Zeto’s CEO, Aswin Gunasekar, recently sat down with Scott Pantel from LSI – Life Science Intelligence™ to discuss the future of brain monitoring and how Zeto is addressing unmet needs in neurology. Aswin highlighted Zeto’s work in transforming clinical EEG for patients around the world.
Key points from the interview include:
About EEG market
The screening/routine EEG market in the US is quite large, with an estimated 5-6 million procedures performed annually in the office EEG space alone. The market for Epilepsy Monitoring Units (EMU) is also significant, and there is also a separate market for sleep disorder EEGs. Overall, the EEG brain monitoring market is large and growing, as it is being used for a wider range of neurological conditions, and the demand for products that make EEG acquisition and interpretation easier is increasing.
About Zeto ecosystem
We are building a comprehensive ecosystem that includes not just hardware but also cloud-based software capable of handling thousands of simultaneous uploads and downloads globally. Additionally, we envision opening our infrastructure to other experts in the field to develop specialized applications for conditions such as stroke rehabilitation, autism, and Alzheimer’s detection. This also allows us to integrate other EEG service provider applications for the existing market. This ecosystem was built from scratch with a long-term vision in mind, and it has proven to be successful for us.
Regarding the potential for a future partnership with a major technology company
We collect a lot of brainwave data, which is time-based and contains a lot of valuable information. This data can be anonymized and used for machine learning and AI. Tech companies like IBM, Verly, or Qualcomm are interested in this type of data and may be interested in acquiring a company like ours to extract value from our large patient database across various indications. It’s a long shot, but the potential is there.
Aswin will also be a speaker at the LSI USA ’23 Emerging Medtech Summit in March 2023.
The profound lack of access to EEG outside of urban academic centers is a substantial health disparity. Most rural and suburban hospitals do not have the EEG equipment or trained staff available to obtain and read EEG studies. Thus, they must transfer patients who need EEG monitoring to a medical center that can provide these diagnostic services.
These transfers delay diagnosis and treatment, burden patients and families, and increase healthcare costs and lengths of stay.
As this article will show, even the smallest rural hospitals can provide their patients with high-quality, cost-effective, sustainable EEG using modern technologies and remote services.
Lack of Staff is an Insurmountable Barrier to EEG Access in Rural Areas
In a lecture presented at the ASET 2022 Annual Conference, Dr. Suzette LaRoche highlighted the disparities in access to neurodiagnostic technology faced by patients in rural areas. As per Dr. LaRoche’s insights, it is no secret that neurologists tend to practice in urban areas. More specifically, they cluster in large academic medical centers. A small community hospital in a rural area likely doesn’t have a neurologist or an EEG technologist on staff. The hospital may not even have EEG equipment. Consequently, every patient who needs EEG either doesn’t get this critical study or must be transferred to another hospital. Medium-sized hospitals may have a general neurologist on staff, but a dearth of techs. Moreover, even if the hospital employs neurologists and EEG techs, they are usually only available from 9 to 5, Monday through Friday. Even large community hospitals with neurologists and perhaps even epileptologists struggle with EEG tech coverage. Hiring more neurologists and EEG techs is not the answer—they are simply not enough of them who choose to work in rural and exurban areas.
Overcoming Barriers to Rural EEG
Dr. LaRoche identifies the following factors as the main obstacles to EEG testing in rural areas:
No trained technician is available on site to perform the EEG study
No one to read or interpret the EEG study (i.e., no neurologists or epileptologists)
No EEG equipment
If you cannot get neurologists and EEG techs to work in rural areas, how do you adequately care for patients? The solution is to change the way we obtain and read EEGs:
Use rapid EEG devices that can be correctly placed by any medical staff member in minutes
Record EEG studies to the cloud so that they can be read remotely by board-certified neurologists
Use an EEG system that integrates video with EEG recording for remote review
As remote medicine continues to become commonplace, we expect to see a rise in remote EEG monitoring companies, and expanded opportunities for remote EEG techs.
Zeto Brings EEG to Rural Hospitals
Zeto EEG is a wireless, adjustable EEG headset with integrated dry electrodes. Zeto offers a rapid full montage EEG solution and might be used for cEEG for up to 4 hours and for routine EEG.
If an EEG technologist is not available, any medical staff can correctly place the EEG headset in minutes (the average setup time is 5 minutes) with minimal training. It’s possible to use cross-trained personnel such as a nurse, medical assistant, or respiratory specialist. The Zeto team trains onsite and offers remote support.
The Zeto headset wirelessly sends EEG recordings to the cloud so the data can be monitored in real-time by anyone who has access to the HIPAA-compliant cloud platform. In situations where in-house registered EEG technologists are unavailable, Zeto is partnering with accredited EEG remote monitoring services that provide live remote video monitoring at an hourly flat rate.
