The new IONM supervision “guideline” asserts that routine phone-based communication with the surgeon and other members of the operating room team meets a minimum expectation, but offers no supportive empirical evidence. Crucial surgeon and anesthesiology stakeholders were not consulted. It does not conform to Institute of Medicine standards; it does not provide systematized evidence, benefit/harms analysis, or disclosure(s) of potential conflicts of interest with the remote monitoring industry. Therefore, by Institute of Medicine criteria, the article is not a guideline. Unfortunately, the literature demonstrating that optimized operating room collaboration avoids surgical errors has been ignored. The telemedicine literature recommending enhanced audiovisual connectivity in high risk environments like the ICU and during teleStroke care has been excluded. The new guideline may be interpreted as a license for maintenance of the status quo, thereby inhibiting the adoption of new technologies that have the potential to elevate the quality of remote monitoring. Although “communication” and “collaboration” and “patient care” are rhetorically supported, no effective mechanisms are described to realize these patient-centered goals. Effective communication within multidisciplinary teams does not start and end with a case. It is increasingly acquired over years of collaborative work. The new “guideline” appears to be chiefly aimed at protecting the business model of the remote monitoring industry. Surgeons, hospitals, payers, and the broader IONM community may wish to assess the implications of its many flawed premises 2).