Kettering Health Breast Centers was facing a challenge: Its cancer risk assessment process was inefficient and fragmented.
Staff there relied on a separate tablet-based system where patients or staff completed risk questionnaires. This setup posed several hurdles: The tablets depended on unstable Wi-Fi, the process was time-consuming to explain to patients, and consent was required before conducting assessments.
THE CHALLENGE
Moreover, the output lacked integration with internal systems, making it difficult to generate actionable reports or stratify breast imaging recommendations based on assessed risk.
Ultimately, staff had no streamlined, consistent process for assessing, documenting or acting on cancer risk data across the health system.
PROPOSAL
The proposed solution to the challenge was to integrate cancer risk assessment directly into the centers' health information system, eliminating the need for external tablets and enabling a more efficient, streamlined workflow.
"An interface could also be established with the radiology reporting system for automatic inclusion for external reporting," said Deanne Rose, director of the Kettering Health Breast Centers. "This integration would allow documentation and storage of risk data directly in the HIS, improving both accessibility and continuity of care.
"The interface for reporting allowed for a streamlined communication of results for patients and providers," she continued. "At the time, several risk models and vendors were in use across the organization, leading to inconsistencies in assessments – some factoring in mortality risk, others not."
Consolidating to a single, system-wide platform offered the opportunity to standardize care, support one best practice and simplify provider workflows, she added.
MEETING THE CHALLENGE
Initially, Kettering used the Hughes – later CRA (Cancer Risk Assessment) – tool on iPads. Eventually, the organization's Radiant Epic analysts worked closely with CRA – acquired by Volpara – to fully integrate the system within the Epic EHR.
"This system-wide integration eliminated the need for patient consent and ensured every screening mammography exam includes a risk assessment, with results directly embedded in the mammography report," Rose explained.
"Access to the tool was initially granted to breast imaging technologists, surgeons and OB/GYNs, and later extended to primary care providers," she continued. "The risk assessment questions were embedded into the clinical history section of the technologist workflow within Epic and are reviewed annually."
Clinicians can complete risk assessments during any encounter. Although the system is not integrated with other external platforms, having a centralized tool within Epic significantly improved the centers' ability to assess and act on risk data efficiently.
RESULTS
Integrating the risk assessment into the Kettering HIS eliminated redundant manual workflows, streamlined patient data collection and enabled automatic inclusion of risk results in reports. This consistency has improved overall operational efficiency and enhanced communication between providers.
"Year over year, we've seen a consistent increase in breast MRI screening rates, particularly among patients identified as high-risk," Rose reported. "From 2021 to 2024, the volume of screening breast MRIs for patients identified as having elevated risk increased by 47%, 22%, 35% and 19%, respectively, compared with the previous year.
"The ability to stratify patients earlier and more accurately allows us to provide appropriate follow-up, such as genetic counseling or additional imaging, before cancer is detected," she added.
Using one risk assessment model across all locations has ensured consistent, evidence-based practices and eliminated confusion caused by varying tools and methodologies, she continued. This uniform approach helps ensure all patients receive equitable, guideline-based preventive care, she said.
ADVICE FOR OTHERS
"Start by identifying how automation can replace time-consuming manual workflows, especially in high-volume environments like imaging," Rose advised. "Integration with your existing HIS is critical – not only does it streamline documentation, but it also supports better communication and decision making across care teams.
"You should also consider whether risk assessments will be offered universally or only to specific patient populations, and how the results will be reported and acted upon," she continued. "For patients identified at elevated risk, have a clear clinical pathway in place – whether that's through a dedicated cancer prevention clinic or individual provider management."
Ultimately, success depends on strong alignment between clinical, technical and operational teams to ensure the technology supports standardized, patient-centered care, she concluded.
Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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