Even a family medicine physician who is the closest doctor to the patient can carry out an EEG test using Zeto’s remote video monitoring service after being trained by Zeto,
If the rural hospital has a neurologist on staff, that professional can review the EEG from a medical office or from home. If a neurologist is not available, Zeto offers an EEG reading service staffed by board-certified neurologists.
Also, Zeto has recently implemented FDA-cleared seizure detection software, a robust tool that provides automatic pattern notification to detect critical events and notify medical staff and neurologists.
Zeto can bring cost-effective remote EEG services to any size hospital even if there are no EEG technologists or neurologists on staff. Indeed, Zeto’s rapid full-montage EEG headset could eliminate a major health disparity that currently plagues rural hospitals.
Source: The blog is inspired by a lecture by Suzette LaRoche, M.D., FACNS, FAAN “Disparities in Access to Neurodiagnostic Technology” presented at the ASET 2022 Annual Conference
It is important to use the appropriate CPT codes when seeking reimbursement by payers for covered outpatient procedures, including routine and long-term EEG studies. This article aims to provide guidance on potentially applicable CPT procedure codes for EEG while using Zeto EEG. The details we provide here are informational only, and you should consult your own billing advisors for what is required by your payors. Following this guidance is not a guarantee of coverage or reimbursement.
Billing for Routine EEG
For many reasons, a routine EEG is the most commonly performed EEG study. Choosing the correct CPT Code for routine EEG depends on two factors: how long the EEG is recorded and the patient’s state of consciousness. The EEG billing codes for the applicable time-period are set forth in Table 1.
While procedures with a length of 20-40 minutes require a different code depending on the patient’s level of consciousness, there is a single code for EEGs lasting 41 to 60 minutes, and another single EEG billing CPT code for EEGs lasting greater than 60 minutes, but not in excess of 2 hours. The codes for the longer sessions apply whether the patient is awake, drowsy, asleep, or comatose.
The CPT Code for a 41 to 60-minute routine EEG is 95813 and the code for a routine EEG more than 60 minutes in duration is 95812 (Table 1).
Table 1. CPT Codes for Routine EEG
EEG Length
Clinical Status
CPT Code
Awake and drowsy
95816
20-40 minutes
Awake and asleep
95819
Coma or asleep
95822
41-60 minutes
Awake, drowsy, asleep, or in a coma
95812
>60 minutes
Awake, drowsy, asleep, or in a coma
95813
Other EEG Billing Codes Applicable to Zeto EEG > 2 Hour Recordings
EEG recordings that last longer than 2 hours (“long-term EEG studies”) have their own set of CPT codes. EEGs greater than 2 hours, but less than 12 hours, are billed using the CPT Codes listed in Table 2. Additional CPT codes for EEGs greater than 12 hours are also available but are less applicable for Zeto’s current use case and we have not included them here.
The fact that these EEG billing codes are predicated on the time that the procedure takes makes it imperative that the clinician properly documents the reasons that the particular duration is medically necessary.
Another variable that affects the selection of the correct code for billing the professional component of a long-term EEG monitoring study is whether the EEG is video-recorded. Two EEG “professional component” CPT Codes are available for studies lasting 2 to 12 hours: 95717 is the CPT Code without video, and 95718 is the code with video.
There are also technical component CPT Codes for long-term EEG studies. The CPT Codes for long-term EEG technical components vary based on whether they are unmonitored, monitored intermittently, or monitored continuously.
Table 2. CPT Codes for Long-Term EEG from 2 to 12 hours
Video
Monitoring*
CPT Code Technical Component
CPT Code Professional Component **
Unmonitored
95705
Without Video
Intermittent
95706
95717
Continuous
95707
Unmonitored
95711
With Video
Intermittent
95712
95718
Continuous
95713
* Zeto EEG enables providers to schedule intermittent or continuous EEG monitoring services via third party monitoring providers ** Zeto enables providers to obtain professional EEG reads via third party reading service providers
For individualized guidance on EEG billing, several third-party consulting service providers are active in the market – for questions or an introduction to a consultant familiar with Zeto, complete the form below.
The only zero-prep, full-montage, rapid EEG solution for clinical use now offers near real-time notification of ongoing seizures by using reliable FDA cleared seizure detection software
Santa Clara, California, December 1, 2022 –
Zeto, Inc., an innovative EEG brain monitoring company, announced today the integration of FDA cleared seizure detection and trending algorithms developed by encevis, now available as part of the Zeto EEG platform. Encevis is powered by the AIT Austrian Institute of Technology, a renowned research and technology organization in Europe, and their EEG analysis software is widely utilized and peer reviewed by physicians across the world.
These new tools will help Zeto’s customers speed up EEG reviews. The trending module graphically reports several hours of EEG into a simple display to allow rapid assessment of brain states. The seizure detection component offers high sensitivity with low false alarm rates, matching and in parts surpassing industry benchmarks. Proven by three independent clinical publications, and harvesting the power of AI and deep learning, the software provides a detailed overview of seizures and suspicious EEG activity.
