Mammography Information Systems
By Kathy Hardy
Vol. 13 No. 11 P. 28
Breast imagers face a challenge to keep up with regulations and improve workflow.
Keeping up with evolving standards and regulations while leveraging IT to simplify and streamline mammography workflow is a challenge for the increasingly digital breast imaging community. For example, the capability to generate automatic notifications is a plus as breast imaging standards continue to evolve and new issues such as dense breast notification add to facilities’ tracking demands.
From gathering patient history through imaging and reporting to follow-up care, notification, and follow-up scheduling, breast imaging professionals are looking for new capabilities in IT. This article looks at a new entry in the mammography information system (MIS) arena and updates from several well-known MIS systems.
With integration as its goal, earlier this year Viztek introduced the Opal-Mammo Women’s Healthcare Suite, which combines PACS and tracking software in a Web-based mammography viewer with linked tracking software, eliminating the need for a separate workstation. According to Steve Deaton, vice president of sales, this is the first solution in the marketplace that combines a Web-based mammography viewer with linked tracking software.
“Opal-Mammo is a tightly integrated system,” he says. “It’s unique in that it ties together the different interests of radiologists and technologists along with the triggers built within the tracking software that manages patient follow-up protocols and follow-up letters.”
On the viewing side, this system features a multimodality mammography viewer. On the IT side, the system’s PACS can be integrated with customers’ existing EMRs, helping streamline patient management.
As Deaton explains, once a woman undergoes a mammogram, traditionally a radiologist views the images and dictates a report. Reports are gathered, and individual radiologic technologists usually manually coordinate the transcription and tracking process, from which they act in accordance with protocols regarding follow-ups and patient notification. This process can be overwhelming and time consuming. It also leaves the process open to the potential for human error.
“Many practices are still tracking their mammography patients on paper or in Excel spreadsheets,” Deaton says. “In the field, we see technologists reading and digesting radiologists’ reports and then starting their own information management from there.”
Opal-Mammo automates the process, he says. “It’s like a domino effect,” he says. “Once the mammogram is performed, the radiologist goes to the view to see the images. From there, the tracking software is launched. Once the radiologist is done, the next steps are more automatic. It’s all in the software.”
The system’s tracking software component reduces the chance of oversight and allows practices to establish rules for patient follow-ups. In addition, Web-based dictation and voice recognition allow physicians and staff to create reports from any Web-enabled location.
Opal-Mammo’s turnaround time (TAT) management feature consists of a custom dashboard that uses color coding and reviews time parameters to manage priority levels for patients. The offering also fully complies with the Mammography Quality Standards Act (MQSA).
“With a dedicated viewer and reporting system, radiologists have the ability to start declaring different triggers as they review a patient’s breast images,” Deaton says. “In addition, the software includes BI-RADS quality controls for consistency in reporting.” Overall, “Opal-Mammo ties together the mammography process.”
Tracking items that are presented to the radiologist while reading images and dictating findings include BI-RADS assessment and recommendations, breast density, calcification, and geometry selection and biopsy protocol selection. “The tracking aspects of the software are transparent to the person reading the mammogram,” Deaton says.
In addition to the day-to-day mammography functionality, the system can draw information from a patient’s earlier mammograms or biopsies and link them to the current event as well as any future scheduled events. This helps to prevent any protocol breaks between visits, Deaton says.
“Maybe a patient’s previous visit was never closed out,” he says. “You think you followed up with the patient, but you might not have. You can have hundreds of BI-RADS 2s to work through. Opal-Mammo closes up loose cases. There’s no dirty laundry list. It’s like a no-woman-left-behind product.”
In answer to the system integration question, MIS vendor PenRad offers PenView, a reading station that can integrate breast MRI, ultrasound computer-aided detection (CAD), and PenRad’s patient care workflow and full MIS reporting. Dan Bickford, executive vice president of sales and business development for PenRad, says the company offers this option to clients but says its MIS also will interface with clients’ existing workstations.
“We’re continuing to work toward providing a one-stop offering, but if a client has a workstation they like, we can work with that as well,” he says.
PenRad’s MIS touts complete integration with the entire patient care workflow infrastructure, including mammography, MRI, ultrasound, and PACS.
“Physicians access images through the PACS,” Bickford says. “If they find something negative, one mouse click triggers the proper follow-up letters and notices, which are prepared in the background. On the front end, the physician has moved on to the next patient. The system autoloads the next patient’s information for viewing. Physicians and technologists don’t have to worry about reporting and letters. That’s done for them.”
On the tracking front, PenRad Trac helps to standardize the mammography process with patient tracking and MQSA reporting. Overall, the process enhances patient care workflow by automating the management of patient recalls and reminders, letter generation, and maintaining statistics.
With standardization also comes a level of customization, dependent on what clients are looking for in their reporting. Bickford says the PenRad offerings can be tailored based on customer feedback, making them adaptable to myriad unique workflows. Specialized features can be turned on or off as needed.
“Workflows vary from doctor to doctor within a practice as well as among different imaging centers,” he says. “PenRad’s autoreader feature takes dictated reports and extracts the pertinent information without technologists having to manually pull that data.”
Flexibility also allows for the incorporation of BI-RADS updates and features, such as dense breast notification, which Bickford says PenRad addressed by integrating Volpara breast density assessment software in its offerings.
