Breast-center Care Anywhere: Bringing Subspecialty Expertise to the Rural United States

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Arlene SussmanAccessing high-quality radiology services in rural areas of the United States always represents a challenge, and nowhere is this dilemma more poignant to both patients and providers than in the area of mammography. Arlene Sussman, MD, director of breast imaging at Virtual Radiologic (vRad), Eden Prairie, Minnesota, says, “Imagine waiting months to get a mammogram because there are not enough specialists to go around: People in outlying areas often postpone a mammogram because it is not convenient, and local hospitals may not invest in the equipment and technology if they don’t have radiologists who are certified in mammography. The result is lack of access to screening and timely diagnosis. It’s an injustice.” The challenge is further underscored by the enhanced regulatory oversight of mammography. Congress enacted the Mammography Quality Standards Act of 1992 to ensure that all women would have access to high-quality mammography for the detection of breast cancer at its earliest, most treatable stages. These requirements, however, represent a challenge even for the best-equipped facility; a rural clinic or community hospital might lack the IT and personnel resources to meet them adequately. “The problem with mammography is there is a regulatory element, and unlike other subspecialties in radiology, it’s not only regulated, but also inspected yearly,” Sussman says. “Data need to be collated in a place that’s easily referenced and suitable for remaining credentialed in this specialty. Couple that with patients' desiring of, and right to receive, timely delivery of results, and what you need is an advanced reporting system.” Subspecialty Access for All Responding to both of these needs, vRad launched its new breast imaging program in March in order to provide mammography subspecialty expertise through a technology platform that enables regulatory compliance and rapid results delivery. “Now that we can send mammographic images over the Internet, in theory, any patient—anywhere—can access this level of care,” Sussman says. “You still need a means of reporting those results, though, and that’s what our technology does. It bridges the gap between the clinical needs and the technological requirements.” Sussman notes that as of this year, over 70% of the country’s mammography equipment has been converted from analog to digital, creating the potential for images to be read by experts irrespective of the imaging location. “It’s using digital mammography in a nontraditional way,” Sussman says. “With the right staff to support a program like this, you can allow these patients to have access to high-quality care, for the first time in their lives, in a timely and compassionate way. In this scenario, their mammograms will be turned around as quickly as if the radiologists were present in the facility.” The aim of the vRad program is to provide breast-center–level care, which means going beyond mammography to support all diagnostic breast services, including breast ultrasound and MRI exams. “If a woman feels a lump, and the standard of care includes a sonogram, we support that,” Sussman notes. “If a woman needs a breast MRI exam, we have not only fellowship-trained mammographers, but also fellowship-trained breast MRI specialists. We’re offering a full menu of services: Sites may just need us for primary mammography, or they may need us to be the primary caretaker for a diagnostic abnormality.” Platform for Care Sussman adds that because of the uniquely stressful nature of a patient’s experience when undergoing breast imaging, vRad aims to leverage its technological platform to provide care that is not only comprehensive, but also compassionate. “A mammogram has a great impact on you, as an individual,” she observes. “Any calm you may feel deserts you the minute you walk into that office, because you know that in 20 minutes, your life may change. Anything we can do to improve that experience is providing compassionate care.” Because vRad’s clinicians will be reading remotely, the company is offering what it calls virtual office hours, during which patients can use video chat to communicate with their radiologists. “When they can speak directly to our physicians, they can ask questions live,” Sussman says. “The physicians can see and assess their nonverbal behavior and address the issues and concerns they have. That really goes a long way.” Once clients of the breast-imaging service have connected their modalities and information systems to vRad’s technology platform, breast studies will be routed to the company’s MagViewTM structured-reporting system. Within 48 hours, results will be available to both referring physicians and their patients, Sussman explains. “If patients can access a computer, they can access our secure website and get their results,” she says. “Our system takes the results and tracks them, so no patient falls through the cracks—and it has the added bonus of allowing us to audit those data.” Sussman notes that the regulatory component of providing mammographic services can prove burdensome to smaller facilities. “The need is so great, but many breast facilities are closing,” she says. “They can’t function because the paperwork is so heavy, and they have no way to take care of the data they’re generating, nor do they have the physicians. This program couples the technological ability to acquire digital-mammography images with a means of reporting those results.” She concludes, “This program uses technology in a very compassionate way to deliver excellent care.”