“According to current studies, 18% of critically ill patients with serious brain diseases suffer from unrecognized non-convulsive epileptic seizures, frequently leading to neurological disabilities. The joint efforts of Zeto and encevis will make EEG faster to read by automatically detecting and orienting the reader to abnormalities. Seizures will be automatically detected and marked in the EEG for review. Near real-time detection notifies medical staff about patients with ongoing clinical seizures,” said Dr. Tilmann Kluge, head of Medical Signal Analysis of AIT.
“We are excited to integrate encevis’ seizure detection and trending tools into our platform. Collaborative projects such as this ensure a seamless user experience and enable healthcare providers to offer the best care to their patients at an affordable price,” said Florian Strelzyk, Chief Sales Officer at Zeto.
Zeto EEG analysis features will continue to evolve as more third party integrations become available. Zeto is committed to driving innovation in brain monitoring by opening its platform to strategic projects and partnerships that empower health care providers to diagnose their patients rapidly and more effectively.
About Zeto
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, California, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century.
encevis is a part of the AIT Austrian Institute of Technology, Austria’s largest non-university research institute, is among the European research institutes a specialist in the key infrastructure issues of the future.
EEGs are an invaluable tool for monitoring real-time brain function at the bedside in the ICU.
Nonconvulsive seizures and nonconvulsive status epilepticus in the ICU are very shockingly common. Now that continuous EEG monitoring (cEEG) has entered clinical practice, we know the incidence of nonconvulsive seizures is between 8% and 37% of ICU patients.1 Up to 22% of patients in the medical ICUwithout brain injury have periodic discharges or seizures.2 Up to 16% of patients in the surgical ICU have seizures.3
Nonconvulsive seizures and nonconvulsive status epilepticus are extremely hard to detect at the ICU bedside—physicians missed 88% of these cases in one retrospective study.4 Sadly, delays in diagnosing and treating nonconvulsive status epilepticus treatment are associated with poor patient outcomes.5,6 Because of this dire need, professional societies and experts are calling on ICU staff to routinely order EEG monitoring in critical care units.7-9
Why order EEG in the ICU?
Seizures and/or status epilepticus causes neuronal damage10 and in some cases, hippocampal atrophy.11 These treatable conditions lead to poor outcomes in both children and adults. Prolonged seizures are associated with chronic cognitive problems and neurological sequelae . In short, undiagnosed and untreated seizures are dangerous for patients.
Making matters worse, seizures are often missed in the ICU setting when the diagnosis is based on clinical signs alone.4 Indeed, as Dr. Lawrence J. Hirsch of the Comprehensive Epilepsy Center of Columbia University in New York put it, “it is fair to say that anyone who works with critically ill neurologic patients and does not see nonconvulsive seizures and nonconvulsive status epilepticus on a regular basis is missing the diagnosis.”12
Given the complex nature of patients’ deficits in the ICU, it is unreasonable to rely on physical/neurological examination alone to detect nonconvulsive seizures.
EEG monitoring does appear to be better able to detect both subclinical seizures and subclinical status epilepticus compared to routine EEG according to a systematic review and meta-analysis study of over 20,000 critically ill adult patients.13
However, this might not translate into long-term clinical benefit, as suggested by a recent multicenter randomized clinical trial in Switzerland called the CERTA study, which evaluated 364 patients using continuous EEG or two routine 20-minute EEGs. The researchers did not find that mortality significantly differed between the two groups at 6 months.
Nevertheless, Neurocritical Care Society guidelines recommend the institution of continuous EEG within an hour of suspecting status epilepticus in all patients.14 Availability of EEG technologists, who can set up a routine and continuous EEGs, play a vital role in enabling ICU EEG monitoring, yet only 26% of institutions have technologists accessible 24/7 in-house.15
According to a study of 625 critically ill patients, preliminary findings from the first minutes of EEG recording have a high predictive value in detecting patients at greater risk for seizures and who would benefit from long-term monitoring.16 The absence of epileptiform discharges after two hours of EEG recording reduced the probability of seizure occurrence to less than 5%, and less than 10% after only 15 minutes.
When to order EEG in the ICU
EEG should be ordered without delay for any ICU patient with suspected nonconvulsive seizures. As mentioned, however, clinical suspicion is not terribly reliable4, thus the bar for ordering cEEG in ICU patients should be very low.
