Mammogram Ownership to Improve Quality of Care

September 6, 2016

Making a case for women to take control of their breast imaging.

It is technically difficult to keep patients connected to their prior mammograms. Even in this digital age of electronic medical records, with mobile devices and the Internet connecting them all together.

Why? The lack of interoperability between health data systems, combined with the migratory nature of today’s patient population – they travel for extended periods; they winter in warmer climates far from their permanent residences; and they move for career and family – making the process difficult.

Without access to a history of images, the detection and cure of breast cancer is far more complex for the caregiver. Patients and caregivers need a unified point of access to mammograms that increases accuracy in the early detection of breast cancer and reduces the need for expensive and unnecessary additional imaging, follow-up, and biopsies.

Radiologists reading mammograms outside of large academic centers are more susceptible to migratory patients who present without available prior mammograms. These radiologists are generally under more pressure to reduce report turnaround times to propagate their private practice value. The majority of mammograms in the United States are interpreted by general radiologists, who interpret mammograms as a small percentage of their overall caseload and hence depend even more on prior mammograms for confident interpretations.

Anecdotal stories are rampant with radiologists complaining of lack of prior studies being ''the biggest pain-point of their day," increasingly pressured to interpret the exam – with difficulty and frustration – without available comparison studies.

ln Jonathan Bush's book, Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care, he notes that hospitals are even "holding hostage" the prior exams and medical records, making it exceedingly difficult to produce and send out prior comparison studies, hoping this will dissuade patients from seeking care elsewhere. These hospitals feel that even unhappy patients will stay put within their system due to the difficulties in transferring their own records.

So this is when the insurance payer gets involved. After all, the lack of available prior exams hits the payer with the biggest pain point: higher false-positive recalls mean more unnecessary imaging and biopsies. [[{"type":"media","view_mode":"media_crop","fid":"51637","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1841298274173","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6364","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 238px; width: 170px; border-width: 0px; border-style: solid; margin: 1px;","title":"Kathryn Pearson Peyton, MD, breast imaging radiologist and founder of Mammosphere, currently serves as Chair of Women's Health Advisory Board at lifeIMAGE.","typeof":"foaf:Image"}}]]

Perhaps the insurance companies will incentivize obtaining prior mammograms for the more accurate interpretation – a case for value-based incentive payments? The cloud will be a powerful platform for improving access to prior comparison mammograms by providing a technical solution for secure, electronic access and exchange of prior comparison exams. Comparison exams allow for earlier detected cancer. This will significantly improve radiologists’ mammography image interpretation, thereby improving patient care while reducing societal costs.

Soon the day will come when patients are empowered, or incentivized, to own and manage their own imaging studies, much as they already do with family photo albums in the cloud. As physicians and medical records staff are increasingly overworked in the EMR/PHR world, women need to take control of the future of their own health by demanding or supplying their own prior comparison studies electronically with the push of a button.