Kettering Health Breast Centers had been struggling with an inefficient and fragmented cancer risk assessment process. The staff relied on a separate tablet-based system for patients or staff to complete risk questionnaires, which presented various challenges. The tablets relied on unstable Wi-Fi, the process was time-consuming to explain to patients, and consent was needed before assessments could be conducted. Additionally, the output lacked integration with internal systems, making it difficult to generate actionable reports or stratify breast imaging recommendations based on assessed risk. This lack of integration led to inconsistencies in assessments across the organization, with some risk models factoring in mortality risk while others did not.
To address these challenges, the proposed solution was to integrate cancer risk assessment directly into the health information system of the centers. This integration would eliminate the need for external tablets, streamline the workflow, and improve accessibility and continuity of care by allowing for documentation and storage of risk data directly in the HIS. An interface would also be established with the radiology reporting system for automatic inclusion in external reporting, simplifying communication of results for patients and providers.
Initially, Kettering used the Hughes – later CRA (Cancer Risk Assessment) – tool on iPads before working 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 that every screening mammography exam included a risk assessment, with results embedded directly in the mammography report. The tool was made accessible to breast imaging technologists, surgeons, OB/GYNs, and later extended to primary care providers, with risk assessment questions embedded into the technologist workflow within Epic.
The integration of the risk assessment into the Kettering HIS resulted in eliminating redundant manual workflows, streamlining patient data collection, and enabling automatic inclusion of risk results in reports. This consistency improved overall operational efficiency and enhanced communication between providers. The integration also led to a significant increase in breast MRI screening rates among high-risk patients, allowing for appropriate follow-up such as genetic counseling or additional imaging before cancer is detected. Using a single risk assessment model across all locations ensured consistent, evidence-based practices and eliminated confusion caused by varying tools and methodologies.
In conclusion, the success of integrating the cancer risk assessment process depended on strong alignment between clinical, technical, and operational teams to ensure that the technology supported standardized, patient-centered care. By identifying areas where automation could replace manual workflows and integrating with the existing HIS, Kettering Health Breast Centers were able to improve efficiency, communication, and decision-making across care teams.
