Solving the Digital Dilemma: A Strategic Approach

Digital mammography is rapidly gaining acceptance across the US. The technology is more expensive than film screen mammography, but it presents significant opportunities for positively changing the delivery paradigm-if it is properly implemented. Implementation is, however, not simply a matter of exchanging film screen mammography units for digital acquisition units. Digital mammography, by contrast, must be viewed as a system that, in its ultimate iteration, integrates mammography both with other breast imaging modalities and with the supporting infrastructure that is critical to the entire process of mammography delivery. To realize the full potential of digital mammography, it is necessary to approach implementation in a strategic, as opposed to a tactical, manner. The strategic “driver” is the electronic format of the digital image. With this final electronic link, all information concerning the patient has the potential to be transferred and presented electronically, and the physical file, which has long controlled workflow in the breast center, can be relegated to historical memory. Such a transformational change requires a strategic approach that focuses on what is possible, rather than what is simple. It begins with infrastructure, and it leaves the choice of acquisition technology until last. This article will develop the strategic process for those considering implementation of digital mammography, and also provide a framework for reengineering existing digital programs to provide strategic integration of the various elements of the delivery system.