Physician Oversight

Marcos J. Cruz, M.D.

Medical Director

• Board Certified in Clinical Neurophysiology by the ABCN
• Board Certified in Neurology by the ABPN
• Fellowship-Trained in Neuromonitoring/Neurophysiology
  Vanderbilt Medical Center
  Nashville, TN
• Fellowship-Trained in Neurology
  St. Christopher’s Hospital for Children
  Philadelphia, PA
• Residency in Adult Neurology
  Hahnemann University Hospital
  Philadelphia, PA
• Completed Medical Doctor Training
  New York Medical College
  Valhalla, NY
• Licensed in NJ, NY, PA, TN

What is remote monitoring and how is it performed?

Through a secure, HIPAA-compliant Internet,connection, our team of physicians use leading-edge remote desktop software that links with our technologist’s computer in the operating room while it is collecting neurophysiologic data on the patient. This connection allows our team to see EXACTLY what the technologist is seeing, at the same time. The remote monitoring team can also communicate with the technologist in the operating room through an instant messenger chat function. This system allows our remote monitoring team to see critical changes in the neurophysiologic data as they are occurring and then to communicate with the technologist to discuss a possible intervention.

The technologist(s) monitoring my surgeries are very good. Why do they need remote physician supervision?

Even though our IONM technologists may be competent enough to function without supervision, it is still necessary to have real-time physician oversight for a few reasons. First, CMS guidelines require that IONM data be interpreted in real-time by a physician (M.D., D.O). Secondly, when a physician is not supervising in real-time, the hospital or surgery center could be liable for not providing the standard of care. The operating surgeon could also be held responsible for the IONM technologist’s work. Lastly, when critical changes in IONM data occur, it could indicate that an irreversible, catastrophic neurological injury is in the making. A second opinion by a physician that confirms the technologist’s findings is very reassuring and can serve to call the surgical team into action more swiftly.

Am I exposed to any risk if the IONM service at my hospital does not have remote physician supervision?

Yes. When real-time remote physician supervision is not used, the hospital or surgery center could be found liable for not providing the standard of care, and the operating surgeon could be held responsible for the IONM technologist’s work.

Can a physician review the IONM data after the surgery?

No. CMS guidelines require that remote physician supervision be performed in real-time. Additionally, reviewing the data after the surgery serves no benefit to the patient. The goal of IONM is to detect changes in the patient’s neurophysiologic status DURING the surgery so that an intervention might be made in order to PREVENT serious, permanent neurological injury.

Is remote monitoring HIPAA-compliant?

Yes. The remote desktop software that we use is secure, encrypted and HIPAA-compliant.