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. “

..says:
“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.

..says:
“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!”

..says:
“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.”

..says:
“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. 

If you are in the Healthcare business and rely on IT to improve patient care you may want to check out the Citrix community site for Healthcare IT. The site includes video tips with examples of what IT Pros like Nick Volosin have come up with using the Citrix SDK to speed access for providers. There are forums to ask questions of others in the industry and share feedback. Currently we are looking for feedback on pilots regarding the use of iPads in healthcare as well as requested new features.

Also Florian Becker, Director of Citrix Consulting Solutions and our resident Healthcare IT expert will answer questions and share his thoughts on the blogs. So if your looking for ideas, have questions, or can share what you have done to improve patient care with IT check out the site.

http://Community.Citrix.com/Healthcare

Citrix XenDesktop Delivers Cost Efficiencies for Hospital

• Needed to streamline desktop delivery while supporting multiple campuses.
• Construction of new main hospital limits staff onsite, therefore remote access for staff are remote sites are critical.
• “…without the centralized management capabilities of XenApp and XenDesktop, I would need twice as many people.”

Alameda County Medical Center

Alameda County Medical Center in Oakland, California, serves as the healthcare safety net for the county, providing care to all residents regardless of their ability to pay. The medical center has six campuses that include two hospitals, ambulatory clinics, rehabilitation services and a psychiatric facility. There are approximately 2,700 employees.

The challenge: streamlining and tailoring desktop delivery to reduce IT workload

As user requirements evolved, the IT team began looking at ways to tailor the standard desktop being delivered to all clinicians and staff. “For simplicity, we created one published desktop with all the applications that the clinical and support staff could possibly require. Unfortunately, even if they didn’t use all these applications, people tended to click on the icons to see if the applications would work – and call helpdesk when they didn’t. This situation added to our workload – and with multiple campuses, we were already stretched very thin. We needed to find an easier way to build and deliver customized desktops with only the applications each person needed to do their job.”

Expanding the Application Delivery Infrastructure from Citrix

When Citrix introduced Citrix® XenDesktop™ for desktop virtualization, Alameda County Medical Center decided to add this solution to its application delivery infrastructure. Bennett selected the Platinum Edition of XenDesktop to enable delivery of tailored, virtualized desktops to about 200 users.

In addition, the medical center turned to another Citrix solution – server virtualization – to support a planned disaster recovery site. “We have a small datacenter located about 13 miles away from the main campus that we want to use for disaster recovery,” said Bennett. “To save money and optimize flexibility, we decided to implement Citrix XenServer and Citrix Provisioning Server for Datacenters. Virtualization will reduce the amount of server hardware needed in the failover site, and will accelerate server provisioning during an interruption.”

Policy-based desktop virtualization enhances control, efficiency and flexibility

Bennett looked at XenDesktop as a way to leverage the existing Citrix XenApp environment, but manage it more easily and efficiently with a small IT staff. “XenDesktop offered us the ability to use policies to tailor desktops to the particular needs of different users. We can provide a basic desktop and then specify the required applications for each user or group of users. For example, based on policies, registration clerks will get all the applications and resources they need – but no more. With XenDesktop, we don’t have to spend time building each desktop or worrying about adding a new resource – everything is automated, and the correct desktop is dynamically assembled each time the user logs in.”

With XenDesktop, policies can also be applied to control the user’s environment, such as limiting the ability to upload files if the user is connecting from a home PC, to support confidentiality of medical information.

He added, “And Citrix technology has improved the performance of our picture archiving and communications system, or PACS, enabling us to include it and any other problem application together with XenApp hosted applications in the virtualized desktops. XenDesktop gives us more flexibility in what we can deliver to our users, and avoids the need to run applications locally.”

“Overall, Citrix enables us to accomplish more with the staff we have. In fact, without the centralized management capabilities of XenApp and XenDesktop, I would need twice as many people.”

A consistent user experience on any device

With Citrix virtualization technology, the medical center’s employees can access their desktop from any device in any location, such as a cart on wheels, or a PC in a doctor’s home office. “Some of our doctors want to connect remotely in order to work outside the medical center,” said the IT director. “XenDesktop supports that by delivering a desktop with same look and feel they are used to in the hospital.”

Another benefit of XenDesktop will come into play when Alameda County Medical Center begins rebuilding a portion of its main hospital to meet earthquake standards. During construction, only a limited number of staff will be able to work on the main campus, and many will have to be relocated to remote sites. “XenDesktop will help facilitate this project because we can centrally deliver desktops anywhere, with the same user experience. We expect this to ease the disruption for employees and my IT team.”

