1. National Mammography Database
Margarita Zuley, MD Associate Professor of Radiology University of Pittsburgh Medical Director Breast Imaging Magee Womens Hosp of UPMC

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

3. 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

4. nrdr.acr.org

5. 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

6. 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

7. 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

8. Joining Any radiology facility can participate
A participation agreement and a business associate’s agreement between ACR and the facility must be signed first

9. 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

10. NMD-Certified Software Partners
                              
                           
                       
                
                         
                             
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11. 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

12. Data Elements Patient Identifiers Race, ethnicity Gender
Patient name, SSN, facility MRN, zip code
Race, ethnicity
Gender
LMP, height, weight
Family and personal h/o breast cancer
Biopsy and surgical history

13. Data Elements Mmg date Radiologist NPI number Reason for exam
Clinical symptoms
Prior mmg date, was it compared at read
Breast density

14. Data Elements BI-RADS category (7 point) Recommendations
Mmg only
Combined assessment
Recommendations
Classification of most significant finding
S/F or digital
Use of CAD or double read

15. Data Elements Biopsy results Modality used
Biopsy result ( benign, HR, malignant)
If cancer
Type ( invasive or DCIS)
Size
Nodal status
Stage at diagnosis

16. 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

17. Goals CDR (Ca/1000) 2-10 Recall rate 10% or less Sensitivity >85%
Prevalent
Incident
Recall rate 10% or less
Sensitivity >85%
Specificity >90%
From Linver et al AJR;1995;165:19-25

18. SAMPLE FACILITY REPORT18 18

19. 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

32. SAMPLE PHYSICIAN REPORT32 32

35. 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