NationalMammography

DatabaseMargarita Zuley, MD

Associate Professor of RadiologyUniversity of Pittsburgh

Medical Director Breast ImagingMagee Womens Hosp of UPMC

Credit and thanks to Mythreyi Bhargavan Chatfield, PhD Director, Data Registries for sample report slides

NMD

American College of Radiology (ACR) Initiative

Part of the NRDR ( National Radiology Data Registry)

Collects MQSA required data Provides comparative information back

to participating sites every 6 months Allows sites to do national and regional

benchmarking

nrdr.acr.org

What is NRDR?

Information system Provides objective measures of practice

processes and outcomes Designed by radiologists Includes

National Oncologic PET Registry (NOPR) CT Colonography Registry General Radiology Improvement Database

(GRID) IV Contrast Extravasation Registry (ICE) National Mammography Database Registry Quality Improvement Registry for CT scans in

Children (QuIRCC) Dose Index Registry

Benchmark Data

National benchmark data provided by Breast Cancer Surveillance Consortium (BCSC) are used for comparisons with facility data in the semi-annual reports provided to NMD participants

Also uses NMD results of all participating facilities as benchmarks

Facilities receive facility level and provider level data

Benefits

ABR has qualified the NMD for practice quality improvement (PQI) for ABR Maintenance of Certification (MOC) Program

3 PQI projects are required every 10 years for all radiologists who have not been given a lifetime certificate by the ABR

Joining

Any radiology facility can participate

A participation agreement and a business associate’s agreement between ACR and the facility must be signed first

Upload from facility to NMD

Obtained through input of data elements into facility RIS/ HIS

The RIS/HIS vendor must support the NMD platform (HL-7) fields

Vendor software must be approved by NMD

Facility requests upgrade to NMD version Assign one person to upload data Upload is one click

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NMD-Certified Software Partners

                              

                           

         

              

          

      

                           

                              

                         

                           

                             

                               

Data Security

PHI, NPI is uploaded Encryption of all incoming traffic to NRDR Firewalls to secure data Has third party safety monitoring Data on individual patients stay property of

facility Aggregate, anonomyzed data from registry

are property of ACR

Data Elements

Patient Identifiers Patient name, SSN, facility MRN, zip code

Race, ethnicity Gender LMP, height, weight Family and personal h/o breast cancer Biopsy and surgical history

Data Elements

Mmg date Radiologist NPI number Reason for exam Clinical symptoms Prior mmg date, was it compared at

read Breast density

Data Elements

BI-RADS category (7 point) Mmg only Combined assessment

Recommendations Classification of most significant

finding S/F or digital Use of CAD or double read

Data Elements

Biopsy results Modality used Biopsy result ( benign, HR, malignant) If cancer

Type ( invasive or DCIS) Size Nodal status Stage at diagnosis

Goals

PPV1 5-10% PPV2 25-40% Tumors found- stage 0 or 1 >50% Tumors found- minimal >30%

(1cm or less invasive or DCIS) Node positive rate <25%

From Linver et al AJR;1995;165:19-25

Goals

CDR (Ca/1000) 2-10 Prevalent 6-10 Incident 2-4

Recall rate 10% or less

Sensitivity >85% Specificity >90%

From Linver et al AJR;1995;165:19-25

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SAMPLE FACILITY REPORT

Data Presented

Initial upload can be last 6 months or year Can elect to upload prior data if you like Initial older data can be incomplete First report back will only give data

results that you upload Will get 2 reports going forward, data

with at least 1 year follow up and preliminary data that does not yet have 1 year follow up

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SAMPLE PHYSICIAN REPORT

Summary

NMD will help with MQSA audit NMD will help with required PQI NMD provides a feedback

mechanism for radiologists and facilities to see if their practice can be improved