Modernizing the delivery of healthcare applications

Over the last decade, electronic health record (EHR) initiatives and a wave of related healthcare applications have revolutionized information delivery at the point of care. PCs have sprung up at the bedside, nursing stations, and numerous other clinical stations throughout hospitals to provide healthcare teams with anywhere access to the new systems. The main goal driving these advancements – improving quality of care – is closely tied to other high-priority goals such as eliminating errors and giving patients better in-hospital experiences.

Traditional PCs, however, put a mammoth burden on a hospital IT staff that is already under pressure to continually reduce operating expenses. This creeping complexity led North Kansas City Hospital to look for a better model for healthcare application delivery. The 451-bed acute care facility has always focused on providing uniquely personal care, and IT was tasked with researching options that could better equip nurses, physicians, and clinicians to meet or exceed the hospital’s high standards.

The technology team started with a review of the previously deployed PCs and the in-place EMR system. As pointed out by the hospital’s CIO, the PCs were taking up too much space and restricting workflows. For example, at the beginning of a shift, each nurse would “claim” a PC. They would then return to that specific PC to do their work. Everyone avoided using a system that was already in use, even if that person had stepped away to work elsewhere.

Overall, the inefficiencies could be summed up in three categories:

• Productivity – too much time was spent looking for a free PC or returning to a claimed PC in another location.

• Asset utilization – at any point in time, many of the point-of-care PCs were idle.

• User experiences – logging in to the point-of-care applications was cumbersome, and called for a more streamlined process that could free hospital personnel to focus on delivery of the highest-quality patient care.

NEXT: The road to virtual applications sessions

The Road to Virtual Applications Sessions

Addressing all of the inefficiencies did not happen over night. The ideal solution emerged over the last couple years, and started with evaluating virtual desktop infrastructure and thin clients.

The initial VDI and thin client pilot test, which was restricted to a few clinical areas, did not prove to be satisfactory for those healthcare teams. However, compared to the previous PCs, the virtual desktops and thin clients did give the staff more mobility. The main objection centered on the cumbersome session start-up routines. Each time during the workday that an employee moved to another client, they had to repeat the login and authentication processes. They were not used to this, and it raised objections that made it difficult for the hospital to fully embrace VDI.

A combination of technology advancements overcame those objections, and made it possible to broadly deploy a virtualized approach for application delivery at the point of care. With help from a healthcare solution provider, North Kansas City Hospital has been able to leverage VMware View for virtual desktops, zero clients with integrated Teradici PCoIP technology, an Imprivata No Click Access authentication solution, and badge readers that provide tap-in/tap-out initiation of preconfigured application sessions.

The initial rollout replaced 650 PCs with PCoIP zero clients. Today, two years later, the total has expanded to almost 900 zero clients that are available to the doctors, nurses, and clinicians at the hospital. The new endpoints enable more efficient use and sharing of the point-of-care systems and truly mobile access to the mission-critical applications. Caregivers can roam from location to location, and simply tap-in with their badges when they need to access any healthcare application. A similarly simple tap-out step avoids any hassle of closing down EMR applications or repetitious logging out steps, and provides exceptional security for patient and hospital information.

Zero clients also support session time-outs, which can be configured to further safeguard sensitive information in the event that a caregiver forgets to tap out. The time-outs do not slow down or inconvenience caregivers; restarting a session requires only a simple tap of their badge. Because of the ease of the session initiation process, IT has been able to cut time-outs in half for most doctors. Over the last year, however, the team has observed that time-outs are rarely invoked. The ease of the new badging-out step has made it a natural reflex when they leave a screen.

The new zero clients and easy access solutions have created an integrated, interoperable platform for application delivery that has exceeded the end-user expectations for ease of use. The integrated PCoIP technology and the latest VMware View release have also yielded superior viewing experiences. The virtual machines on the servers handle all processing, and PCoIP efficiently compresses the pixel streams that are sent to and displayed on the zero clients. The virtual sessions and high-performance communications between hosts and clients ideally suits high-fidelity imaging for many healthcare areas such as radiology. 

The strengthened security and easy-to-maintain endpoints have likewise met with the approval of both management and IT. And zero clients are quieter, cooler, and consume less power than traditional PCs. Overall, the availability, flexibility, and security – all high priorities for any IT initiative at North Kansas City Hospital – make the zero clients a logical foundation for healthcare applications.

NEXT: Some lessons learned

Some Lessons Learned

The new foundations for application delivery called for integrating solutions from multiple vendors. The existing partnerships between the main technology providers was a distinct benefit, and made it possible to shield the end-users from the underlying components.

Today, physicians and care providers have one-touch desktop roaming for conveniently accessing vital information anytime and anywhere. As a result of the secure and efficient application delivery, increased staff mobility is improving quality of care and ultimately saving lives.

For IT, zero clients require less time to support. The CIO has noticed the improvement in terms of how quick and easy it is to deploy and centrally manage endpoint devices throughout the hospital. Compared to physical machines, IT spends much less time deploying and configuring zero clients and can quickly build out extra capacity as needed.

The new application delivery model has changed how the hospital budgets for endpoints as well. Instead of the previously employed three-year leases, North Kansas City Hospital now purchases endpoints. Estimates based on the reliability of the zero clients put life span at five or even six years. Compared to PCs, there are no disadvantages with the new zero clients.

Next Steps

One of the main reasons for selecting zero clients was the ability to easily deploy and refresh endpoints. The hospital recently took advantage of this benefit, and started introducing clients with second-generation PCoIP technology. Easily swapped in, the new clients resulted in no changes for IT.

The next project involves evaluating hardware accelerator cards that can reduce VDI server CPU utilization and increase zero client consolidation ratios by up to 200 percent. The accelerator cards will allow IT to cost-effectively maximize the number of virtual machines placed on blade servers, while ensuring a consistent, high-performance computing experience for the end-users, at all times and regardless of task or activity level.

The early deployments of the latest zero clients and the evaluation of the hardware accelerators have both validated the flexibility, scalability, and long-term efficacy of the new application delivery model. With the right endpoints and the right access solutions, VDI represents an exciting advancement that can benefit the end-users as well as the operations teams that must deliver and support the underlying technology for modern healthcare applications.

Geoff Schillare is manager of information technology at North Kansas City Hospital.