A Telemammography Dynamo Rides New PACS from the Deep South to Boundless Frontiers

Eight years ago, Women’s Imaging Associates in Birmingham, Ala., was a small, well-respected mammography practice serving six OB/GYN offices in its area. Today, having embraced a 100% telemedicine model, its three fulltime breast specialists read images for 22 client facilities scattered around the U.S.—not only OB offices but also outpatient imaging centers and hospitals large and small. The practice is licensed in 25 states (so far). It has expertise in every 2D and 3D modality. And it even consults for breast centers looking to launch or expand services.

For Caroline Reich, MD, PhD, the group’s founder, president and CEO, the journey has been rewarding at every step even when the challenges have seemed as sizeable as the opportunities.

“Over the last few years, as we moved to expand beyond our in-office OB client base, we realized there were some technology components that we needed,” Reich says, adding that one such item was as basic as airtight assurance of HIPAA compliance. “We found ourselves increasingly challenged to keep up, because we had to be absolutely sure that there could be no [unintentional] cross-communication of patient information between our growing number of client facilities.”

With that realization, Reich began contemplating replacing the practice’s PACS even though it was only a little over three years old. Soon other reasons to go shopping began to surface. Not least among these were the image-handling demands of burgeoning 3D digital breast tomosynthesis, the radiologists’ mammography-specific preferences on workflow-related particulars such as hanging protocols and—on the growth-opportunity side—the practice’s chance to add a large, urban academic medical center to its client roster.

Last year Reich and colleagues completed the selection process, settling on Sectra PACS. Their first client site came online with it in February and, by May, all 22 were up and running. That includes the academic client, the University of Alabama at Birmingham (UAB) Hospital. Reich is particularly delighted with this development, as it will likely lead to collaboration on research. (Her PhD is in neuroscience and her initial career plan was to work as an educator-researcher.)

Looking back now, Reich realizes that the Sectra PACS installation represents a vital turning point in the unfolding success story that is Women’s Imaging Associates. She walked imagingBiz through some of the details in a recent phone interview.

Advanced-visualization powerhouse

Being a teleradiology company that works with multiple sites—and so having no influence or direction over the sites’ equipment selections—Women’s Imaging Associates needed viewing software that was truly vendor-neutral, Reich recalls.

“Not all viewing software is created equal,” she says. “A lot of vendors have recently added tomosynthesis, for example, without really testing it. I had already been the guinea pig for one company, and I was looking for somebody who really had tomosynthesis viewing software that was in use, that was tested, that was proven and efficient.”

And then there was breast MRI. “For several years I had been asking around, ‘Doesn’t somebody have the ability to do the [optional but hugely helpful] CAD processing for breast MRI within their viewing software?’” She felt it shouldn’t matter who was sending images to Women’s Imaging Associates; the radiologists wanted the ability to do all CAD processing internally, at their own viewing stations, rather than logging on to their clients’ systems.

Sectra’s MRI Breast application is one piece of the company’s advanced-visualization application. It’s tailored to specific MR image-interpretation scenarios, according to materials supplied by the company. It features all sorts of efficiency-improving helps, from auto-selection of relevant image series to 3D lesion-localization diagrams to motion-subtracting image enhancement.

Reich says the application makes work faster and easier not only for the radiologists but also for their clients. “If they want to move into breast MRI, they can just buy the coils. They don’t have to buy CAD software or anything else,” she says. “They just send the images to us and we do all the processing for them. This saves them money and makes us more efficient. The CAD feature was huge for us in picking Sectra in the first place.”

Additionally, Reich points out, Sectra PACS gives breast radiologists a means of comparing and contrasting images from mammography, breast MRI and breast ultrasound all together, all at once. “Having one workstation to read all our images,” she says, “tremendously enhances our efficiency as well as our interpretive accuracy.”

Here comes a good problem to have

Reich says she’s grateful for the February-to-May transition of all 22 Women’s Imaging Associates clients being a “fairly benign” experience.