Continuous EEG should be ordered in ICU patients with7,12
Fluctuating mental status
Head trauma
History of convulsive seizures (especially convulsive status epilepticus; about one in two patients with coma and previous convulsive status epilepticus have nonconvulsive seizures.1)
Ischemic stroke
Intraparenchymal hemorrhage
Aneurysmal subarachnoid hemorrhage
CNS infection
Brain tumor
Sepsis
Recent history of ECMO
Hypoxic brain injury of any cause
Continuous EEG monitoring can help critical care physicians properly characterizing “spells” in the ICU “sudden posturing, rigidity, tremors, chewing, agitation, or sudden changes in pulse or blood pressure without an obvious explanation.”12 cEEG can also provide useful information about the level of sedation and can detect clinically silent, but significant neurologic events.12
How to get EEG in the ICU: Rapid EEG Solution
Rapid access to clinical EEGs in ICUs has a significant impact on diagnosis and outcomes in patients with seizures and acute neurological disorders. Despite the obvious need, it is still difficult for most critical care staff to get a rapid EEG in the ICU. The biggest hurdles to EEG in the ICU are a lack of dedicated EEG equipment and full-time staff that can run and read EEG and cEEG studies.
What is Rapid EEG?
EEG performed acutely for new onset of patient events and/or seizures
Designed to be started within a critical time window with the goal of triaging/treating sooner to prevent brain damage
Can be placed quickly by bedside care providers
May be in “screening-quality” category, or may be equivalent to standard EEG quality
How Zeto Can Help
Zeto offers a rapid full montage EEG solution that can be easily deployed in the ICU without a dedicated technologist. Zeto might be used for cEEG for up to 4 hours and for routine EEG. Zeto EEG can provide accurate, high-quality, 19-channel medical-grade EEGs in a matter of minutes (average setup time is about 5 minutes) without skin prep or cleanup.
Virtually anyone who works in the ICU can place the Zeto device with minimal training, it’s possible to use cross-trained personnel. The Zeto team trains onsite and offers remote support.
Once the wireless EEG system is placed on the patient’s head, the resulting EEG is available in real time for live monitoring. ICU staff has the additional paid-on option of real-time remote patient monitoring by registered EEG techs and short-notice remote reads by certified neurologists.
Most importantly, Zeto integrates FDA cleared Seizure Detection and continuous Seizure Load monitoring tools from encevis into its User Interface for automatic detection/notification of such critical events, providing more integrated functionality vs. competitors.
With Zeto, it is now possible to obtain medical-grade EEGs in the ICU setting without an on-site EEG staff. Within minutes, our integrated EEG solution notifies staff of continuous seizures enabling physicians to intervene in a timely manner and save lives in critical care settings.
References
1. Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012;12(4):419-428. 10.1007/s11910-012-0289-0
2. Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37(6):2051-2056. 10.1097/CCM.0b013e3181a00604
3. Kurtz P, Gaspard N, Wahl AS, et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med. 2014;40(2):228-234. 10.1007/s00134-013-3149-8
4. Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol. 2008;25(4):181-186. 10.1097/WNP.0b013e31817be70e
5. Pang T, Hirsch LJ. Treatment of Convulsive and Nonconvulsive Status Epilepticus. Curr Treat Options Neurol. 2005;7(4):247-259. 10.1007/s11940-005-0035-x
6. Trevathan E. Ellen R. Grass Lecture: Rapid EEG analysis for intensive care decisions in status epilepticus. Am J Electroneurodiagnostic Technol. 2006;46(1):4-17.
7. Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32(2):87-95. 10.1097/WNP.0000000000000166
8. Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015;32(2):96-108. 10.1097/WNP.0000000000000165
9. Rossetti AO, Hirsch LJ, Drislane FW. Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate. Clin Neurophysiol Pract. 2019;4:170-177. 10.1016/j.cnp.2019.07.001
10. Palmio J, Keränen T, Alapirtti T, et al. Elevated serum neuron-specific enolase in patients with temporal lobe epilepsy: A video–EEG study. Epilepsy research. 2008;81(2-3):155-160.
11. Vespa PM, McArthur DL, Xu Y, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010;75(9):792-798. 10.1212/WNL.0b013e3181f07334
12. Hirsch LJ. Continuous EEG monitoring in the intensive care unit: an overview. J Clin Neurophysiol. 2004;21(5):332-340.
13. Sharma, S., Nunes, M., & Alkhachroum, A. (2022). Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review. Frontiers in Neurology, 13.
14. Brophy, G. M., Bell, R., Claassen, J., Alldredge, B., Bleck, T. P., Glauser, T., … & Vespa, P. M. (2012). Guidelines for the evaluation and management of status epilepticus. Neurocritical care, 17(1), 3-23.
15. Gavvala, J., Abend, N., LaRoche, S., Hahn, C., Herman, S. T., Claassen, J., … & Critical Care EEG Monitoring Research Consortium (CCEMRC). (2014). Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia, 55(11), 1864-1871.
16. Rubinos, C., Alkhachroum, A., Der-Nigoghossian, C., & Claassen, J. (2020, December). Electroencephalogram monitoring in critical care. In Seminars in neurology (Vol. 40, No. 06, pp. 675-680). Thieme Medical Publishers, Inc.
