By Kelley Allison, M.D., Breast Imaging Radiologist and Co-Chair of the Sentara Breast Program Leadership Committee
Following the FDA’s approval in 2011 of digital tomosynthesis, more commonly known as 3D mammography, hospitals and health systems across the country have entered a new era in breast cancer discovery. As with any new technology, the most critical component of successful integration begins and ends with a carefully orchestrated implementation.
Drawing from Sentara’s wide-scale adoption, here are a few lessons learned and key takeaways on how this 3D technology can be successfully introduced, tested and, ultimately, integrated system wide, resulting in swift improvements in the diagnosis of breast cancer.
Testing New Technology
Based on clinical and market research following its approval, the promise of 3D technology has been validated: digital tomosynthesis identifies more breast cancers – especially in dense breast tissue – while also making screening more comfortable for patients. But, at the time the Radiology team made their opening case for Sentara’s adoption, large-scale studies were not yet available to demonstrate and prove efficacy. However, the team convinced the hospital leadership to introduce the technology in a phased approach that would allow time to evaluate initial use and integration, compare results to national studies, and identify adjustments needed for future implementation.
For the first phase, the technology was introduced in two select Sentara hospitals based on specific criteria: each had the highest incidence of patients diagnosed with breast cancer, performed the greatest number of mammograms, and had aging mammography equipment. Sentara began offering the service to patients with a $50 co-pay, which reflects the additional time and resources needed to review the images associated with 3D mammography.
Building a Case for Full-Scale Implementation
As with any pilot program, collecting and reviewing data is key. After several months, the two pilot centers were seeing a 40 to 50 percent patient conversion rate from regular to 3D mammograms. Overall, the 3D technology was diagnosing 53 percent more invasive cancers and 35 percent more cancers and reducing callbacks by 38 percent and biopsies by 11 percent.
Additionally, by this time, national studies aligned with the pilot sites’ data and further demonstrated how 3D mammograms could improve cancer detection and lower recall rates, especially with invasive breast cancers. After presenting these positive metrics, testimonials and findings to Sentara leadership, the Radiology team gained approval to introduce 3D mammography in eight additional sites across Sentara’s network.
Emphasizing Agility During Adoption
A critical tenet of successful technology integration is conscious organizational agility. The Radiology team quickly recognized that in order to accommodate the size and number of 3D images, the bandwidth and speed of Sentara’s IT network needed to be upgraded and data storage capabilities at the breast centers had to be increased.
Another critical need included dealing with administrative challenges and training staff to adapt to new processes. As Sentara’s breast center staff began introducing and encouraging 3D mammography to patients requesting appointments, the staff had to adopt new booking processes, as well as pay special attention to workflow issues resulting from patients switching from regular to 3D mammograms. The Billing and Legal Departments also needed to coordinate new codes for the mammography exam and implement the advance beneficiary notice (ABN).
Keys to Successful Uptake
A comprehensive education program that informs both patients and referring physicians of the benefit and availability of 3D mammography technology was critical in ensuring utility and widespread success. Sentara used social media and interactive digital displays to reach patients and sent information packets and case studies to the hospitals’ key referring physicians. The Radiology team coached front desk personnel, technologists and file room staff – anyone who may have to answer a question about 3D mammography – so that all employees were appropriately equipped.
Organizational coordination and a culture that supports innovation were also essential elements for the technology’s smooth implementation across a geographically dispersed hospital network. Organizations looking to adapt this cutting-edge 3D system should plan a careful, phased introductory process to accommodate future changes needed; be prepared to invest significant time and resources; and involve and coach all stakeholders as early as possible in the process. While the integration of 3D mammography across Sentara Healthcare required a heavy amount of time and patience, what we have accomplished has significantly improved our ability to deliver better care to our patients.