Statement on ElectromyographyJuly 11, 1990 (Revised April 14,1994) This Policy Statement is made by the State Medical Board of Ohio for the purpose of restating to its licensees their continuing obligations under Sections 4731.22 (B) and 4731.34, Ohio Revised Code, as they relate to the practice of electromyography. The Board has stated the same position in previous policy statements. WHAT IS ELECTROMYOGRAPHY?Electromyography (EMG) falls into two primary categories: needle electromyography testing and nerve conduction testing. Needle electromyography testing involves insertion of needle electrodes into skeletal muscles and concurrent observation of the electrical activity in those muscles by means of an oscilloscope and a loudspeaker. Nerve conduction testing is performed using the same equipment, but consists of surface stimulation or needle stimulation of peripheral nerves with an evaluation of the motor and/or sensory action potentials produced. The purpose of both categories of electromyography is to detect abnormalities of the peripheral neuromuscular system or to determine the extent and degree of recovery of neuromuscular abnormalities -- that is, to diagnose. IS ELECTROMYOGRAPHY THE PRACTICE OF MEDICINE?Section 4731.34, Ohio Revised Code, defines the practice of medicine in the State of Ohio and provides, in part: A person shall be regarded as practicing medicine, surgery, podiatry, or midwifery, with the meaning of sections 4731.01 to 4731.60, inclusive of the Revised Code . . . who examines or diagnoses for compensation of any kind, or prescribes, advises, recommends, administers or dispenses for compensation of any kind, direct or indirect, a drug or medicine, appliance or cast, application, operation or treatment, of whatever nature, for the cure or relief of a wound, fracture or bodily injury, infirmity or disease. Electromyography is an extension of the history and physical examination and must be considered only in the light of the clinical finding. The person performing electromyography must be able to elicit the pertinent history and perform the necessary examination to define the clinical problems. Differential diagnoses must be considered, and as abnormalities unfold or fail to unfold during the course of testing, the electromyographic procedure may be modified until a probable diagnosis is reached. Results of electromyographic examinations are used for recommending surgical procedures, and for determining the absence of disease with most serious prognoses. In fact, there may exist no better example of an examination or diagnostic procedure fitting within the definition of the practice of medicine in Ohio. CAN ELECTROMYOGRAPHY BE DELEGATED TO A NON-PHYSICIAN?Though electromyography may appear somewhat similar to electroencephalography (EEG) or electrocardiology (EKG) testing, which involve recording techniques and are routinely delegated to non-physician technical personnel supervised by specifically trained physicians for later interpretation by those physicians, the electromyographic test procedure itself differs from them as it does not follow any stereotyped pattern. For example, in assessing a patient with a possible lumbosacral radiculopathy the needle electromyograph consists of examining muscles of the back, pelvic girdle, and lower extremity innervated by the various lumbar and sacral nerve roots; but the specific parameters of the procedure vary greatly from patient to patient. Although there may exist a relatively routine pattern of muscles to be examined, the number of areas to be examined in each of these muscles, the need to examine other muscles, and not infrequently, the need to examine muscles in other areas of the body depend entirely on the patient’s history, symptoms, clinical findings at the time of examination, and electric potentials demonstrated as the test proceeds. It is impossible to formulate standard electromyographic test procedures for the non-physician to carry out. Needle electromyographic testing also differs from EEG or EKG testing with respect to the mechanisms utilized for the display of test data. Because of the high frequency electrical potentials demonstrated during the electromyographic testing direct writing mechanical devices cannot be used to preserve the results. The primary display mechanism is a cathode ray oscilloscope, which must be continuously monitored by the individual doing the procedure. In addition, the sound of the electrical activity displayed on the oscilloscope, as reproduced by the loudspeaker at the same time, can be vitally important. Even if a standard electromyographic test procedure for non-physicians could be developed and adequate recording devices existed for preservations of the oscilloscope displays and concurrent sounds, it must be remembered that the electrical activity displayed depends on the examiner’s actions at a given moment. The exact depth and precise location of the electrode tip must be known in relation to the oscilloscope display and the loudspeaker’s sounds. Simply stated, needle explorations can no more be standardized than the test procedure itself. Although the surface electrode placement and nerve stimulation in nerve conduction studies may be performed by a non-physician technician and the results recorded, that individual must be supervised on-site by a specifically trained physician who can interpret the results into a diagnosis. Even nerve conduction studies involve interpretation of factors such as spread of stimulus, volume, conduction of muscle action potentials, and the alteration of neurophysiological phenomena by the patients’ pathologic states. The impossibility of standardizing electromyography, which includes needle explorations and nerve conduction testing, and the need to consider or reach differential diagnosis during testing itself prevent delegation to non-physicians. In summary, it is the position of the State Medical Board of Ohio that:
Statement on Electromyography |
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