Examine | Mammography: A Conversation with . . . Edward Sickles, MD, FACR

A new national database will collect mammo data

The National Mammography Database, which the American College of Radiology launches this month, aims to collect audit data from mammography facilities across the United States in an effort to provide them with a standardized benchmark and ultimately improve mammography practice. rt image checks in with Edward Sickles, MD, FACR, chair of the National Mammography Database Committee, for more information about this initiative.


rt image: What is the National Mammography Database (NMD), and how did it come about?

Edward Sickles, MD, FACR: It’s part of a larger effort by the American College of Radiology (ACR) to collect data into a data warehouse from different aspects of radiology. What the NMD will do is collect outcomes data from mammography facilities so that they have a convenient, consistent, reliable, and user-friendly way to get their outcomes analyzed and fed back to them in a meaningful way. The purpose is to help them with medical auditing.

As a background, most mammography facilities at this point are already using some kind of computer software to help them with the reporting of mammography exams, and that is simply because the federal regulations require not only reports to physicians, but also require reports directly to patients. And most facilities would find it onerous to have to make dictations or print out letters individually to patients when their usual transcription services don’t do that.

So they get computer software that not only will put out a report to the clinician who referred the patient, but will also print out a report separately, directly to the patient. Given that these facilities are using some kind of computer assistance, many of them already have built-in auditing modules that will do the kind of outcome analysis that NMD will do.

The problem is that each one of the computer software programs works slightly differently. Not that it makes the calculations using different definitions, but it sets up the data going into the calculations somewhat differently in a proprietary way, and the results that you get out of an audit from one software provider are unlikely to be exactly the same as the results you would get from the same data if it were entered into the software of a different provider.

It becomes hard for the facility that’s getting back the report to be able to benchmark its data with those of other places unless they are limited to places that happen to use the same software. And that would be very difficult because the only benchmarks that are available are the ones published in literature, and the people who publish don’t even indicate which software they use.

One of the purposes of NMD is to standardize all of this. In fact, the ACR now requires that all of the providers who want to be licensed to use BI-RADS change their software so it collects and permits uploading of data into the NMD using standardized format. That requires many of the software providers to make minor adjustments in their programming so that the little inconsistencies among the different providers are all standardized.

If the program is compliant, it also provides a very ready access to uploading data. (It’s as easy as pushing a button.) The NMD itself will be set up to do the analysis of all the data that’s uploaded. What it gets back to the facility is exactly the same kind of analysis for every facility. Because the ACR has set up appropriate HIPAA protections, it is able to pool the data so that not only can the facility get back its own audit report of its performance, but it also can get back a composite of all the facilities in the whole United States.

Obviously they’re not identified specifically, but they represent a compilation of everything that’s in the database. And this is meant to be more meaningful to the facility than just what they get from their own software program.

It can also get back a compilation of all the facilities that are similar to the one that’s submitting. When a facility signs up, it’s supposed to indicate certain characteristics for the facility, whether it is a hospital-based, community-based, academic, private group, etc. And the reason for asking those questions is that the audit data of different types of facilities might be different, for example, depending on the facility’s location and patient population. Is it an area that’s indigent or wealthy? They have different outcomes.


image: How does sharing data help advance the practice of mammography?

Sickles: Having facilities and the individual radiologists who work in the facility not only get back results but be able to compare with others is a known education device that helps people improve their performance. If you give people feedback on how they’re doing, and they see there’s a need for improvement, they know exactly what needs to be improved, and they can work on it.

One of the bonuses of using NMD is that the facility will have a convenient way to show that it’s doing good auditing, and it will also have standardized results available. One of the things that the government is getting into are initiatives called pay-for-performance (P4P). That’s supposed to be a cornerstone of Obama’s plan. He wants to reward places that are doing quality care.

One of the ways you do this is with P4P initiatives, and the ACR has applied to the Centers for Medicare & Medicaid Services (CMS) to have one of their provisions be that people who participate in NMD and have outcomes demonstrate they are entitled to somewhat increased reimbursement.

And this would be good for the facility because it would pay back whatever the cost is to participate in NMD and probably more than that, and it would also give the people in general better performance because the ones that are performing well are going to get more money. And the ones that aren’t are going to know what they need to do to improve and therefore, gradually, they will improve, and they’ll also get paid more. Ultimately, it’s meant to be a win-win for the facilities and the patients they serve.


image: How does a mammography facility get hooked up to the NMD?

Sickles: The first thing they need to do is check with whatever software provider they’re using for their mammography reporting. If they’re not doing it through a software provider and they have a homegrown system, then they need to talk to the people who made the homegrown system because any system can easily be adapted to be NMD-compatible.

The ACR is committed to get every software program NMD-compatible as soon as possible. They’re already working with four or five of the larger software providers and some homegrown systems (such as the one we use at the University of California, San Francisco).

The next step is for a facility to register for the NMD itself, which includes signing a confidentiality agreement to comply with HIPAA, since patient health information will be shared.


image: Do you think participation in the NMD will catch on quickly?

Sickles: I don’t know. I would guess that it would take some time. It’s going to take a while to get the word out. If the CMS agrees to put NMD into the Physician Quality Reporting Initiative, that will help move things along. The pieces are clearly going to fall into place. The question is how many facilities are actually going to participate, and the more that do it, the more powerful the NMD will become. It will be a mirror of practice across the United States.

— Jane Kollmer