Providing this end-to-end solution will make EEGs accessible to any healthcare facility in the US
SANTA CLARA, Calif., August 29, 2022 (Newswire.com) – Zeto, Inc., a medical technology company, has announced its partnership with Next Gen Neuro, a continuous and routine EEG monitoring company, to provide remote EEG monitoring services.
Next Gen Neuro (NGN) will serve Zeto customers with real-time EEG monitoring within 30 minutes of a request via the Zeto software. Their registered EEG technologists (R.EEG.T) would then remotely view the EEG and patient video and make annotations. More importantly, they will promptly notify care providers of important clinical events.
“We can help improve patient outcomes by reducing delays in EEG care and allowing for patients to receive care in place, when and where they need it. We are eager to embrace new technologies such as Zeto and develop innovative workflows that will allow us to accomplish these goals while providing the highest quality EEG and cEEG services,” said Leisha Osburn, CEO of NGN.
“Our new service will make an end-to-end solution for EEG monitoring accessible to any health care facility in the US, from our easy-to-use device to continuous technologist monitoring to timely physician reading, all via our secure cloud, enabling timely, high-quality care for patients. Zeto continues its progress towards serving the growing unmet need of EEG brain monitoring. We are excited to partner with NGN, which provides cutting-edge remote Neurodiagnostic services without boundaries,” said Aswin Gunasekar, CEO of Zeto, Inc.
Zeto also offers remote EEG reading service to its customers and the monitoring service would serve as an ideal complement to customers. Continuous or intermittently monitored EEGs are also eligible for higher reimbursements by payers.
To learn more on how this new service will work and how it can benefit the patients in hospitals and physician practice settings, read the interview excerpt with Next Gen Neuro Co-founders, CEO Leisha Osburn, and COO Amanda Ritchey.
About Zeto, Inc.
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, CA, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century. The company plans to leverage its hardware and software technology to improve noninvasive monitoring of the brain’s electrical activity and achieve better outcomes for neurological conditions such as epilepsy, sleep disorders, autism, stroke and concussion.
Next Gen Neuro (NGN) is a veteran and women-owned organization inspired and determined to make a difference in the field of Neurodiagnostics. NGN’s goal is to be your partner of choice in providing cutting-edge remote Neurodiagnostic services without boundaries. NGN strives to provide flexible, up-to-date Neurodiagnostic Solutions.
To learn more about Next Gen Neuro services, please visit www.teamngn.com
On August 3rd, Zeto announced the launch of its new remote routine and continuous EEG monitoring services. To provide this service, we partnered with Next Gen Neuro LLC.
We asked Next Gen Neuro Co-founders CEO Leisha Osburn and COO Amanda Ritchey, innovative leaders in the neurodiagnostic industry, about this new service and how it would benefit patients in hospital and clinic settings.
What is your mission and how can your services improve patient outcomes?
Our mission is to be the Next Generation EEG-focused Neurodiagnostic service provider for our partners and their patients, helping them navigate this ever-changing field. We believe we can help improve patient outcomes by reducing delays in EEG care and allowing the opportunity for patients to receive care “in place, when and where they need it.”
We are eager to embrace new technologies and develop innovative workflows that will allow us to accomplish these goals while providing the highest quality EEG and cEEG services.
Why did you decide to start offering remote EEG monitoring?
Leisha Osburn: Around 2007, my team in the Neurophysiology Department at IU Health Methodist hospital became involved in the care of a man in his early 40s who was in status epilepticus. We began EEG monitoring and treatment aimed at stopping the seizures with high doses of medications that placed him in a medically induced coma. The medications had to be kept at just the right levels—enough to suppress the seizures, but not too suppressed — through continuous recording of the EEG.
At that time, the technology involved in continuously recording long periods of EEG and video data was not very evolved. The concept of having EEG technologists available to continuously monitor the recordings of patients in the ICU like this had never been applied. We would leave the machine on to record at the bedside overnight and the nurses and physicians would check intermittently to see if the brainwaves were still relatively suppressed or if the patient had again begun to have seizures. Then, about halfway through some nights, the storage capacity on the EEG machine would fill up and they would lose the best tool in caring for the patient.
Unfortunately, this patient passed away after several weeks in the ICU. It motivated all of us to look for better tools and methods for EEG monitoring in the future.
In 2008, I pushed to gain approval for the first ICU continuous EEG program in the country that would have registered EEG technologists (R.EEG.Ts) watching the brainwaves continuously, in real-time. We launched this program successfully and because of the significant impact it had on the care of ICU patients at Methodist hospital, we soon expanded this service to Riley Children’s hospital and Indiana University hospital. It wasn’t long after, that we began providing the service remotely for other IU Health hospitals.
