In the fall of 2015, the Beverly Hospital Lahey outpatient medical imaging center in Danvers, Massachusetts needed to replace one of its magnetic resonance imaging (MRI) scanners, and Peter Curatolo, MD, its MRI medical director, was tasked with leading the capital acquisition process. At the outset of his exploration, Curatolo didn’t want to just upgrade necessary imaging equipment, he also wanted to seek out ways to expand and improve upon the array of services provided at the center, specifically in serving patients with claustrophobia and those scheduling breast imaging studies.
“Looking through our cancellations and no-show rate, I found that a disproportionate number of [those] patients were either claustrophobic or having breast imaging,” Curatolo said. “We started doing due diligence, got all the vendors in, and at that time, a couple of them presented to us the idea of a patient-centered imaging suite. As we were building it, I started to appreciate that the design of the suite had a major impact on the physical and emotional well-being of the patient.”
The principle behind creating a suite designed to help patients remain calm during their imaging studies isn’t just to eliminate artifacts on scans and avoid re-takes, although those benefits certainly lend themselves to quality improvements for imaging technologists and the clinicians who review their work. By remediating the center’s deficits in reaching people who struggle with the anxiety around diagnostic imaging, and seeking to refine its approach to breast imaging, Lahey Outpatient Center Danvers is also elevating its profile among patients in its service area, and recapturing lost revenues.
The facility settled on Philips as its vendor, and began construction of an Ambient Experience MR In-Bore suite. The suite is designed to give patients control over their sensory experiences within the room, allowing them to select from among any number of video and audio themes that relax them with soothing sensory experiences. Only the MR magnet and power injector are visible to patients, and the injector is strategically positioned so it’s not visible when patients enter the room. A wide-bore magnet is designed to appear more open to patients than other systems appear, which helps those battling claustrophobia to be calm during their studies.
A ceiling-mounted projector draws the patients’ focus, and once they’re positioned within the magnet, mirrored glasses allow them to view a second, 55-inch LED screen on the back wall of the suite, which displays the same video while they’re supine. The room is lit by a large halo light and soft LED spotlights; its corners are gently curved, which lends a greater sense of depth to the space by creating the illusion of edgeless walls. Audio tracks can be set to coordinate with the video display, or patients can bring their own music to listen to during the study.
Those sensory modifiers all make the imaging suite about 10 percent more expensive than comparable rooms without them, which meant Curatolo needed to demonstrate the business case to leadership for adding them.
“The hospital understood that there’s value in giving patients a good experience,” he said: “better exams, fewer no-shows and high patient satisfaction. That makes them think better of our institution, better of our imaging system, and there’s value in that; not just soft value, but real value.”
“Patients are more likely to come back to our institution if they have a good experience with MRI,” Curatolo said. “I think, in an ideal world, every imaging suite would be like this.”
When the installation was completed in the second quarter of 2016, it opened to positive feedback from patients and staff. As one of the first centers in the area to have installed the Ambient suite, Lahey Outpatient Center Danvers became a show site for Philips, and the magnet became the most-requested at the center, drawing in patients from as far away as Maine on the strength of word-of-mouth, positive reviews and media attention. Among staffers, the suite had also become the most popular worksite at the facility, “which is interesting because you’re getting the most difficult patients there from a technologist’s point of view,” Curatolo said.
“We did a lot of surveys, and a lot of direct interviews by technologists with patients, and easily demonstrated that the cost-benefit analysis worked out in our favor,” he said. “Patient satisfaction is a big driver. In the Northeast, we have lots of competition, so the idea of patient retention, and attracting new patients, and keeping our patients satisfied is all very valuable.”
Although the facility hasn’t quantified specifically how much recaptured revenue its patient-centric imaging suite has generated, Curatolo said the center has paid for the 10-percent premium by not only having fewer cancellations and no-shows, but also by halving the number of patients who reported feeling claustrophobic during their experience.
The suite also improved patient satisfaction among women undergoing breast MRI. Although those patients are treated in a prone position, and cannot see the video screens during their exams, the suite still offers other calming elements, including soft, ambient lighting and customizable audio tracks to help calm them during the experience. Those sensory palliatives can help alleviate what might be an intensely intimidating experience for women who may be already apprehensive about undergoing breast imaging. Breast MR may not come with the compression and physical discomfort of a mammogram, but it takes longer to complete, the patient’s breasts are exposed to the device while in a prone position, and those women who are undergoing the study “are, on the average, more apprehensive than a woman getting a routine screening breast study,” Curatolo said.
“Most of the patients we see fall into one of three categories: they’re recently diagnosed with breast cancer and getting a study before they start their treatment, or they’re high-risk for breast cancer, or they’ve had a previous cancer,” he said. “All of these patients are different from the general screening population of women.”
That’s a sentiment shared by Christopher Austin, MD, MSc. Austin is the chief medical officer for Kheiron Medical Technologies of San Francisco, California. As device manufacturers focus on improving patients’ physical experiences and making them more calming, comprehending their state of mind is equally important. Austin rightly points out that “what can cause the greatest anxiety are the unknowns” involved in the study.
“What is the machine actually seeing?” he said. “What if an abnormality is detected? Will the radiologist pick it up? How quickly will my scan be read and reported? How long will I have to wait to access the results?”
