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I could list all the reasons I think the iPad + Citrix are a great fit for healthcare, but it may be more meaningful coming directly from Physicians and IT Pros in the heathcare industry. This is a sample of what has been shared on the blogs when we asked what would Citrix Receiver for iPad be used for.
Dr. Paul Altmann says:
” Chris, the combination of Citrix and the iPad will, I am sure, be a huge success in the healthcare setting where the form factor of the iPad makes it the best all round device to access medical records in real time as clinicians care for their patients.Specifically, I am looking forward to showcase this for Cerner Millennium users who routinely access the application over Citrix.
There will be many other settings where the iPad, which is the first really decently sized, light, with good battery life “thin client”, will become very popular.
Dr Paul Altmann
Clinical Director – Health Informatics – NHS South Central & Oxford Radcliffe Hospitals NHS Trust
Consultant Nephrologist – Oxford Kidney Unit The Churchill – Oxford OX3 7 “

.. says:
“I would love to be able to use citrix on an iPad.  I currently use Citrix to log into our hospitals EMR, Epic, from home.  Being able to do so both at home and even in the hospital would be awesome. “

“So Are you saying that I would be able to use my GE Healthcare Centricity EMR Application from the Ipad? We connect to it using XenApp. This is really the only thing holding me back from getting an iPad is that whether I would be able to run my EMR for work.

“Please tell us you are working on a citrix client for the IPad.  It will be so “revolutionary” if you have one ready by the time the IPad is available. Physicians will love to use an IPad to handle their Electronic Medical Records at bedside, exam rooms.”

“Chris Smith says:
Yes, I think this would be fantastic. Many EHR (electronic health record) applications have developed stylus-driven interfaces for slate PCs (tablets with no keyboard option), so touch interface is a natural easy win for those already developed applications. Many of the EHR applications are also already deployed via Citrix, so this is a serious WIN WIN for Citrix to pursue… and as you mentioned, Citrix has already done quite a bit of work on the Citrix Receiver for the iPhone. This really does have so much more capability, now that you have the larger screen.
Also, multi-touch is supported in Windows 7, so it will be interesting to see how the XenReciever can interact with the Win7 host operating system environment, or even hosted application environment, but having the Receiver bridge that gap in the user experience via the iPad would be amazing!”

“I work for a health care provider and this could be huge. It turns the iPad from an interesting toy, to potentially powerful tool for business”

Todd Bruni says:
“Being in a large Healthcare environment I also see this device as having huge potential. First for ARRA/Hitech initiatives such as CPOE, BMV, Physician Documentation, etc physicians, clinicians, and/or nursing are going to want, need, demand mobile devices. As multiple people have pointed out one of those devices are tablets. The cost of those devices intended for Healthcare are extremely expensive (Motion Computing, etc).  Second, as people have pointed out protecting patient data is a requirement.  That is one of the beauties of desktop virtualization whether its hosted shared desktops or hosted dedicated desktops that data stays in the data center.  Finally organizations need to hit meaningful use in the not so distant future. Most of the large EMR vendors are not web-based today and organizations have to start taking steps now to meet the meaningful use timelines. That means these applications are client based today which is another reason to do desktop virtualization now until the ISVs solutions are ported to the web.
So how does this wrap back around to this device? Any device that is going to help healthcare organizations start taking steps now to adopt desktop virtualization, mobility, extend battery life, and move data into the datacenter without having to spend $2k on a tablet, $3k on cart solution is a great candidate. Being able to purchase 4 or 5 of these devices at the cost of one tablet makes it very intriguing. Add a docking station with keyboard and mouse for $40-50 in key locations and now you don’t have to worry about real estate on the floors (another huge healthcare issue) and the device becomes easy to stop and make updates to your EMR.
Finally, I don’t remember who said it but I completely agree with whoever said that we won’t know any of this until we get these devices into the clinicians hands we won’t know.”

“Already have XenDesktop environment pushing around 20 desktops using Nextgen out to several medical clinics in my area. Was able to get budget money for purchasing 5 iPads as a demo in less than 2 minutes. Will be an interesting demo as I have connections to several hospitals that are all looking into the EPIC Haiku Application also being developed with Keiser Medical Group in mind. A current rolling wireless cart with a WYSE Thin Client typically costs a Hospital in Oregon $20,000 after we did our full ROI 2 years ago. Interesting what happened in 2 years! “

Checkout the Heathcare IT Community site http://community.citrix.com/p/healthcare

Learn how to make the iPad work for your healthcare organization at Citrix Synergy

