At HCA Florida Ocala, we are committed to improving patient outcomes via earlier cancer detection and prevention. Since launching our High-Risk Women's Program in partnership with the Ambry CARE Program® (CARE) in June 2023, we've been on a journey of continuous improvement. We’re also sharing what we’ve learned with the cancer care community—most recently presenting our findings at the 2025 National Consortium of Breast Centers (NCoBC) annual conference.  

Revolutionizing Our Risk Assessment Approach with CARE 

Before implementing CARE, our breast cancer risk assessment process was like many other radiology practices and imaging centers: paper-based questionnaires about personal and family histories that patients filled out while waiting for their mammograms. This information was primarily used by radiologists to include in mammogram reports, but we were not systematically leveraging this data to identify high-risk patients who needed additional cancer screening or genetic testing. 

CARE changed everything. Instead of patients hurrying to complete potentially redundant paperwork in the waiting room, they answer questions digitally ahead of their visit. With more time to complete the questions, patient history now tends to be more accurate and comprehensive. The CARE risk assessment algorithm then automatically calculates the breast cancer risk through the Tyrer-Cuzick model and qualification for hereditary cancer testing. 

This was revolutionary—a new data access point we had never fully utilized. Suddenly, we could identify every patient with an elevated Tyrer-Cuzick (TC) score (≥20%) who qualified for enhanced screening with breast MRI and/or genetic testing based on national guidelines. 

Identifying an Opportunity for Program Improvement 

Six months after launching our program, we expected to see an increase in breast MRI volume, with the recommendation to alternate between breast MRI and mammogram screening every six months for high-risk patients. However, December 2023 came, and we weren't seeing the predicted uptick in breast MRIs.  We had the data, we had the recommendations in our mammogram reports, but patients weren't getting the additional screening they needed.  

We realized the barrier: referring providers receive faxed reports from labs, imaging facilities, and other doctors all day, every day. Their staff members are focused on getting those reports into patient charts—not necessarily flagging special recommendations within the reports. Our carefully calculated risk scores and recommendations were getting lost in the daily paperwork shuffle. 

Creating a Care Coordination Workflow 

Rather than accepting this gap, we developed a care coordination workflow in December 2023: 

1. Our mammography navigator now proactively faxes breast MRI order requests to referring providers, highlighting the elevated TC score in the mammogram report. 

2. We send reminder letters to patients about their upcoming recommended breast MRI—two weeks before the due date and a follow-up two weeks after if they haven’t already scheduled 

3. Once the signed order comes back, our MRI scheduler proactively calls the patient to get the MRI scheduled. 

The results? In 2024, our breast MRI volume increased by 27% compared to 2023. And 2025 is off to an even stronger start, up 42% year over year as of March. 

The Importance of Continuous Improvement 

The most valuable lesson from our experience is the importance of constantly reassessing and refining your program. CARE provides us with powerful tools to identify high-risk patients, but technology alone wasn't enough—we needed to address human and systemic factors to ensure patients received the care they needed. 

This isn't our first research project related to our high-risk program. We've been quickly learning and improving in partnership with the Ambry team since implementation. There's significant interest in not just building, but continuously improving, our high-risk program, as evidenced by various research projects, including this latest one presented at NCoBC. Sometimes our feedback even helps Ambry enhance the CARE platform itself. This collaborative improvement approach benefits everyone involved—most importantly, our patients. 

While the increased breast MRI numbers are impressive, the true impact of our program goes much deeper. By offering enhanced screening to high-risk patients, we're detecting cancers earlier or even preventing them altogether. By combining powerful digital tools with thoughtful human workflows, we're transforming cancer risk assessment and management at HCA Florida Ocala.