“This is really where there’s a great opportunity for radiology to think beyond the device and look very closely at what artificial intelligence (AI) can do to reduce patient anxiety,” Austin said.
“This may include accelerating image interpretation, providing added diagnostic confidence to the radiologist, getting the information back to the patient in a timely manner, and reducing the probability of further unnecessary additional diagnostic procedures.”
From Austin’s perspective, efficiently delivering accurate study results is the most important part of breast screening for patients. AI mechanisms can provide “the added reassurance of a second pair of eyes,” he said, especially in the United States, where not every patient enjoys the benefit of two, independent radiologist reviews of their studies, as is done in Europe.
AI may act as a stand-in for the “gold-standard” of screening, improving cancer detection rates, and reducing the frequency of recall visits, “which for most women end up being normal … but may cause emotional trauma and anxiety, prolonging the uncertainty and the wait for results,” he said.
“In the United States, we have a single human radiologist who looks at every breast scan,” Austin said. “AI offers the possibility to shift from the single-reader paradigm to what is achievable in Europe. We are starting to show through our clinical trials that AI can bring double-reading quality to the single-reading screening world of the United States.”
To better strengthen patients’ understanding of these benefits requires better patient education on the role of technologies like AI-based algorithms, its benefits in decision support and the assurance that it is developed inclusive of a regulatory process.
“There’s still a pilot in the driver’s seat, and that is the doctor,” Austin said, “and the computer is helping them read the images.”
Austin also believes that AI-supported patient screening helps improve workflow by improving image quality. That can have a direct impact on patient comfort by again reducing technical recall rates, which also limits the risk of additional exposure to ionizing radiation in the case of mammography, and cuts back on “the mental anxiety of having to wait for the scan and the final report, which for some women could be a few additional weeks,” Austin said.
There’s also a business case for the implementation of AI-augmented diagnostic solutions; namely, that providers can lean on it “to differentiate their services and better compete for patients, especially in large, competitive markets,” Austin said.
“If a provider can confidently show that AI is giving patients improved confidence in the clinical service, and returning the results faster, this can influence patients who have choice in selecting their provider,” he said.
Failing to account for patient comfort, however, can negatively affect an imaging facility by providing a subpar patient experience, which “will always define where your patients go,” Austin said.
“Breast screening is one of the best examples, because women will talk about where they go for their screens, which modality was used and how friendly the technologist was,” he said. “Your bottom line is going to be impacted by their experience.”
Included within that calculus, he argues, is the importance of attracting and retaining qualified staff.
“Patients and staff want to see more transparency around those things that the organization is doing to try and really improve patient service,” Austin said, as well as innovating improvements based on understanding the patient experience.
“All great innovations in health care come through thinking about the patient journey,” Austin said. “Organizations are going to be blindsided if they haven’t prioritized this.”
Focusing on the patient journey is one of the foremost precepts of the design philosophy at Marlborough, Massachusetts-based Hologic, said Jennifer Meade, president of its breast and skeletal health solutions division.
Meade cited the findings of the April 2017 “Ten Thousand Quantitative Findings Research Study” by Kadence International, in which a survey of 10,000 women revealed that the most-cited reason for avoiding a mammogram was fear of physical discomfort. Among the women surveyed, compression force, breast pinching and time under compression were the top three complaints made about undergoing a mammogram.
With that information in mind, Hologic’s SmartCurve breast stabilization system was designed to address the discomfort those women experienced. Switching out the flat paddles that historically have been used in mammogram acquisition for a curved shape that more closely mirrors the contours of the breast, Hologic was able to develop a device that reduced patient motion during the study, and also created a more uniform image. Modifying the algorithms used in image processing also retained image quality, offering a more specific analysis of the images, improving diagnostic rates and reducing unnecessary recall studies.
“We really think about integrated solutions across the spectrum of patient care,” Meade said. “We consider how that path fits together, and the opportunity to drive more clinical certainty. We’re constantly thinking about how we drive detection, time under compression, and how to speed up workflow in that entire continuum, making sure the experience is seamless, with overall faster and better-quality outcomes for our patients.”
Better-quality patient experiences also can result in healthier patients and better disease detection rates. As patients who have the best experiences return to those settings in which they received a high standard of care, they improve their likelihood of achieving routine screenings and earlier detection of abnormalities.
“You want patients making their screening choices because of their positive experiences and we know we’ve made an impact there,” Meade said. “Think about the funnel of care: having a woman go get her mammogram is where it starts. Having the best technology, having the best experience, gets people in the door, and then we approach compliance on an annual basis. The more uncomfortable the experience, the more the risk that a patient will not be compliant next year.”
Meade said Hologic follows a few key tenets in guiding innovation of its products; these include image quality, cancer detection, workflow and improving patient experience. The takeaways from patient feedback are based not only on patient reports of their experiences, but also that of the technologists, whom she points out spend the most time with patients and can have the most impact on their experiences.
“When we think about things that we’re working on for the future, we do look at how do we arm that technologist with the very best workflow so we can spend time with the patients,” Meade said. “A really big environmental factor is the technologist. Having a passionate, skilled technologist who can spend time with the patient to make sure that the patient knows what to expect and guide them through that workflow – that has a really big impact on the patient.”