ASETnews Summer 2013 IN THIS ISSUE BRIEFINGS FROM THE BOARD TECHNICAL TIPS INTEREST SECTIONS GOVERNMENTAL AFFAIRS AND ADVOCACY CONNECTIONS CORNER

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1 IN THIS ISSUE BRIEFINGS FROM THE BOARD TECHNICAL TIPS INTEREST SECTIONS GOVERNMENTAL AFFAIRS AND ADVOCACY CONNECTIONS CORNER NEW MEMBERS ASETnews Summer 2013

2 SUMMER 2013 VOLUME 37, NUMBER 2 ASET OFFICERS PRESIDENT Judy Ahn-Ewing, R. EEG/EP T., CNIM, CLTM, FASET, BA St. John Providence Health System Detroit, MI jahnewing@tir.com PRESIDENT ELECT Brian Markley, R. EEG/EP T., R.NCS.T., BS The Neurology Center, PA Silver Spring, MD bam@neurologycenter.com SECRETARY/TREASURER Pat Smith, R. EEG T., AA Child Neurology Center of Orlando, PA Orlando, FL psmith016@yahoo.com BOARD OF TRUSTEES 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 Sara Batson, R. EEG/EP T., RPSGT, CNIM, CLTM Jacksonville, FL Scott Blodgett, R. EEG T., RPSGT, RST, MBA ResMed Corporation Rochester, NY 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

3 BRIEFINGS FROM THE BOARD BYLAWS AMENDMENTS TO BE VOTED ON AT ANNUAL BUSINESS MEETING Three 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. 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. 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 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. 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 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. 3

4 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 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. 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 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 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. 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. 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

5 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

6 TECHNICAL TIPS A PROACTIVE APPROACH TO REIMBURSEMENT Kathryn Hansen, R. EEG T., BS, CPC Healthcare Consultant Integration Consultants Lexington, Kentucky Reimbursement 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 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 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

7 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. 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 Medicare Physician Fee Schedule covered services furnished during the respective (2012 or 2013) reporting period. Providers who have not successfully reported PQRS measures in 2013 will incur a 1.5% negative adjustment with the 2015 Medicare Part B reimbursements. The negative adjustment will increase to 2% for 2016 and 2017 thereafter. The provider must elect to report at least one measure group, as listed above, or at least three individual measures listed in one group to obtain the incentive. There is a provision for retrospective reporting with 2012 outcome indicators, which will benefit the provider s value-based profile for subsequent years. Providers who have not successfully reported PQRS measures in 2013 will incur a 1.5% negative adjustment with the 2015 Medicare Part B reimbursements. To be specific, if a provider elects to report a measure group, which for sleep apnea includes four individual measures, the provider must report all four outcomes for at least 20 eligible patients, and of these eligible patients, at least eleven must be Medicare Part B fee schedule claims submitted patients. 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 time to review this process and establish a plan for integrating. With the changing landscape for clinical providers, there are other opportunities to consider in the face of all these changes. Collaboration with third party payers, the patient, your referral network, and the community will boost reimbursement for services. Integrating monitoring of testing outcomes is needed to ensure effective therapies and patient adherence with therapy. Our focus is changing: we are now transitioning from performing volume to documenting the value of our patient encounters. This is a patient-centric care continuum, with savings realized through efficient care, improved access to care, and better care coordination. It requires a partnership with our primary care network and other specialists to effectively manage our patient s care plan. For most healthcare providers, this was an overarching reason to become a healthcare provider. Therefore, have the many changes we are experiencing within healthcare taking us back to our personal commitment and mission? 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? 7 SAVE THE DATE SATURDAY, AUGUST 3, 2013 ASET ANNUAL CONFERENCE RENO, NV CPT CODING WORKSHOP with Kathryn Hansen

8 INTEREST SECTION BRIEFINGS WELCOME FROM THE INTEREST SECTION COORDINATOR By Margaret Hawkins, R. EEG/EP T., CNIM, CLTM The 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. INTEREST SECTION COORDINATOR Margaret Hawkins, R. EEG/EP T., CNIM, CLTM Wausau, WI margaret.hawkins@ministryhealth.org INTEREST SECTION LEADERS 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 8

9 EPILEPSY MONITORING Susan Agostini, R. EEG/EP T., CLTM Phoenix, AZ Cheryl Plummer, R. EEG T., CLTM, BS Pittsburgh, PA INTRAOPERATIVE NEUROMONITORING Jeff Balzer, PhD, FASNM, DABNM Pittsburgh, PA Ryan Lau, R. EEG/EP T., CNIM, CLTM, MS Indianapolis, IN Justin Silverstein, CNIM, R.NCS.T., CNCT, MS Deer Park, NY MAGNETOENCEPHALOGRAPHY Hisako Fujiwara, R. EEG/EP T., CLTM, RPSGT Cincinnati, OH JP Lowe, R. EEG/EP T., CNIM, CLTM Summit, NJ NERVE CONDUCTION STUDIES Dorothy J. Gaiter, R. EEG T., R.NCS.T., CNCT, FASET, MHA Birmingham, AL Jerry Morris, R.NCS.T., CNCT, MS Shreveport, LA NEURODIAGNOSTIC EDUCATION Mary Feltman, R. EEG T., MEd Hewitt, TX Mark Ryland, R. EP T., RPSGT, R.NCS.T., CNCT, AuD Parma, OH 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

10 NEUROFEEDBACK Bill Coslett, CNIM, PhD, BCIA, EEG-C Lake Worth, FL Ambulatory Monitoring...Continued Background Rhythms: Riki Rager, R. EEG T., FASET, BS Nashville, TN NEW TECHNOLOGIES & RESEARCH Andrew Ehrenberg, R. EEG T., CNIM, BS Atlanta, GA Marco Moreno, R. EEG T., MS Fenton, MO PEDIATRICS & NEONATOLOGY Shelly Gregory, R. EEG T. Snohomish, WA Melanie Sewkarran, R. EEG T., CLTM St. Louis, MO 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

11 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 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

12 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 12 Ambulatory Monitoring...Continued 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.

