning. Never
stop learning.
Thank you Petra for sharing your story with us. Your passion
for education and betterment of the profession is exceedingly
clear. It is that passion and desire that is so important for us
all to have. Your ideas and vision of the future will launch
the profession in a new direction as the go-to field for allied
health professionals. It is that enthusiasm that is necessary
for our professional members to keep striving for bigger and
better things of the neurodiagnostic field. We will need your
voice and excitement as we move forward. You are another
excellent example of the type of individuals that make up this
unique field.
ASET: What do you think will change in neurodiagnostics
over the next five years?
Petra: Hopefully we will see several changes in our field.
First of all, I would like to see legislation get put through for
us to maintain doing EEGs, since that is what we have been
trained to do.
I’m also hoping over the next five years, ASET can help
market the EEG as a go-to test for assessing brain function.
27
CONGRATULATIONS TO OUR NEW MEMBERS
[since 04.10.13]
Institutional Members
Bon Secours Maryview Medical Center
King Faisal Specialist Hospital & Research Centre-Jeddah
Naval Medical Center San Diego
UC San Diego Health Systems
University of Texas Medical Branch
Individual Members
Donald Adkins
Qurban Ali, BS
Jennifer Alicata
Actual Facts Allah, BA
Robin Bagley
Gabriel Baguyos, LPN, BS
Ted Baird, PhD
Erin Balsis, BS
Toni Barnett
Roylynn Batiste
Andrew Beach, CNIM
Jeffrey Bercasio, BA
Mark Berkins
Fira Berlin, R. EEG T., AS
Elizabeth Berry-Long
Mary Betinis, R. EEG T.
Marcy Bierman
Barbara Blackburn
Edna Boksenbaum
Blayon Bolay
Alaa Bouzhar, R. EEG T., AA
Aiyanna Briggs, RPSGT
Shirley Brown, BS
Lori Brown
Joseph Bukowsky, AA
Megan Calamaras, CNIM, BS
Fe Cardenas
Nisveta Careaga, AS
Keane Carlson
Amanda Caruso
Paulette Case
Santos Casiano
Lata Casturi, RPSGT, MS
Ryan Ceciliani, CNIM, BS
Abderrahmane Chahidi, PhD
Santhi Chigurupati, PhD
Kellie Conklin, RPSGT, AS
Martha Costello, BS
Courtney Costilow, R. EEG T.
28
Emmalyn Daniel, BA
Troy Davis, R. EP T.
Frank Deans, R.NCS.T.
Shari DeSilva, R. EEG T., MD
Fritz Desrosiers, R. EEG T.
Robert Devore
Jay Dickinson, LPC, MA
Catherine DiSalto
Charlene Dodge, CMA, AS
Ehsan Ejaz, CNIM, BS
Jacob Elias, BS
Devin Fadelsak
Aymaan Faleh, BS
Ashley Faris, R. EP T., R.NCS.T., CLTM, RET
Lucien Kilonda Fataki, BS
Regina Faught
Enrique Fernandez
Beatriz Fernandez Tomlinson
Igor Fishbeyn, BS
Rommy Foteh, CNIM, BS
Richard Foy, MBA, MHA
Sarah Fraser
Robert Frye, BBA
David Gaiser, AS
Monique Garcia, R.NCS.T.
Ingrid Garcia, BS
Patricia Geoco
Michael Ginzburg, R. EP T., BS
Jeanie Giunta
Ileana Gordon, BS
Kori Griffin, RPSGT, AS
Sarita Gupta, CNIM, MD
Thelma Gur-Smith
Chris Hansen, CNIM, PhD
Iryna Hapyuk
Elouise Hayes
Jennifer Heiman
Donna Hendershot, AS
Jamilah Henderson
Steven Hennessy, CRT-NPS, AS
Cheryl Higgins, R. EEG T.
Melanie Hintz, BS
Pamela Hogan, BA
Justin Hogan
Paula Hohn
Nathan Hollenbeck, MA
Michael Hopkins, CNIM, PhD
Eric Huffman
Cynthia Hughes, MS
Abdusalam Hussein, AS
Shelia Jackson
Tesia James, AS
Mary Jones, RPSGT, AS
Camille Jones, BS
Kim Justice, R. EEG T., AS
Brittany Justus, CNIM, BS
Ghada Kadi, BA
Jonathan Kao, BS
Taylor Kaufman, AS
Atrac Kay, MD
Holly Keane, MA
Andrew Kopka, CNIM, BS
John Kramarczyk II
Lisa Lambert, CNIM, CST, BS
Kerry Lanaghan
Daniyal Laryea, MSc
Christine Lawrence
Sandi Lemmon, RPSGT
Gilbert Leos, RRT, MBA
Wei Li, R. EEG/EP T.
