Resources That Don't Go Together

A Hilo radiologist asked for breast cancer data on July 12. He had it on the 14th. By September, an independent practice and the public hospital had a tentative plan to keep screening in East Hawaiʻi.

HHTF Staff · 2026-09-23

A Hilo imaging practice, the public hospital, a congressional office, the state, and a data team. One problem.

David Isei, MPH, MAOL, PMP · Executive Director, Hawaiʻi Healthcare Task Force

The best thing I have seen happen in Hawaiʻi healthcare this year started with a two-line email.

On July 12, a radiologist in Hilo asked whether we could run breast cancer numbers for each island the way we had run them for stroke. I wrote back: "Absolutely, yes, we can." Two days later he had a written evidence briefing and a working dashboard, by island, by ethnicity, and by screening capacity.

That is not a brag. It is the point. Speed is what happens when people trust each other enough to skip the formalities.

What was at stake

The independent practice he helps lead has done most of the open-access breast screening in Hilo and Kona for decades. By its own account, it was the first in the state to earn the American College of Radiology's breast imaging center of excellence designation, and for years it ran the first breast MRI screening program in Hawaiʻi. Women flew from Oʻahu to Hilo for it.

Fifteen years ago, the same practice helped start a radiologic technologist training program with a community college and the island's hospitals. About 40 local kids came out of it with good jobs.

This summer, that practice was at risk of closing.

The island cannot absorb that loss.

Honolulu County 79.5% Maui County 76.6% Kauaʻi County 73.4% Hawaiʻi County 69.8% DIRECT Women ages 50 to 74 up to date on mammography, age-adjusted. CDC PLACES, 2022 release. These are modeled small-area estimates from federal survey data, not a count of women screened. Hawaiʻi County already has the lowest estimated screening rate in the state, 69.8 percent against 79.5 percent in Honolulu. It has five certified mammography facilities on an island bigger than all the others combined. That is 1.24 facilities for every thousand square miles. Oʻahu has 34.96. And our own analysis of 26 island communities found that screening falls, measurably, as the drive to the nearest facility gets longer.

What this cannot tell you. These numbers describe communities, not individual women. The screening rates are modeled estimates. The pattern is consistent across three sources. It is not a diagnosis of anyone.

Who came to the table

Here is who worked this problem between July and September.

A family physician in Kona asked whether the community could save breast imaging itself, even if the whole practice could not be saved. Then she asked whether the practice could become a school. The radiologist answered that it already had been one.

A foundation director pointed out that new rural workforce funding might offer a temporary lifeline.

Our data team built the briefing. The state's health planning administrator and its physician workforce researcher had it the night it landed.

The radiologist took the evidence to the University, to lawmakers, to the state medical association, and to the island's hospital leaders. In September he briefed the office of a member of Congress, and that office asked to meet.

And the public hospital in Hilo sat down with the private practice. As of mid-September, they had reached a tentative agreement for the hospital to take over breast cancer screening in East Hawaiʻi. The breast radiologists will keep caring for those patients, now working with the hospital.

Read that again. In most of America, an independent imaging practice and a hospital are competitors. In Hilo, they found a way to keep the service on the island.

Why it works here

This month I recorded a short talk for myself about integration. It is not a fancy idea. It is the habit of connecting things other people keep in separate boxes. Information is getting cheap. AI can summarize anything. What stays rare is the person who can see that a radiology practice, a hospital, a foundation, a community college, and a congressional office are pieces of the same puzzle.

The Big Island is full of those people. Maybe it has to be. When you know what you lack, you stop waiting for the perfect partner and start working with the one in front of you. I said it on that press call and I will keep saying it. They bring resources together that you might not think should go together.

The part that is not done

Kona does not have a solution yet. When the practice's Kona clinic closes, there is no plan today to replace its mammography, breast ultrasound, and breast MRI in West Hawaiʻi.

So this is a story with a middle, not an ending. Hilo shows what is possible. Kona is where the rest of us come in. If you run a hospital, a clinic, a foundation, or a budget line that touches West Hawaiʻi, call us.

Truth in the data. Care in the community.

Sources and data modes. MEASURED means computed by us from record-level data. DIRECT means published by a named authority. FIELD-VERIFIED means reported by the people doing the work, corroboration pending. Mammography screening, women 50 to 74, age-adjusted, by county: CDC PLACES, 2022 release, county-level (MAMMOUSE). DIRECT, modeled small-area estimate.

Certified mammography facilities, Hawaiʻi County (5) and facility density per 1,000 square miles (1.24 against Oʻahu 34.96): FDA MQSA Certified Facility Database, computed by the Task Force. MEASURED, August 2026.

Distance and screening across 26 Hawaiʻi Island ZIP code areas: Task Force and Hawaiʻi Healthcare Intelligence Platform analysis of CDC PLACES and distance to the nearest certified facility. MEASURED, ecological.

Practice history, training program, and the status of the Hilo and Kona screening services: the practice's own account to lawmakers and a congressional office, August and September 2026. FIELD-VERIFIED. The Hilo agreement is tentative as of mid-September 2026.