“Because none of the technologists who acquire the images and interact with the PACS at the sending sites are our employees, it was important that we wouldn’t burden them with a lot of extra work,” she says. “That wouldn’t lead to healthy, long-term relationships.”

The feedback from techs has so far has been very encouraging. “They tell us the Sectra PACS is much more intuitive” than what they’d been using before. It also has greatly reduced the number of calls the Women’s Imaging Associates’ PACS administrator gets from techs checking to make sure the images they sent did, in fact, reach the practice.

“One of the problems now is that we no longer hear from our techs as much as we’d like to,” Reich says, chuckling. “It used to be that they were calling us often due to images seeming to get lost during transmission, and now it’s so rare for them to call.”

Many technical issues, she adds, “seemed to just go away when we installed Sectra.”

The improvements aren’t merely matters of convenience. Reich says her former PACS had been increasing her payroll expenses. “I had to have a person manage all the little peculiarities that it could not manage on its own,” she explains. “A lot of those manual interventions have stopped. We were able to cut out half a fulltime salary, and our administrative staff has been freed up to do things that help us move forward rather just babysit the PACS.”

A solution to a shortage

Women’s Imaging Associates has also unleashed its boosted fiscal confidence to beef up its technology toolbox. “We’ve invested in the Barco 12-megapixel color monitors, which are the Cadillac of monitors, to go with Sectra, which is the Ferrari of viewing software,” Reich says.

The idea, she says, was to give her radiologists—present staff as well as future recruits, growth permitting—the best systems possible to read from.

“That’s not trivial, because right now there’s a shortage of breast imagers around the country,” Reich says. “In fact, it’s this shortage that is opening up opportunities for us to work at places like academic medical centers.”

Meanwhile new doors are opening for the rads of Women’s Imaging Associates to serve more women who need topnotch breast imaging, wherever they may be.

“We’re providing radiologists with tools that make it easy for them to do their job,” she says. “They don’t feel like they are fighting with their computer to dictate a report”—Sectra PACS incorporates productivity aids like embedded voice recognition and blazing fast image transfer regardless of dataset size—“and all the tools are now working together seamlessly. Our radiologists are very happy.”

Radiologist productivity is key, Reich explains, since the practice has no control over fluctuations in patient volumes at client sites: The more productive the rads, the more time they have to pursue new clients.

From Alabama to everywhere

And their future is very bright. Reich says Women’s Imaging Associates now has the technology in place to serve breast-imaging clients in every setting and, eventually, if the pieces fall into place, in every state. One of the practice’s client hospitals is a critical-access facility in Washington state, adding heft to her vision of providing breast radiology wherever and whenever it’s needed.

Confident in her blossoming partnership with Sectra, Reich is ready to add new sites and quickly solve any technical hurdles that may pop up. Early on in the PACS rollout, for example, she realized that almost all the practice’s client sites use GE or Hologic mammography modalities—but every imaging system was either a different version or configured in some one-of-a-kind way. Connectivity and integration, she thought, were going to be big problems.

Her fears proved unfounded as Sectra PACS proved readily customizable. Working remotely, the company’s technical experts “figured out how they could make things work the way we needed for every individual center. I would come to them and say, ‘You know, this is really complicated. I’m not sure it’s even possible.’ And their attitude was always, ‘We’ll figure out a way to make it work.’ And they always have. I’ve been amazed.”

Asked where Sectra PACS fits into her hopes and plans going forward, she says the technology is “a big part of our being able to scale to those different levels and win new accounts. We have gotten our technology base stabilized. We have the best technology base that we could have so that we are really poised now to grow in a way that we weren’t until we had that piece taken care of.”

That doesn’t mean Women’s Imaging Associates is looking so far ahead and afield that it’s lost sight of its own neighborhood.

“Here in Birmingham, a lot of the patients in the community need access to breast specialists, and they need access to surgeons at UAB,” Reich says. “Anything we can do to help make that process more efficient so they can get in and be seen faster is really important.”