In 2013, I left IU Health and the idea of expanding these remote monitoring services led me to meet our COO, Amanda Ritchey in 2014. Together, with the help of a great team, we built this service successfully for another company, and left at the end of 2019 to create Next Gen Neuro, with the goal of focusing on partnerships with hospitals and other healthcare providers to provide this service with patient care and quality first, above all else.
You recently partnered with Zeto to provide remote EEG monitoring services to Zeto’s customers. Could you describe how this service works?
When Zeto customers need real-time EEG monitoring coverage from Next Gen Neuro they can notify us two ways. If the patient is already set up for the EEG using the Zeto headset, the Zeto customer will click on a service request button in the Zeto software that notifies our monitoring team immediately and monitoring can start in 30 minutes or less. Alternatively, monitoring services can be requested via email at least 30 minutes before the EEG is set to begin. In this case, monitoring will start immediately when the setup is complete.
Then, continuously, in real time, an R.EEG.T remotely views the EEG and patient video, making annotations hourly, and more often as appropriate. Most importantly, they also rapidly notify care providers of relevant EEG and clinical events, per pre-established, customer directed protocols, as they occur. EEG annotations and logs of all significant events are available immediately at study completion. Technical summary reports inclusive of a descriptive analysis of the EEG are available within 2 hours of study completion.
Will the service actually be available in real time on demand, within 30 minutes, 24/7/365?
Yes, we have R.EEG.Ts scheduled around the clock and multiple layers of redundancy built in to assure this. In addition to the technologists who are pre-scheduled to provide monitoring, we also have shift coordinators available and ready to assist within 5 minutes of add-on requests, monitoring technologists on-call, and a clinical administrator on-call, all of whom are available within 30 minutes.
Will EEG monitoring be done only by registered EEG technologists?
Yes, to be eligible for a position with Next Gen Neuro all candidates must at a minimum, have their R.EEG.T, at least 3 years of ICU and/or epilepsy monitoring unit (EMU) experience (including experience with neonatal, pediatric and adult EEG), and they must commit to obtain their CLTM certification within 2 years of hire if they do not already have this higher-level credential. They must also pass an oral competency and skills assessment as a part of the initial interview process.
Is it possible for healthcare providers to combine their own EEG services with this remote EEG monitoring service? For example, how would this work if one of Zeto’s customers wants to use their own EEG technologists only during certain hours and order remote EEG monitoring from you at times when their EEG specialists are not available.
Yes, in fact this is very common. Many of our customers have their own EEG staff to monitor during the day and only need coverage overnight and on weekends. In the example you gave, we would work with the Zeto customer during the implementation planning process to determine what times, each day, we would receive and hand off EEG patients to and from the facility.
You work with many healthcare providers. What is the most popular use case and what are the biggest benefits of remote EEG services for healthcare providers?
Generally, there are two common scenarios.
We are contacted by hospitals or physician offices to provide on-site EEG technologists after they have been unsuccessful at this due to the ongoing significant staffing shortages in our field.
Our most popular hospital use case is to provide supplemental/as-needed remote and hybrid on-site/remote coverage of cEEGs and Stat EEGs, primarily overnights and weekends. We believe the biggest benefit of remote EEG services for healthcare providers comes when there are no onsite EEG staff available to set up and perform EEGs and cEEG monitoring. That’s where we provide credentialed, highly qualified technologists, available remotely, in real-time, to perform these services and sound the alarm on any critical events or findings during the EEG.
The ASET Annual Meeting just finished! What are your career recommendations for EEG technologists?
Be a sponge and learn as much as you can. Get involved with ASET and ABRET. Seek formal and informal mentors who can encourage and support your growth in this wonderful profession. There are many areas of focus in Neurodiagnostics, both current and on the horizon. Explore them all and find your passion!
This service is available in real time upon request with a 30-minute notice 24/7/365.
SANTA CLARA, Calif., August 3, 2022 (Newswire.com) – Zeto, Inc., announced today that it now offers remote routine or continuous electroencephalography (EEG) monitoring services to its customers. At a fixed hourly rate, an accredited monitoring service provides real-time remote video EEG monitoring by registered EEG technologists (R.EEG.T) when such personnel are unavailable on-site. This service is available in real time upon request with a 30-minute notice 24/7/365, at no extra charge during nights, weekends, or holidays.
Driven by the shortage of in-house monitoring capability, this additional service has become increasingly relevant to hospitals and clinics alike to meet the need for timely, high-quality patient care. Zeto is committed to opening its EEG cloud platform for such services as remote work by medical personnel is gaining adoption.
How it works: When Zeto customers need EEG specialists, they simply click on a service request button in the Zeto software, which notifies the monitoring service immediately, and monitoring starts within 30 minutes. By choice, this service can be requested in advance. In real time, an R.EEG.T remotely views the EEG and patient video, making annotations and notifying care providers when needed.
