Cleveland Clinic Union Hospital

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Changing Times Call for a Changing Strategy at Cleveland Clinic Union Hospital

One facility’s journey from isolated PACS to consolidated Enterprise Imaging

Cleveland Clinic Union Hospital (CCUH) has served the community of Ohio’s Tuscarawas Valley for more than 100 years. Although times have changed, the hospital remains devoted to ensuring the highest levels of patient care and the most advanced medical technologies and treatments for its patients.

The hospital is acclaimed for its successes in information security and technological sophistication, having earned multiple special recognitions in recent years. This acclaim includes consecutive years on Becker’s Hospital Review’s 100 Great Community Hospitals list. The facility has also achieved certification as a Primary Stroke Center and has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR).

After years of growth, CCUH’s software could not keep up with the amount of data the hospital was generating–they needed a solution capable of consolidation and organization on a level that PACS could not achieve. Jacqui Bianchi, IS Application Manager with CCUH, explained how the situation was creating inefficiencies and challenges, especially for physicians.

“Software has become a major player here. A physician wants to see the story brought together, to see the patient as a whole. They don’t want to see radiology and then have to look somewhere else for a mammography,” Bianchi said. “What Novarad has given us is the ability to look at all of these different images together, not just from the current stay, but from past stays as well. In this industry, with every healthcare dollar being scrutinized, we’re spending our dollars wisely.”

EI’s Support for Comprehensive Patient Care

CCUH had been having some difficulties managing DICOM and non-DICOM images across multiple image-generating departments including radiology, wound care, ED, etc. Yet, all of these images play a critical role in the care continuum. The inability to see all of them together has posed a unique problem for care providers, and for patients looking to become actively involved with their healthcare.

CIO David Baumgardner chose to illustrate this with a wound care comparison. “In the wound center, every patient has a series of pictures. They make up progressive episodes of care for that patient. So there’s a great loss of productivity if you don’t have a process in place that is efficient, doesn’t use a lot of staff time, and offers the convenience of finding those images when the doctors need to have that information at their fingertips. Storing those files securely is very important.

Ensuring that only the right people have access to them, being able to track that access, and being able to have those pictures archived in an orderly way accelerates and improves the quality of the patient care we provide.”

The Enterprise Imaging (EI) sytem manages a facility’s information by providing an efficient workflow for managing both DICOM and non-DICOM images throughout the hospital by transitioning the storage of images and patient information from hard drives, disks, disparate archives, and USB drives to a vendor neutral archive (VNA).

The enterprise imaging solution offers a great ROI because you won’t be pursuing three or four different solutions. It can all be managed from our servers here–one server, one vendor, one solution, one interface.

– David Baumgardner, CIO at Cleveland Clinic Union Hospital

The Wound Care Imaging Dilemma

Wound care is a challenging area for healthcare facilities due especially to the varying natures of certain wounds and the need to document conditions with visible light imagery through the continuum of care. Properly monitoring wound progression is vital to achieving desired clinical outcomes and plays an essential role in improving the quality of patient care and reducing healthcare costs (Frykberg & Banks, 2015).

“Our typical wound care patient is a patient with a ‘chronic wound,’” explained Marsha Schrock, clinical nurse manager of the wound healing center. “It’s a wound that has been there for a while that is having difficulty healing, so we use special care procedures including hyperbaric oxygen therapy.”

While radiology has been using image management tools such as PACS for a long time, other departments including wound care do not have a similarly accessible solution. Because of the differing processes, wound care images (especially those taken with mobile devices) have traditionally ended up in a folder on a drive on one of the hospital computers, or on a USB storage device somewhere within the department.

This naturally makes them difficult to pull up on-demand; however, the ability to see all of these images is vital in wound care to track the progress of healing wounds. It also gives providers a record of care, so that in case of legal issues or abuse cases the images are both secure and easily accessible.


