Bringing student health and Well-Being onto a health system EHR: the benefits of integration in the COVID-19 era.

ObjectiveTo detail the implementation, benefits and challenges of onboarding campus-based health services onto a health system's electronic health record.ParticipantsUC San Diego Student Health and Well-Being offers medical services to over 39,000 students. UC San Diego Health is an academic medical center.Methods20 workstreams and 9 electronic modules, systems, or interfaces were converted to new electronic systems.Results36,023 student-patient medical records were created. EHR-integration increased security while creating visibility to 19,700 shared patient visits and records from 236 health systems across the country over 6 months. Benefits for the COVID-19 response included access to screening tools, decision support, telehealth, patient alerting system, reporting and analytics, COVID-19 dashboard, and increased testing capabilities.ConclusionIntegration of an interoperable EHR between neighboring campus-based health services and an affiliated academic medical center can streamline case management, improve quality and safety, and increase access to valuable health resources in times of need. Pertinent examples during the COVID-19 pandemic included uninterrupted and safe provision of clinical services through access to existing telehealth platforms and increased testing capacity.

Transverse versus vertical camera port incision in robotic radical prostatectomy: effect on incisional hernias and cosmesis.

OBJECTIVE: To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate. METHODS: Of 900 consecutive RARPs, the initial 735 had a vertical and subsequent 165 transverse incisions. Two methods were used to identify IHs: clinic visits noted in the prospective database and screening using electronic mail. We compared the baseline factors between the vertical IH and IH-free cohorts. The maximal scar width was recorded in 178 consecutive men presenting to our clinic: vertical (n=107) and transverse (n=71). RESULTS: IHs occurred significantly more often after a vertical incision (5.3% vs 0.6%, P=.005). The IH rates after a vertical incision could be estimated to be as great as 16.7% (18 of 108) using the electronic mail respondents or as low as 3.3% (21 of 627) according to clinic follow-up. On univariate analysis, baseline age, International Index of Erectile Function 5-item questionnaire, prostate weight, bother score (all P≤.05), and body mass index (P=.058) were associated with an increased risk of an IH. After adjusting for baseline factors on multivariate logistic regression analysis, the relative odds of developing an IH with a vertical versus transverse incision was 11 (95% confidence interval 1.5-82). The average maximal scar width was reduced from 5.5 to 2.0 mm (P<.0001). CONCLUSION: In the present sample population, the vertical IH rate was estimated to be potentially as low as 3.3% or as great as 16.7%. On multivariate analysis, a greater body mass index and larger prostate size significantly increased the risk of hernia development. Transverse incisions dramatically reduced the rate of IHs and the maximal scar width. The IH rates varied significantly by reporting method.