At an affordable hourly flat rate, providers now have the choice to use this simple and quick remote service. Alternatively, providers can use the Zeto Cloud to have their own EEG technologists monitor and annotate from afar. These options are crucial steps that ensure patient needs can be met with minimal delay while complying with standard practices and documentation requirements.
“We believe this service will be beneficial for everyone, including hospitals that would not be limited by the shortage of EEG professionals and can take care of their patients as fast as needed. Patients can have an EEG recorded, monitored, and reviewed for escalation of critical findings within minutes after the doctor orders it, and registered EEG technologists across the U.S. can apply their skills, even if they are not on-site 24/7/365,” said Florian Strelzyk, Chief Sales Officer at Zeto.
In May, Zeto began offering a remote EEG physician reading service to its customers. This was made possible through a partnership with a physician-led organization dedicated to providing expert, high-quality telemedicine-assisted EEG interpretation to hospitals and outpatient settings, regardless of geographic location.
About Zeto
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, California, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century.
To learn more about Zeto’s products, including the remote EEG monitoring, please visit:https://zeto-inc.com/ or email us at info@zetoinc.com.
As with all healthcare professions, neurodiagnostic technologists struggle with staffing shortages, unpredictable situations, and caring for patients with life-threatening physiological disorders. While many healthcare roles have shortages, qualified neurodiagnostic technologists are a rare breed and positions can go unfilled for many months.
In healthcare, there are many things around you that may be out of your control, but you can control how you respond to stressors by being proactive rather than reactive.
Burnout in healthcare workers is very real and is a major concern. Recognize it before it gets worse – people are often so busy that they don’t notice they’re burning themselves out until it’s too late.
We asked Renee DeVere, MS, REEGT, CNIM, Associate Director of Customer Success at Zeto, and an experienced registered EEG technologist to share her recommendations on how to alleviate burnout. She also holds a Masters degree in Industrial-Organizational Psychology.
Self-acceptance
Don’t persecute yourself for what you are experiencing. Burnout is not a weakness, it is a physiological condition.
Take time each day to walk, stretch, and perform relaxing breathing exercises.
Eat healthily and watch your caffeine and alcohol consumption. If you’re drinking a lot of caffeine to keep going and then having an alcoholic drink to reverse it at the end of the day, your physical and mental well-being will suffer. It can be a real rollercoaster and it will affect the quality of your sleep as well.
Compartmentalize your work life from your home life; compassion fatigue is real. Acknowledge when you are feeling it and allow yourself to leave your work behind when you get home. You can have compassion for your patients without living in their shoes. Working in healthcare, you have too many shoes to fill.
Sleep
If your schedule allows you to keep the same bedtime and waketime each day, do it. Switching your sleep schedule all the time causes jet lag. Your mind and body will not perform as well.
If you are on rotating shifts or taking calls, make your sleep a quality one. Darken the room, turn off all electronics before bed, if possible, at least an hour before bed, and create a relaxing bedtime routine and a soothing bedroom environment.
Don’t forget to spend time with supportive friends and family. Share with them, but don’t turn your social time into negativity-binging time. Show others you appreciate them and make time for fun.
Set limits
In healthcare, you can’t control when the stat requests come in, when you get called, when you’re on call, or when your colleagues call in sick and leave you shorthanded, but do learn to set limits wherever possible. Sometimes, if your well-being is on the line, you need to learn when to say no and if it is appropriate to do so. If you empower yourself, you can find the line between essential and excessive.
Be efficient
Look at your workflows, processes, etc. Find out the areas where there is waste, extra steps, overprocessing, etc. Streamline your workflow to reduce redundancy and excess so that each action matters and unnecessary actions are eliminated. Work with your team and team leaders to identify and reduce waste. Promote efficiency by making sure you do not run out of materials needed to do the job and finding additional tools and resources to make work faster or simpler.
For managers of healthcare organizations, ensure that your team members have a voice, respect, and resources needed to perform their roles properly.
Technology Helps
Since 1924 when the first EEG was performed, not much has changed when it comes to picking up the signals from the scalp. Measuring the head, marking electrode locations, scrubbing the skin, applying the conductive paste, gluing down the electrodes, and eventually, tethering the patient to a box with wires – EEG technologists’ jobs involve doing all of these steps again and again.
They spend an average of 20 to 40 minutes just on the set-up. And despite the goal of helping patients, the EEG procedure often makes the patient feel sick.
Modern technology has helped make this process easier in recent years. Today, portable EEG devices offer maximum convenience without compromising the quality of the results. For the EEG techs, these devices reduce prep times (they’re easy to put on and adjust, and there’s no messy glue or wires to clean up), and for the patient, they offer increased comfort (for example, Zeto’s electrode tips are gentle on the skin).
