Group Buy Equips Entire City with Digital Mammography

Four competing organizations join forces to improve patient care

In today's competitive health care environment, what happened in Cedar Rapids, Iowa, a Midwestern American city of 250,000 people, seems almost unthinkable. Four organizations vying for the same patients worked together to focus on the real bottom line - providing the best possible care for their community. For the first time, an entire city adopted Hologic digital mammography for breast cancer screening.

Last September, the area's four major health care organizations - Mercy Medical Center, St. Luke's Hospital, RCI Imaging Center and OB-GYN Associates culminated a joint effort to acquire and install Selenia digital mammography equipment from Hologic.

"If one hospital were to acquire technology just to get a leg up on another, in very short order, other facilities would obtain the same systems. So, you're clearly not finding a market share value for a very long period of time by providing that technology," says Arnold Honick, MD, radiologist at RCI. "By doing it together instead of making it a [competitive] process, we provide a fiscal benefit. We also can put our heads together as far as the technological hurdles that we have to overcome."

A patient undergoing a digital mammogram should notice little difference in the way the examination is conducted, though exam times may be shorter. With no film to process, technologists can view images immediately and reposition the patient to obtain alternate images as needed. Images are typically saved as digital files that can be transmitted electronically to a radiologist or hospital instead of being sent through the mail or hand-carried. According to Dr. Honick, "Digital mammography provides process improvements and allows us to send information more quickly from one point to another - out of town or in town. We can also use a lower dose of radiation while improving the overall quality of the image."

"Digital mammography provides process improvements and allows us to send information more quickly from one point to another - out of town or in town. We can also use a lower dose of radiation while improving the overall quality of the image."

Initially, there was some resistance - both to the necessity of digital mammography as well as to the collaboration with competing hospitals and imaging centers. Much of the resistance could be attributed the to lack of proof that digital imaging provided improved cancer detection capabilities as compared to screen-film.

That all changed when the results of the U.S. Digital Mammographic Imaging Screening Trial (DMIST) sponsored by the National Cancer Institute were published in the New England Journal of Medicine in September 2005.

The 4-year study enrolled 49,528 women, who had no signs of breast cancer, at 33 sites in the United States. On the appointment day, women had both digital and film mammograms taken, each with a minimum of two views of each breast. Two different certified radiologists interpreted the conventional and digital mammogram exams for each individual patient. All radiologists who participated read both types of mammograms, and each radiologist read approximately an equal number of mammograms of each type.

Participants were asked to return in one year for their annual mammogram. At that time, a mammogram was performed as part of routine health care. Women who were not able to return to the same site as in year one were asked to submit films from another institution for review by study radiologists.

The DMIST trial showed that digital mammography was significantly better than film mammography in screening women who were under age 50, or women of any age who had very dense breasts.

"Working together allowed us to put all of our heads together, putting the best of the best to work and enabling us to come up with answers that always kept the customer foremost in our minds," says Kristi Thomson, supervisor of the Women's Breast & Bone Health Services at St. Luke's Hospital. "I believe that more and more organizations will collaborate in the future, because the benefits far outweigh any negatives."