A cost-effective solution for server virtualization

In addition to providing flexible, consistent access to applications during normal operations, Alameda County Medical Center is working to ensure uninterrupted delivery in the case of a disaster. With Citrix® XenServer™ and Citrix Provisioning Server™ for Datacenters, the organization not only will benefit from rapid provisioning of virtual servers in its new failover center, but is saving money in the process.

“Public hospitals today face severe financial challenges, so any time I can get more bang for the buck I need to do it. We compared XenServer to the competition and found that we could achieve the same results but at a definite price advantage. I estimate we saved 30 or 40 percent with XenServer, and we got the Platinum Edition to boot.”

Bennett concluded, “We have had phenomenal success with Citrix products and now we are expanding on that success with desktop and server virtualization. Citrix is changing the way we look at application delivery and opening new doors for the medical center.”

Electronic Medical Records (EMR) implementations have their own, unique challenges. Healthcare organizations are concerned with selecting a vendor, complying with a myriad of regulations, and basically transforming the way healthcare is delivered to their patients.
Given the transformative nature of an EMR implementation, virtualization is often just a side thought for health CIOs. Therefore, I’d like to shed some light into the topic and share my personal top 5 reasons to pursue this topic further- starting with the centralization of medical records data.
For a quick definition of the term itself, please refer to yesterday’s blog.
I assume that the backend database for your electronic health records reside in a single, centralized datacenter. Through global server load balancing, you may have already implemented site-to-site redundancy, but that’s beside the point for today’s discussion.
So, traditionally, you would have rich client applications or web browsers on the user’s endpoint to consume and manipulate the medical records data. This automatically implies that a lot of health data moves to and from the datacenter and often to remote locations where it is challenging to maintain a tight grip on security.
Application or Desktop Virtualization can solve that problem. Both of these techniques move the client software piece (or web browser) to the datacenter, where it executes securely inside your facility. The health data never even leaves the datacenter. The user interaction happens via a secure, high performance protocol (such as Citrix’ HDX in the XenApp and XenDesktop product lines) and gives the user a snappy interaction with the software, while only exchanging screen updates and keyboard/mouse events between the end user and the datacenter. Additional data streams pertaining to peripherals, printers, USB devices, scanners, and client hard drives are possible, but can easily be disabled to promote further security.
No data ever makes it to the end point, and therefore reducing the risk of HIPAA/HITECH covered security breaches. In addition, user sessions can be audited to establish an independent trail of information in case the regulators or courts require a closer look.
If you’re curious, I encourage you to check out Dan Feller’s Ask the Architect site. Dan has a wealth of information on desktop and application virtualization and associated whitepapers and reference architectures.
Florian Becker
Twitter: @florianbecker
Virtualization Pulse: Tech Target Blog
Ask the Architect – Everything Healthcare

The following is a blog I posted on my “other” site – Virtualization Pulse, hosted by Tech Target. Most readers on these pages are already very knowledgeable, so please forgive the simplistic view. In the near future, I will publish additional blogs on virtualization and specifically focus on the the healthcare IT space. Consider this one a relatively simple level-set for the audience. Enjoy.
———————————

Given that there are a lot of incentives associated with the adoption of Electronic Medical Records, medical CIOs and their teams are inundated by vendor messages these days. Phrases like “Meaningful Use”, “HITECH”, “HIPAA” are on the forefront of everyone’s mind, but you may also hear about virtualization. Given that there is still some confusion on the topic, I’d like to clear a couple of things up:

“Virtualization” is a term that has been traditionally used in the context of server virtualization. The technology involved is often referred to as “Hypervisors” which basically allow a modern server with plenty of CPU and Memory resources to share those resources between multiple “workloads” or “virtual servers”. So, instead of having one physical server with 16 CPU cores and 128 GB of RAM, this server can often house 40-60+ individual workloads that act on your network just as if they were much smaller individual servers. The benefits are obvious. Today’s servers are relatively cheap to acquire and most server workloads don’t require nearly as many computing resources to do their job. IT departments can lower cost by running fewer physical servers, consume less rackspace, lower power consumption and cooling costs. Advanced virtualization solutions also allow for virtual servers to automatically move to a separate physical host in case of a hardware failure. The failover process is often seamless and therefore provides resiliency, but typically requires a separate, redundant storage area network for this to work on the fly. Workloads with less criticality can be moved in a semi-manual fashion where they are simply restarted on another physical host by the administrator.
Vendors in this space include VMware (vSphere), Citrix (XenServer), Microsoft (Hyper-V) and a number of other players.

