Innovation for Pelvic Health

Every year, whether the subject is healthcare,  industry,  or personal lifestyle, you hear the famous phrase Do more with less. How is it possible to gain more out of something with fewer resources? In our everyday lives everything is becoming more expensive, and we see how we are getting less for the same money. When someone asks you to turn the tide and do more with less, you have got to think this request is completely unreasonable! Doing anything impacts the time, people, and efficiency that relate to productivity. Certainly we can try to improve patient processing to improve efficiency, but is it enough to demand more work to be done in less time or at less cost? Processes in patient care and management can do only so much, and once they are optimized, what is left to consider?

Technology, however, is the magic enabler that  facilitates new f orms of productivity that could never be achieved before.  Some naysayers may cite the paperless society predicted with widespread use of computers, but somehow I think the pulp and paper industry has continued to flourish because of the proliferation of printers attached to personal computers. Technology, when used appropriately, can have marvelous effects on productivity, and it can even allow many new scientific opportunities to flourish. While the computer has not managed to cut down on paper use, the goal of reducing paper consumption remains. Hospitals must continue to coordinate their electronic medical record (EMR) initiatives in order for productivity gains to be realized.

At LABORIE we are already seeing some benefits of having our urodynamic and ultrasound equipment interface directly to computer networks. This allows reports to pass into patient records faster and without errors. Authorized physicians can access diagnostic test results anywhere that there is a computer terminal or access to the Internet (at the hospital, clinic, office, or home). Soon this accessibility will come to popular PDAs (personal digital assistants) such as Blackberries and iPhones. While physicians are always in need of these records, patients themselves will also be able to access them and monitor their own progress during treatment.
The equipment itself is changing to better accommodate the realities of busier clinics. Treatment rooms are valuable real estate (and they are not that big to begin with). Equipment that is smaller and offers better layout possibilities (e.g., with wireless connectivity) helps in making sure that the tools of medicine do not interfere with the practice of medicine.

In addition, we are looking at integrating different diagnostic modalities and conservative treatment solutions so that more can be done in the same space. Consider for a moment a patient who requires urodynamic evaluations and ultrasound imaging as well as biofeedback treatments: the possibility of doing this in one session without equipment being wheeled in and out of a small room is starting to exist. Although multiple tests performed in sequence are not always needed, what sense does it make to have multiple carts, monitors, printers, and keyboards in the room when one workstation will suffice? It actually might make operation of the equipment easier when a common control philosophy can be applied to multi-use devices.

Going beyond pressure measurement and catheterization to obtain new diagnostic information is always a plus. We are just scratching the surface on NIRS (near infrared spectroscopy) technology when applied to urologic measurements. Using a special laser patch system, the Tetra bladder-monitor system can provide insight on bladder behavior through measurement of oxygen intake (as indicated by oxyhemoglobin levels) by the detrusor muscle. This measurement may not be a direct correlate to bladder pressure, but it gives clinically valid information about bladder activity during both storage and voiding phases. Tetra uses abdominal patches rather than catheters, thus saving time and improving patient comfort. The information gleaned from NIRS measurements is informative and augments the data received from simple uroflowmetry alone. This information can reduce the guesswork on whether or not complex urodynamics is appropriate for a particular patient.

But technology does not stop there. Ways of measuring bladder pressures (the goldstandard parameter in complex urodynamics) have become quicker to implement without sacrificing the clinical value of the diagnostic information. Air-charged catheter technology (as opposed to water systems) has reduced set-up time, so more time can be spent in testing rather than preparing a patient.

In cases when urodynamics testing does not seem to validate patient symptoms, the option of taking urodynamics offline with ambulatory Holter systems can come into play. New urodynamics systems will be convertible so that, rather than having the patient disconnected from in-lab equipment and then connected to separate ambulatory equipment, the patient will simply get dressed and walk out of the treatment room for a few hours while data recording continues on patient-worn devices.

Once again, taking the guesswork out of the equation saves time and informs important decisions on appropriate followup diagnostics or treatment. Whether the goal is to figure out how to better manage the increasing patient load of a clinic, or to plan a flexible and efficient diagnostic process that self-documents and finds answers needed for the design of treatment, technology plays a big part in how we can do more with less.  And even if you do not need to do more with less, but would just like to apportion more of your time to direct patient care or to medical research rather than medical administration, it is still a noble objective.