13 Clinical EEG 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 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. 13

14 Clinical EEG...Continued Routine Maintenance vs. Recovery Efforts: As many of you know, routine maintenance on a vehicle, home, and EEG equipment saves thousands of dollars in the long run. Routine maintenance with our bodies is no different. Part of the current healthcare initiative is to increase routine checkups of our various body systems. Through education of the public as a whole, patients can be taught that routine visits to their physicians when problems do not exist can help prevent problems in the future. Patients with epilepsy do not need an EEG every year. If their seizures increase, often the first jump in treatment is imaging. An EEG is much less expensive, much more sensitive to cortical dysfunction and much safer. Educating primary care physicians who treat patients with epilepsy about routine EEG would probably save hundreds, if not thousands of dollars each year in imaging costs. Developing a standard of care for a patient with epilepsy to have an EEG, perhaps every five years, might give a better baseline for their cortical function than waiting until they have problems. Summary: According to Merriam Webster s dictionary worth can be defined as simply monetary or material value. Simply speaking the worth of an EEG outweighs the worth of imaging, we are far cheaper. However, when we partner with imaging in necessary patients, our worth is driven much higher. Worth can also be defined as being at the fullest extent of one s ability. Every day, with every patient, you should feel challenged to be at your maximum worth. Make every EEG count every time. Pay attention to the small clues that may really add that extra insight for the interpreting physician. Take the few extra seconds to study how the patient responds to questions of self, location, and time. Each of us can add more and more worth to our testing when we educate others, listen to our patients, and take the time to learn more about the testing we offer every day. Have a fabulous summer. Don t ever stop learning. Never stop offering your full worth to each patient and each physician you encounter, no matter what the circumstance. Computers in the Workplace By TJ Amdurs, R. EEG T., MS The first thing that came to mind when thinking how to maintain and gain recognition and prove our worth in this new healthcare environment that we face today is: inner-drive. It is becoming harder to prove your worth Each of us can add more and more worth to our testing when we educate others, listen to our patients, and take the time to learn more about the testing we offer every day. due to a trickle-down effect. Due to governmental demands, administrators are now more than ever cutting operating budgets and demanding more frequent reconciliation of worked hours per Key Volume Indicator (KVI). It requires an understanding and self-driven motivation to succeed in today s fiscal environment. I feel that patients do not equate competency with quality. The patient typically does not know what the alphabet soup of credentials following our names stands for. The patient experience consists primarily of us smiling and providing a safe experience. They want to feel that we are going to treat them well and be in good hands. We have to appropriately acknowledge them when we greet them, introduce ourselves with our credentials and how long we have been in the field(s). We need to explain what we are going to do and tell them how long it is going to take. Finally, we should thank them for choosing our hospital, lab, or office. This all goes a long way in driving quality and recognition. The inner drive equates to attaining the education needed to have the credentials behind our name. Now being good at what we do and providing a great patient experience are things we need to let people know. One way to notably enhance the promotion of your departments and/or yourself is to take advantage of social media. Daily life has been impacted significantly by it and has overwhelmingly changed how we interact with each other. Anywhere from: 1. News from business, family and friends on Facebook and Twitter, and groups that you follow for traditional news. 2. Advertisements for departments that do not have much money in their budget to spend can reach a multitude of people through social media. 3. I read an article a while ago that stated: The amount of time that is spent meeting and staying in touch with colleagues has almost tripled in the last year. 4. It seems that people share more about their feelings. I have noticed this on Facebook a multitude of times. 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 friends you have on Facebook. It expands your audience. It is much faster to reach people by posting something on Facebook than it is to call each person. It is faster than in regards to when people read it. So computer software can make a big difference in how we market our services and the social media products can provide a vehicle for your department to do so. 14

15 CPT Coding 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. 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. 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 Stephanie Jordan, R. EEG/EP T., CNIM, CLTM 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

16 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 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! 16

17 Epilepsy Monitoring...Continued 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 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

18 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 18 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. 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

19 Magnetoencephalography...Continued 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! Nerve Conduction Studies By Dorothy Gaiter, R. EEG T., R.NCS.T., CNCT, FASET, MHA 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 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. Neurodiagnostic Education By Mary Feltman, R. EEG T., MEd 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. 19 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?

20 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 ed 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. 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 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. 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 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.

21 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) 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 The second major source is the International Society of Neuronal Regulation (ISNR) 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 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. 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

22 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 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. 22 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. Pediatrics and Neonatology By Shelley Gregory, R. EEG T. 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

23 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 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 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! 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

24 GOVERNMENTAL AFFAIRS AND ADVOCACY By Bradley A. Hix, Governmental & Grassroots Advocacy Manager ASET Who Do You Know Program: In 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 after you return home. If you will not be in Reno you can submit the form by visiting 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 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 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

25 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 Nieder-Monster because of the size of the text book. I studied it harder than I had ever studied before. Neurology and neurophysiology is so fascinating. I saw my first EEG with Bruce about one week later and was completely hooked! I loved taking care of patients; I knew I had a huge passion for it. Petra Davidson (left) with her husband and fellow technologist, Keith Davidson (2012) 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 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. ASET seems to be one of the few organizations where they want to listen to what new techs are doing. 25