The Situation
The quality of a mammogram exam is determined mainly by two elements: 1) the quality of the images (which is determined by the quality of the imaging device & skill of the technologist doing the positioning, compression, etc.) and 2) the quality of the interpretation of the images (determined primarily by the training and experience of the reading radiologists)
Only 10% of all radiologists are “breast imaging specialists.” 61% of all radiologists interpret mammograms, while the majority of screening mammograms are read by general radiologists (70%) with no subspecialized training in breast mammography, This lack of specialized training often leads to greater likelihood for misdiagnosed cases.
Specialized breast radiologists detect more cancers and more early-stage-cancers, recommend more biopsies and have lower screening recall rates than general radiologists. Breast radiologists detected 6.0 cancers/1000 women screened vs. general radiologists detected only 3.4 cancers/1000 women screened.1
1Sickles EA, Wolverton DE, Dee KE Performance Parameters for Screening and Diagnostic Mammography: Specialists and General Radiologists. Radiology 2002;224(3): 861-869.
The Opportunity
Most OB/GYN practices do not currently offer Mammography as a service. Patients are usually referred out to a diagnostic center or general radiologist.
OB/GYN practices can expand their business if they provide Mammogram screening as part of their services. By doing so, these OB/GYN practices can provide additional value add services, improve patient care, and advance overall women’s health.
However, it is crucial that a first-rate breast specialist was associated with the OB/GYN practice; a high caliber breast expert should be doing the diagnostic reading.
The Customer
MemorialCare Breast Center at Saddleback Memorial in Orange County, California, a national leading breast center, wanted to improve the odds of breast cancer screening, and offer this service for OB/GYN practices. A facility devoted to winning the battle against breast cancer, the center is equipped with state-ofthe-art imaging equipment including digital mammography and is recognized as a Breast Imaging Center of Excellence by the American College of Radiology.
The center is strictly dedicated to breast care, employing breast imaging specialists, who by definition are radiologists who define their primary specialty as breast imaging. Led by Dr. Gary Levine1 , who is the Medical Director of MemorialCare Breast Centers, and is an Associate Clinical Professor of Radiology at USC Keck School of Medicine, he and his other two fellow radiologists are fellowship trained in breast (only 21% of breast imaging specialists) and spend all of their clinical time doing breast imaging (only 59% spend more than half of their clinical time doing breast imaging).
1Dr. Gary Levine has served on the Board of the Orange County Radiologic Society, is presently on the Board of Trustees and is the President of the National Consortium of Breast Centers and is the former Chair of the Steering Committee of the American Society of Clinical Oncology (ASCO) – Breast Program. He serves on the Board of the National Accreditation Program for Breast Centers. Dr. Levine lectures nationally and internationally and was recently a speaker at the World Congress on Breast Disease, American Society of Breast Surgeons, American Society of Clinical Oncology and National Consortium of Breast Centers. He has authored peer reviewed medical journal articles, book chapters and appears on TV as a medical expert in the field of breast cancer.
The Challenge
In order to provide access to the center’s breast reading expertise, MemorialCare Breast Center needed the technological infrastructure to create a remote reading situation for outside facilities lacking their resources. As a long-time successful user of Candelis and Hologic products, MemorialCare Breast Center at Saddleback Memorial knew they could harness the Candelis engineering to create a flawless system interface.
One of these outside facilities was Southwest Contemporary Women’s Care, an OB/GYN practice based in Phoenix, Arizona (while MemorialCare Breast Cancer was based in Orange County, California), Candelis enabled the IT infrastructure needed for a remote reading situation to be created via 3 main elements:
- HL7 integration between Site’s EMR and SecurXchange for Modality Worklist (MWL)
- HL7 integration between Site’s EMR and SecurXchange for inbound report
- VPN connection between OB/GYN facility and Dr. Levine’s facility
The Solution
After a six-month process from decision to move ahead, the site was up and running including modality procurement, installation, staffing, integration, and testing among five different vendors and systems, Southwest Contemporary Women’s Care’s site in Phoenix, Arizona was connected with MemorialCare Breast Center ensuring that any mammograms done at the Phoenix site could be read and interpreted by MemorialCare Breast Center in Southern California.
The intricate configuration included the assurance that inbound orders from the site’s EMR were received, processed, and populated to the modality’s MWL, the images produced by the modality could be read and interpreted in the reporting module in another state, and upon completion of the reading, the procedure would be billed from the Phoenix facility. Southwest Contemporary Women’s Care bills for the exam while MemorialCare Breast Center bills for its professional services.
Additionally, Candelis set up its ASTRA Plus cloud solution to retrieve Priors from Simon Med, a nearby facility. When Southwest Contemporary Women’s Care needs prior images from Simon Med, it can just send them the prior – no CDs needed. When the exam is complete, that study can go back to Simon Med. This seamless movement of exams is done via VPN, while the Reporting is done live in Phoenix.
The interface between the two systems required both inbound and outbound orders with Candelis IT acting as a hub for system communication.
The Results
With the system firmly in place, the opportunity to provide more convenient and higher quality care for patients is now available.
“It is a win-win for both patients and for OB/GYN practices because breast care specialists can now interpret your studies, not general radiologists,” said Dr. Gary Levine of MemorialCare Breast Care Center.
“It also allows an outside/rural community to benefit from high quality dedicated breast radiology,” he added.
Additionally, from the patient perspective, health care is even more optimized since it is more convenient to have a screening mammography done at the OB/GYN’s office on the same day a patient gets her pap smear done, rather than schedule another day to visit an outside radiology facility.
“Southwest Contemporary Women's Care is proud to offer our patients the latest 3D mammography screening in a convenient, comfortable, private setting within our Tempe office. Patients are now able to conveniently complete an annual exam, labs, and their annual screening mammography all in a morning or afternoon, limiting their time away from work, family or other responsibilities,” added Dr. Kim Balk of Southwest Contemporary Women's Care.
“Because we are producing high quality images and these images are being interpreted by experts in the field, we know we have optimized breast care for our patients and in our community. Additionally, we have forged relationships with diagnostic imaging centers and breast surgeons in our community which allows for any required diagnostic workups and surgical consultations to be completed in a timely and efficient manner. Our patients receive diagnoses and answers more quickly, eliminating much of the time that they would otherwise be worrying about the unknown. All of this improves and raises the quality and standard of breast care provided to the patients in our community,” Dr. Balk added.