When it comes to quality tracking, PenRad offers clients a digital system that automates the process of calculating quality assurance/control data for digital breast imaging. PenRad DQC tracks all full-field digital mammography, MRI, and stereo modalities, as well as reading workstations, based on guidelines established by the device’s manufacturer and/or MQSA. Tracking is done enterprisewide, with data stored in a centralized location.
“This data can then be used to produce instant MQSA reports for audits and inspections,” he says.
The MagView tracking and reporting system, with its basis in the ACR, focuses on the nuances of mammography regulation while integrating with a facility’s RIS.
“The majority of RISs function in the same way as an MIS when it comes to scheduling and billing, but mammography is so regulated and always changing,” says Jon Morris, vice president of sales and marketing for MagView. “It’s tough to take a multipurpose solution and apply it to fit those specific needs.”
MagView was developed by the ACR to implement the ACR BI-RADS method of standardizing mammography reports. With that, MagView is designed with an algorithm that creates BI-RADS-complaint reports along with MQSA reporting, notification, and outcome tracking.
With its focus on mammography tracking, MagView follows patients from their initial screening mammogram through breast biopsy and subsequent follow-ups. The system functions as a hospital’s or imaging center’s mammography model of its RIS. The two systems work closely together, with information flowing through the MIS while also stored back into the RIS.
Customization is an important part of the MagView system. Morris points out that while BI-RADS regulations make alterations difficult to incorporate into MIS processes, there are areas where facilities can implement their own unique features.
“Each site has different wording they use in their letters,” he says. “Every physician wants their reports formatted a certain way, all within the BI-RADS regulations. There are no two MagView systems in operation that are set up the exact same way. Every workflow at each breast center is different, and we can adapt for that.”
MagView’s composition also allows for customization within an organization to adjust to the varying needs of individual radiologists.
“By making changes to suit each radiologist within a practice, you can make them more comfortable with the system,” he says. “They are under so much pressure to get so much done in a short amount of time that making users comfortable helps to put them at ease.”
Flexibility in the software also comes into play as new regulations and requirements are implemented. For example, breast imaging facilities in five states—California, Connecticut, New York, Texas, and Virginia—need to consider including automatic notifications for women who are found to have dense breast tissue. These states have passed dense breast tissue notification legislation; however, each state’s legislation requires imaging facilities to share slightly different types of information related to a woman’s dense breast tissue. An automatic notification system must address those nuances.
“Our software is based on an open architecture that enables us to incorporate any fields of data into a client’s follow-up letters,” Morris says. “The same is true with our reporting features. We may not have the change incorporated immediately, but we can fast track it.”
MIS vendors also are looking to qualify for certification as EHR technology under meaningful use criteria. Morris says MagView is the first MIS vendor to receive EHR certification.
“Going forward, we’re constantly looking two or three years ahead,” he says. “Best practices today will be replaced two or three years later.”
The company’s MRS7 Reporting system specializes in tracking and reporting systems for all breast-related procedures. According to Mark Morris, president and CEO of MRS, the company has a particular focus on the high-risk aspect of breast screening.
“We did some heavy development over the past four or five years to bring in high-risk screening functionality,” he says. “We incorporated a risk algorithm into the software that reviews the patient’s record for information such as family history and dense breast tissue, which may classify them as being at high risk for breast cancer.”
The system has a dashboard for high-risk factors that displays indicators calculated using the American Cancer Society’s Gail and National Cancer Institute lifetime models, the Myriad Prevalence Table for BRCA genes from Myriad Genetics, the optional Tyrer-Cuzick Breast Cancer Risk Evaluation from Cancer Research UK, and the MRS Risk Manager. Radiologists then can view the patient’s risk percentages for each given model and use that information in their overall assessment and recommendation process, Mark Morris says.
“Based on clinical data entered into MRS, women can be identified for genetic testing or a need for MRI for further screening,” he says.
Different statistical models can be added to the dashboard as they become available, he adds. For example, the Dana Farber BRAC model is expected to be added by the end of 2012, according to Mark Morris.
“There weren’t that many models available at the beginning,” he says, “but as more are developed we revise our software. The algorithms aren’t stagnant either. It always helps to refine the existing models.”
MRS also has the capability to integrate and interface with a large number of vendors, creating the ability to offer more tailored and flexible solutions, with the ultimate goal of easing workflow. MRS works with several vendors to create the most seamless process possible. For example, by teaming with Volpara and Hologic’s Quantra Volumetric Assessment software, MRS provides automated information regarding a patient’s breast density status. That information then is automatically included in the report and, if dense breast tissue is detected, the system generates the proper letter to be sent to the patient.
“Our system allows for a number of options,” Mark Morris says. “For example, only some of our clients offer genetic counseling, so we give those facilities the tools necessary to complete that type of reporting. We recognize that everyone’s workflow varies and can put together a package that meets individual needs.”
From a quality control perspective, an automated system helps to reduce the human error aspect of matching images to patients and issuing the proper follow-up letters and reporting, he says. Users can enter queries for particular patients, see their histories, and enter any updates.
Finally, when it comes to business intelligence, Mark Morris says imaging centers with multiple sites can use MRS to gather patient statistics from each location. “Radiologists can perform data analysis of statistics gathered from each location for comparison purposes and other uses,” he says.
While the technology used to create more detailed breast images continues to advance and refine breast cancer screening and diagnosis, so too does the technology that brings together the data collected throughout the process.
“We all want to end up in the same place,” Jon Morris says. “We just have different ways to get there.”
— Kathy Hardy is a freelance writer based in Phoenixville, Pennsylvania. She is a frequent contributor to Radiology Today.