New EEG systems are wireless, portable, easy to use, and cloud-based. Also known as rapid EEGs, these devices make EEG technology much more accessible, allowing more people to benefit from it.
EEG performed acutely for new onset of patient events and/or seizures
Designed to be started within a critical time window with the goal of triaging/treating sooner to prevent brain damage
Can be placed quickly by bedside care providers
May be in “screening-quality” category, or may be equivalent to standard EEG quality
EEGs during COVID times
The pandemic in a way drove innovative change in neurodiagnostics. When COVID initially broke out, many healthcare facilities experienced reduced onsite staffing, and EEG studies were only scheduled on-call by EEG staff. Healthcare worker burnout from COVID reached crisis levels. That’s when registered nurses (RN) started using rapid EEG solutions overnight or for acute needs while onsite EEG staff focused on continuous EEG studies.
After returning to a routine when COVID restrictions lessened, rEEG techniques remained and slowly became a part of the daily workflow at many healthcare facilities. Now RNs and other healthcare providers can perform the setup for acute needs.
Zeto’s Role in Assisting EEG Technologists
Zeto’s mission is to make neurodiagnostics accessible to more patients using the latest technologies. Even though the gold standard in obtaining quality neurodiagnostic recordings is to deploy a registered EEG technologist, there is an undeniable shortage of them in the US.
According to statistics, there were a mere 6,500 EEG technologists in 2018, with a likely need of 30,000. Throughout the pandemic, the need for EEG technologists has further increased. We believe that Zeto can help fill this gap by providing time-saving innovations with remarkable simplicity.
The Zeto team sees every day how their technology enhances EEG tech work. Modern EEG technology cannot replace EEG technologists, but it can make their job easier and less burdensome. For example, the Zeto setup process generally takes less than 5 minutes, and it is also convenient for patients because no skin preparation is required and no gel is used. Zeto allows technologists to focus on the most important parts of the EEG study – obtaining quality EEG data, scanning EEG patterns, and alerting neurologists as soon as possible when needed.
“In addition to assisting EEG technologists, wealso see a tremendous value of Zeto during triage situations where clinical necessity requires immediate neurodiagnostic testing. In many acute settings, EEG technologists aren’t physically able to arrive soon enough, and ‘time is brain’ for the patient.
In these situations, any trained healthcare professional, such as a nurse, medical assistant, or respiratory specialist, can hook up the patient using Zeto. During recording, it is necessary to know what a high-quality EEG should look like. This is where Zeto’s cloud platform becomes essential. Remotely, using a simple video tool, neurodiagnostic technologists can monitor the EEG in real-time to validate the EEG’s studies quality.
In situations where in-house registered EEG technologists are unavailable, Zeto is partnering with accredited monitoring services that provide live remote video monitoring at an hourly flat rate.
Zeto headsets can bridge the gap until more traditional EEG recordings by registered EEG technologists become available. In the past two years, we saw multiple examples of how Zeto technology helped support providers by making EEGs more accessible even under the most challenging circumstances,” said Florian Strelzyk, Chief Sales Officer at Zeto.
SANTA CLARA, Calif., May 26, 2022 (GLOBE NEWSWIRE) — Zeto, Inc., announced today that the company is now offering its customers a remote electroencephalography (EEG) reading service. This was made possible through a partnership with a physician-led organization dedicated to providing expert, high-quality telehealth-assisted EEG interpretation to hospitals and outpatient settings, regardless of geographic location.
There is a growing need for EEGs to be read in a timely manner, especially in healthcare settings when a neurologist is not on call. “Telehealth-driven technologies, such as Zeto’s EEG cloud platform, are great modern tools that allow EEGs to be interpreted quickly and seamlessly. We are delighted to partner with a board-certified EEG reader group, to cover long-term, acute (“stat”) and routine studies, and help improve patient care. The physician readers use innovative technologies, evidence-based protocols, and medical expertise to help hospitals and clinics start, expand, or improve seizure-related care. We are pleased to offer this service to our customers,” said Florian Strelzyk, Chief Sales Officer at Zeto.
As part of the Zeto Reading Service, a team of remote, certified, and specially trained adult and pediatric epileptologists provide real-time or retrospective EEG interpretation in outpatient settings across all 50 states, the District of Columbia, and Puerto Rico.
Current and new customers can request this service by contacting their Zeto account representative. Via this feature, the user can mark a study for interpretation and the platform notifies the customer-approved reader group to safely and securely read that study. Based on urgency and recording length, users are billed a flat professional reader fee and can receive their results within 24 hours.
About Zeto
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, CA, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century. The company plans to leverage its hardware and software technology to improve noninvasive monitoring of the brain’s electrical activity and achieve better outcomes for neurological conditions such as epilepsy, sleep disorders, autism, stroke and concussion.
To learn more about Zeto’s products including the reading service, please visit: www.zetoinc.com or email us at info@zetoinc.com
