Robotic prostatectomy cuts incontinence risk

Robot-assisted radical prostatectomy appears to provide better functional results for incontinence and potency, according to the authors of a study from Turin, Italy.

First author Francesco Porpiglia, MD, of San Luigi Gonzaga Hospital-Orbassano (Turin), University of Turin, and colleagues studied 120 patients with organ-confined prostate cancer who were randomly assigned to one of two groups of 60 men based on surgical approach: robot-assisted radical prostatectomy or laparoscopic radical prostatectomy. All interventions were performed with the same technique by the same single surgeon.

Demographic, perioperative, and pathologic results were recorded and compared. Continence was evaluated at the time of catheter removal and 48 hours later, and continence and potency were evaluated after 1, 3, 6, and 12 months.

No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the robotic prostatectomy group at every time point: continence after 3 months was 80% in the robotic surgery group and 61.6% in the laparoscopic surgery group (p=.044), and after 1 year, the continence rates were 95.0% and 83.3%, respectively (p=.042), as reported online in European Urology (July 20, 2012).

Among patients who were potent preoperatively and treated with nerve-sparing techniques, the rate of erection recovery was 80% and 54.2%, respectively (p=.020).

“This is certainly the strongest evidence to date [that] laparoscopic surgery done with robotic assistance is going to yield better outcomes than traditional laparoscopy,” Matthew Cooperberg, MD, MPH, of the University of California, San Francisco, told Reuters Health. Dr. Cooperberg was not involved with the study.

Dr. Porpiglia noted to Reuters Health that, “Our results depend strictly on the single surgeon and do not represent a real-life situation.”

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FDA to crash medical app development party

More than 40,000 medical apps are now available for download to smartphones or tablets, and government regulators have taken notice.

In fact, the Food and Drug Administration (FDA) crafted a set of guidelines

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How to successfully plan and implement an EHR | EHR Plans

How to successfully plan and implement an EHR

Hiring outside help, purchasing quality hardware, and getting staff buy-in all important in this phase of adding technology

Buying quality hardware, hiring outside help, and getting buy-in from the practice staff members were three of six key ingredients that helped ease challenges associated with an electronic health record (EHR) system implementation, according to primary care physicians participating in the Medical Economics EHR Best Practices study.

In a recent Medical Economics survey, 30 of the physicians participating in the study were asked to identify key factors that helped them prepare for this implementation. Although the responses varied, the study participants offered this advice:

• Hire a scribe to help with data-gathering and the creation of templates.
• Identify one main resource person at your vendor to help guide you through the implementation process.
• Research and buy quality hardware that supports the EHR. “Cutting corners on hardware is penny wise and pound foolish. The stress, service calls, and cost of upgrades more than offsets the extra cost of buying good hardware,” says Dana Simpson, MD, of Life Center Family Medicine in Summerville, South Carolina.
• Get buy-in from your staff before implementing.
• Establish a timeline to complete online training each week before implementation.
• Set up weekly telephone conference calls with the vendor’s implementation manager to discuss progress, troubleshoot problems, and answer questions.

During the implementation phase, a majority of the study participants contracted with professionals outside of the practice to help during the implementation.According to the survey, 44% of the participants contracted with an information technology (IT) professional or an IT firm, 12% hired other outside assistance, and 8% paid for assistance from a regional extension center.

More than 60% of the survey respondents report that the implementation negatively affected patient flow. And although the unanticipated costs now average $3,094 among study participants, 85% of the respondents say no out-of-pocket charges were billed by vendors.Training was cited by many of the study participants as being a crucial to implementation success, but survey respondents were split about whether their staffs were adequately trained for the EHR implementation. In contrast, nearly 63% of respondents said the doctor was adequately trained.

Only 54% of the respondents identified the practice as having a “super-user.” About 46% of the study’s respondents report that the system’s training modules did meet their expectations. (The other 54% of respondents said they did not.)

Study participants where asked whether they have been able to integrate some of the interfacing features of their systems. The results include:

Images (scanned documents)
Yes: 52%                 No: 48%

Laboratory findings
Yes: 35%                 No: 65%

Billing
Yes: 40%                 No: 60%

Scheduling
Yes: 68%                 No: 32%

Hospital interface
Yes: 0%                 No: 32%

E-prescribing
Yes: 73%                 No: 27%

Health information exchange
Yes: 8%                 No: 92%

Compliance with the Health Insurance
Portability and Accountability Act
Yes: 68%                 No: 32%

Medical equipment
Yes: 8%                 No: 92%

When asked whether software vendors met their expectations, 42% of respondents said yes, but 39% remained undecided. Another 19% said vendors did not meet expectations.

Despite some of the negative views about implementation, the majority of the survey participants report making progress in the EHR implementation, according to the Medical Economics survey.

In the most recent survey, 82% were e-prescribing and 74% were able to maintain an active medication list. Just 19% were able to implement one clinical decision support rule, and 7% were able to exchange key clinical information among providers of care and patient-authorized entities electronically (see table).

Participating vendors

ABEL Medical Software….. www.abelmedicalsoftware.com
Amazing Charts….. www.amazingcharts.com
Aprima…. www.aprima.com
athenahealth….. www.athenahealth.com
CureMD….. www.curemd.com
McKesson Physician Practice Group…. www.mckesson.com
MedNet Medical Solutions….. www.mednetmedical.com
Practice Fusion…. www.practicefusion.com
Vitera…. www.viterahealthcare.com