  Real-time monitoring of nervous system function with immediate communication
of relevant information to the surgeon enables prevention and/or mitigation of
iatrogenic injury in many surgical procedures. The hardware and software
infrastructure and demonstrated usefulness of telemedicine in support of IONM
originated in a busy university health center environment and then spread
widely as comparable functional capabilities were added by commercial equipment
manufacturers. The earliest implementations included primitive data archival
and case documentation capabilities and relied primarily on deidentification
for security. They emphasized full-featured control of the real-time data
display by remote observers. Today, remote IONM is routinely utilized in more
than 200,000 high-risk surgical procedures/year in the United States. For many
cases, remote observers rely on screen capture to view the data as it is
displayed in the remote operating room while providing sophisticated security
capabilities and data archival and standardized metadata and case
documentation.