As is the case with many hospitals, efficiently managing these images within wound care has proven a hard nut to crack. The hospital is navigating this challenge with Novarad’s SnapView image management app, which enables clinicians to securely collect images and PHI in departments such as wound care, ED, ophthalmology and dermatology.

“SnapView has enabled us to allow the physician to see the patient photograph, even in the inpatient units upstairs. That was always a huge challenge for us,” Schrock continued. “Previously, we had to download all of those photos which were quite literally millions and millions of images.”

The app has helped the hospital save time and money by giving personnel the ability to use supported iOS, Android, and Windows devices to capture images without leaving behind any PHI. Healthcare workers first take a scan of the patient’s ID wristband, then the patient. Image files are routed past the device’s memory and transferred directly to the Ncompass Universal Archive, where they can be accessed by those with the proper credentials.

“We take the images with an iPad, but they are never resident on the iPad, so there is no HIPAA violation with images being left on the device,” explained Meegan Yoder, applications analyst with CCUH.

Financial and Operations Implications

Though patient care might get the headlines, budget cannot be ignored—and software pricing must be investigated thoroughly. Fortunately, it is possible to plan pricing and calculate a swift return on investment (ROI) with enterprise imaging.

“The enterprise imaging solution offers a great ROI because you won’t be pursuing three or four different solutions,” Baumgardner said. “It can all be managed from our servers here—one server, one vendor, one solution, one interface.”

One of the common pitfalls of an image management strategy has always been having to manage multiple vendors and the issues associated with systems that don’t necessarily play well together. By implementing an enterprise imaging solution, CCUH has been able to avoid these problems and maintain greater control over its own data.

Novarad’s Ncompass Enterprise Imaging system also comes with a guaranteed Total Cost of Ownership (TCO), which makes the planning process that much easier on both the hospital’s current budget and on its financial outlook years down the road. Going a step beyond budget, operational efficiency could arguably have the greatest impact on care.

“The enterprise imaging approach is helpful for when a patient comes to the hospital for another service,” said Marcy Adkins, iOS applications analyst with CCUH. “If necessary, the provider or any end user can access Ncompass, to view any other images that the patient has had in the past.” According to Baumgardner, its importance can’t be understated.

“Any time we can benefit the caregivers—any time we can make their day, workload, or their workflow more efficient—it improves quality of care for the patients,” Baumgardner said.

We’re working with Novarad—working with a partner—to implement tools that are fun to put in. And, you know, there are big wins from those for both the employee and patient, so these are always neat projects to work on.

– David Baumgardner, CIO at Cleveland Clinic Union Hospital

Working Together for a Higher Standard of Care

When undertaking the grand task of upgrading your entire data management system, who you choose to work with is just as important as the product you choose. You don’t just want to work with a vendor, your goal should be to work with a partner.

“We’re working with Novarad—working with a partner—to implement tools that are fun to put in,” Baumgardner said. “And, you know, there are big wins from those for both the employee and patient, so these are always neat projects to work on.”

Cleveland Clinic Union Hospital plans to continue their high standard of patient care and advancing technology to serve their community, and beyond. Implementation of Novarad’s Ncompass Enterprise Imaging System is only the first step on the hospital’s new path to the future.

Union Hospital is a four-time winner of CHIME’s “Most Wired” award. Healthcare’s “Most Wired” awards recognize those organizations that demonstrate excellence in IT implementation and innovation. Participating hospitals and health systems are assessed based on progress in adoption, implementation and use of information technology.

The Digital Imaging Adoption Model (DIAM) is an eight-stage model developed by HIMSS Analytics in partnership with SIIM and the ECR. It provides guidance for imaging and IT experts to identify and adopt the right digital strategy and improve health outcomes for patients.

Currently, Cleveland Clinic UH is in Stage 4: Fully integrated image management with efficient enterprise-wide image sharing across different service areas.

Frykberg, R. G., & Banks, J. (2015, September 1). Challenges in the Treatment of Chronic
Wounds. Advances in Wound Care, 4(9), 560-582. doi:10.1089/wound.2015.0635