Sheila Loggins
Katie Ludington
Manuel Lutz
Olga Lytvynova, BA
Bryce Mackie, BA
Katherine Manasher
Daniella Marks
Dwight Mathis, CNIM, BS
Kasey McClelland, RRT, AAS
Linda McEwen, MA
Douglas Meyer
Maggen Millin, R. EEG T.
John Mills, BA
Sarah Mizener
Curtis Moersch, BS
David Moerschel, BS
Robbie Moore, CRTT, AS
Sandra Morgan, R. EP T., RMA, AA
Amy Morison, R. EEG/EP T., R.NCS.T., CLTM, BS
Alla Morris, R. EEG T.
Cassie Moser, R. EEG T., AS
Mais Mujarkesh, AS
Karla Murcia
Annie Nelson-Wensman, BS
Mohamed Nuh, BS
Danielle O’Donoghue
Abdullah Osaimi
Jonathan Osmolinski, CNIM, MS
Michael Osterhout, R. EEG T.
Lindsey Osterlund, BS
Jay Overbaugh, R. EEG T., BA
Elizabeth Papineau, R. EP T., R.NCS.T., CMET
Shermaine Poche, AS
Cynthia Prince, R. EEG T.
Letchumy Ramanaidu, R. EEG T., BS
Anna Ramos, AA
Radhakrishnan Rangasamy, R. EEG T.
Christine Renteria, RRT, AS
Amanda Reysack, R. EP T., BA
Colleen Rhoads, BS
Deborah Rivera
Ali Safaa, R. EP T., PhD
Amy Salazar, RPSGT, AAS
Kasie Sargent, R. EEG T., AS
Tarsha Saunders
Lindsy Schaiper
Greg Scholin, BA
Luther Scott, LPN, AS
Manzoor Shah
Zaitoon Shivji, RET
Theresa Siegmann
Melinda Smith
Ora Smith, RRT, AS
Alysia Smythe, RPSGT
Wagner Soares, CNIM, BS
Douglas Souris
Jordan Stottern, RPSGT
Carlar Stroud, CCT, BS
John-Paul Sumaquero
Stuart Swanson
Kristie Swenson, R. EEG T.
Melissa Tarrance
Miya Taylor, BS
Nalee Thao, AS
Brendan Thomas, R. EEG T.
Tiffany Thompson, R. EEG T., MA
Cecile Tolentino, CNIM, MD
Harry Torres, AAS
Laurie Torres
Brooke Traylor, BA
Lori Trefts, MD
Melanie Troutner
Victoria Turek, CNIM, PhD
Jill Tylec, RPSGT, AAS
Karen Ussher, RPSGT, BA
Lori Vaught, BA
Chris Wackel, R. EEG T., DABNM, AS
Lakesha Walker, R. EEG T., BS
Gracie Wallace
Mina Wang, R. EEG T., BS
Peter Whaley, CNIM, BS
Trenjula White, AA
Danielle Williamson, MS
Joanna Wnuk, AS
Pascale Wolfensberger, BA
Kristina Yaun, R. EEG T., AS
David Zimmerman, CNIM, BS
29
ASET STAFF:
Executive Director
Arlen Reimnitz
arlen@aset.org
Marketing & Communcations
Manager
Sarah Dolezilek
sarah@aset.org
Membership Coordinator
Kathy Wolff
kathy@aset.org
Governmental & Grassroots
Advocacy Manager
Bradley Hix
bradley@aset.org
Registration & Fullfillment Manager
Mandy Gist
mandy@aset.org
Director of Education
Faye Mc Nall, R. EEG T., MEd
PO Box 36
East Boothbay, ME 04544
207.350.4087 (p)
faye@aset.org
Director of Publications
Lucy Sullivan, R. EEG T., CLTM
3350 S. 198th Rd.
Goodson, MO 65663
417.253.5838 (p)
lucy@aset.org
Online Education Coordinator
Maggie Marsh-Nation, R. EEG/EP T.,
CNIM, MSIDT
2013 Lime Creek Rd.
Kerrville, TX 78028
830.895.7460 (p)
maggie@aset.org
402 E Bannister Rd, Ste A, Kansas City, MO 64131
816.931.1120 (p)  816.931.1145 (f) info@aset.org  www.aset.org