The HiMSS group on LinkedIn features some interesting discussion. One of the longer threats evaluates why EHR/EMR implementations fail
Well, I must ask – please define failure! And this questions goes right to the heart of the matter. Defining success is probably one of the most prominent things any project management and executive steering committee must accomplish at the onset of the project – even before a vendor is picked.
I am well aware of the challenges associated with the technical implementation, workflow definition, workflow standardization and Computerized Physician Order Entry (CPOE) and much has been written about this topic.
A key point of any successful EMR is that the physicians and nurses accept the system and want to use it. Honestly, what’s in it for them?
Thus far, physicians in larger organizations had the luxury that someone would transcribe their scribbled notes and mumbled dictations, so that they could focus their time on patient interaction. The fact that healthcare administrators want to reduce errors and establish audit trails of clinical decision making has often been perceived as being of little value to the physician – especially if viewed in comparison to the perceived hassle of learning a new system and having to type patient notes. In a litigious society such as the one in the United States, some physicians may be more comfortable without any trail of clinical decision making that could potentially used against them in trial.
So, for EMR implementation success, a few key principles must be considered:

1. Define clear success criteria. Administrators, tech experts and clinical staff must work together to jointly arrive at a common goal.
2. Workflows. Pay close attention to how much hassle it is for the clinician to complete a workflow. Software must support users, not the other way around. When I was at a major EMR vendor, we actually counted the number of required clicks to complete a task as a key performance metric of the system. In the development cycle, no workflow could execute slower or with more clicks in a new version.
3. Access. This is at the heart of the matter. Organizations should establish clear metrics on how a physician accesses the system. Set an aggressive goal – such as “no more than 15 seconds for the first interaction of the day, no more than 3 seconds to log on to any terminal and get the session back”. This can be achieved through virtualization technology and session roaming with Citrix XenApp and XenDesktop. The use of two factor authentication such as proximity sensors in the user’s security badges or certificate carrying smart cards negate the use of typing in passwords. Think about the access modality as well – is it a thin client, a tablet, an iPad, a computer on wheels? How many hands will the physician have to care for the patient? Are cable or monitor arms in the way? Are there terminals in the hallways so that a note can be amended without disturbing the patient?

I’ve written about this topic in a previous blog as well.

Please provide your thoughts and comments.

Twitter: @florianbecker

The American Recovery and Reinvestment Act of 2009 (ARRA) contains a whole chapter called HITECH. This catchy acronym stands for Health Information Technology for Economic and Clinical Health and makes you wonder if “they” construct the acronym before deciding on what information to convey. It basically mandates a number of fairly stringent disclosure requirements for HIPAA covered entities and their business associates  in the case of privacy  breaches leading to the disclosure of patient data. The act is intentionally aggressive in order to entice health care providers and insurance companies to be really cautious about patient privacy and record security.
I am at HIMSS in Atlanta this week and I notice that ARRA, HITECH, HIPAA and other related topics are front and center in many sessions and for many vendors on the floor.
Under HITECH, the burden of proof is on the side of the covered entity to prevent a breach, discover the breach, and then disclose the breach to the patients and – in some cases – to the secretary of health and human services. If the breach is affecting 500 or more patients in a state or region, the covered entity must notify the patients via public media and notify HHS immediately. 
So, let’s define what a breach really is, and then what you can do to never having to call your local newspaper for the disclosure ad.

Under HITECH, a breach is an “unauthorized acquisition, use, or disclosure that compromises the security or privacy of the health record”. There’s also something in the language that this must pose a significant risk of financial, reputational, or other harm to the individual. Note that I am not a lawyer, but I did stay in a holiday….. tonight. Kidding aside, I did listen to Gerry Hinkley and Deven KcGraw during their HIMSS session this week – both are legal experts in this field.

So, having a laptop with unencrypted, and personally identifiable patient information stolen would be a breach. If, however, the data is secured with federally accepted levels of encryption (and the security of the key is not compromised), OR the data does not include certain items such as DOB or the patient’s ZIP code, it’s not a breach.
As you can see, the devil is in the detail. So, how can you take steps to avoid that painful disclosure? For one, ensure that the patient information never leaves your data center. Leverage desktop or application virtualization and disable clipboard and local disk access on the client device. Many electronic health applications can only print through the server, so that client connected printers are not needed and can also turned off without compromising functionality. If mobile access to the data is needed, consider the Citrix Receiver for the iPhone or mobile access platform of your choice to deliver the information without delivering the data.
Even without HITECH, these are important considerations for any Electronic Medical Records (EMR) rollout. When done correctly, you could allow your doctors, nurses, and staffers to use the laptop, netbook, tablet, iPad of their choice without having to worry about IT managing the myriad of devices or any of them leaving the premises.

Now, unfortunately, this is only one aspect of HITECH. The other aspect involves the unauthorized access  of patient records by employees who have legitimate access to the systems, but are basically snooping around. HITECH covers privacy breaches, not just security breaches.  Looking up your own lab results, or the chart of your friend’s sick kid is an example of a well intentioned, but illegal breach. Looking up the local football player’s records to determine if that hamstring injury has healed before Sunday’s game is also an illegal breach, but not an innocent one.  Identifying those scenarios actually requires intelligent data mining to assess whether access was justified for a person to do their job or constitutes a breach. While you can’t fix the latter category through application or desktop virtualization, you can confidently use virtualization technology to prevent breaches through the loss of devices or data without restricting mobility. One less thing to worry about in the complex world of healthcare regulation.

Questions? Comments?
Follow me on twitter: @florianbecker