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Bridging the Gaps

IT reduces resistance and streamlines breast imaging workflow.

A streamlined fetching solution sounds like a new method of dog training, not a component of an enterprise software system that takes images and data from disparate imaging centers and combines them into a seamless workflow. However, combining images and data from different systems is the process that many breast imaging enterprises are adopting as they look to expand regionally, comply with regulatory standards, and provide services to patients. As more facilities expand through mergers and acquisitions, they're learning how IT can bridge the gap between different systems and streamline workflow among multiple facilities and modalities while maintaining a high level of customer service.

"Women's imaging has changed dramatically over the last five years," says Dean Kaufman, principal at Healthcare Service Consultants. "There are increasing numbers of new technologies. Women are getting digital mammograms, and they're now often having other images taken with adjunct modalities at the same time."

A number of factors speak to why IT solutions are needed in the fetching, storage, and distribution of breast images from various sources. Typical digital breast tomosynthesis (DBT) studies average in size from 450 MB to 3 GB. Large files take longer to transmit and require large amounts of storage space. In addition, the Mammography Quality Standards Act classifies original mammograms and their reports as medical records. As such, a facility must "maintain mammography films and reports in a permanent medical record of the patient for a period of not less than five years, or not less than 10 years if no additional mammograms of the patient are performed at the facility."

Whether it's file size, number of prior images, or number of workstations, imaging archives are filling up, and image sharing has become more complicated.

Merging Disparate Systems The radiologists and IT experts at Baptist Health, a multihospital health system that serves south central Alabama, have a clear perspective on the need for streamlining workflow in the face of merging practices and meeting patient needs. The breast imaging services provided by Baptist Health include double reading of all diagnostic exams at one location and offering same-day reports at another location. They also welcome walk-in patients.

Like many large medical facilities, Baptist Health grew regionally through acquisition. Their women's imaging service expanded to provide more than 45,000 studies annually, operating three outpatient breast imaging centers, with image reading performed at two of those centers. What didn't come with the brick-and-mortar purchases, however, was the means to integrate the site-specific imaging workflow from these new centers into Baptist Health's existing PACS and image sharing system. The challenge was to merge workflows and, hopefully, do so with automated solutions, rather than time-consuming manual tasks.

"Unlike most organizations, Baptist Health had varying requirements for data ingestion and timely sharing across disparate locations and systems," says Greg Muller, director of business development for Laurel Bridge Software. Muller explains that Baptist Health was having difficulty accessing breast imaging priors after undergoing business expansion. Images from different centers were being stored in a centrally located PACS, but not all images were readily available in their existing electronic ordering system. There was also no electronic trigger for retrieving historic images.

Baptist Health implemented Laurel Bridge's enterprise imaging software applications for unified data identification, retrieval, and distribution across its three breast imaging centers. The system expedites the retrieval of relevant prior images; images from previous studies can be retrieved in advance of scheduled appointments or pulled on an as-needed basis for walk-in patients.

"Previously, a tech assistant would have to go into our PACS and push prior images to the right workstation," says Tina Hodge, BSRS, RT(R)(M), breast health clinical operations manager at Baptist Health. "That's a time-consuming process of locating the right images and sending them where they need to go. Now, we can have images pulled in advance for patients who have scheduled appointments or fetch images for walk-in patients when they arrive. This takes the manual process out of our workflow."

This streamlined system allows for customization to the workflow at each of Baptist Health's breast imaging centers. Hodge says their radiologists can read current images and compare with priors in about 10 minutes.

"Laurel Bridge gave Baptist Health the