Application Virtualization. This is another form of virtualization, which has virtually nothing to do with server virtualization (pun intended). In this model, an application (think about your office productivity suite, or your electronic medical records client) is installed on a central server and executes there. The user connects from their endpoint (PC, laptop, thin client devices, etc.) via a remoting protocol and essentially controls the application remotely. This can be done on the simple level with Microsoft Terminal Services and the RDP protocol, and on the higher end via specialized solutions such as Citrix XenApp (formerly known as Presentation Server or MetaFrame). The benefits are obvious. Applications can be centrally managed and IT support personnel would no longer have to touch an end users system to install or patch an application. All updates are performed on a few centrally located servers. This approach also has the advantage of the application being physically close to the backend data of the app (on a low-latency, high bandwidth network), which leads to faster execution of the app and much increased security as the data never leaves the datacenter. The only information that is exchanged between the end-user’s device and the central server are screen updates and mouse and keyboard events. The protocols also include the capability of conveying information such as audio, printing, USB device support etc. The performance is actually astonishing in many cases and the most demanding customers in the area of engineering run their complex design applications via Citrix XenApp.

Desktop Virtualization. This is the latest and greatest. Instead of executing just a set of applications in the datacenter, the industry is moving towards executing desktop operating systems in the datacenter and allowing users to connect to the desktops . One could write a whole book about desktop virtualization, so I am trying to keep it brief. Some vendors tout a “VDI” or “Virtual Desktop Infrastructure” model, where each user basically has their own, assigned, virtual desktop in the datacenter. This model moves the headache of desktop maintenance to a central location, but still encounters some of the same challenges associated with traditional desktop management (such as the need to patch multiple desktop instances and troubleshoot/fix corrupted or infected desktops).
More advanced models go towards a shared desktop image model, where each user connects to a brand new, pristine desktop operating system, which folds the applications and user settings into the desktop as the user connects. This has the advantage of ensuring the highest performance (after all, a brand new desktop always performs best) and can also cut down on the number of desktops to maintain. Having just one or a handful of desktop master images to patch and maintain for thousands of users provides great efficiency gains and cost savings.

So, let’s recap. Server, Application, and Desktop Virtualization are three distinct disciplines in healthcare IT and are important to understand. Don’t fall for the siren’s song and believe that a particular vendor who is good at one discipline is automatically an expert at the other virtualization disciplines.
Check back on these pages in the near future for my rundown on virtualization techniques for your EMR implementation.

Florian Becker
Twitter: @florianbecker
Virtualization Pulse: Tech Target Blog
Ask the Architect – Everything Healthcare

…No, I am not talking about the world-famous subway system in London, but rather like to pick up the topic by Dr. Philip Chase on the Physician’s view of an EMR. Dr. Chase describes how a recent visit to his physician revealed that the esteemed healthcare provider spent a lot of time typing Dr. Chase’s answers into an EMR application. The physician’s attention was divided between the patient and the computer system and the entire encounter had the appearance that the EMR itself interfered with the doctor – patient relationship; hence the “gap” between data acquisition and data entry.

Since there’s a lot of talk on EMR’s these days (one recent blog post describes the HITECH Anxiety), I figured it be a good time to reiterate some of the common sense EMR thoughts and best practices.
• Doctors don’t want to be IT admins. Correct. I don’t think they have to. Purely Internet-based EMR vendors use this tagline to entice providers to move all of their patient data to a hosting provider, but many physicians are more comfortable with on-premise solutions. Roughly 50% of office visits are delivered by 1-2 doctor practices. Like many other small business in all kinds of verticals, physicians can rely on other (often small) businesses in the IT / Computing world to setup a local system and support a locally running EMR. It’s “my computer guy” who takes care of installing, maintaining, patching, and backing up the systems in any small business, regardless of the industry. Action: Think about hosted vs. on-premise systems and pick the ones that you are most comfortable with.
• Usability is key. You don’t want your patients to stop seeing you, because the visits have become impersonal. Don’t focus more than 5-10% of your patient time looking at a computer screen. This will require discipline and some practice. Pick EMR software that lets you work from selection lists and templates rather than free text. Practice some typing (if that’s new to you) and have a vendor demonstrate the speed of documentation and order entry to you.
• Devices play a big role. Bigger than you think. Vendors bombard you with different options. Everything from regular office PCs, laptops, tablet PCs (including the Apple iPad), to computers on wheels (COWs) are options. Depending on your practice setup, one or more of these may fit. Here are some thoughts: Don’t set up your devices statically (that would require you to turn your back on the patient on occasion). If you go for wheeled devices, make sure they are not clumsy or blocking your space and movement in the practice. Ensure that wireless networks reach all your exam rooms and provide good signal strength. Consider a tablet device as you can carry it around. Be mindful of the device often occupying at least one of your hands that you won’t have avalailable to examine or treat the patient. Some devices with smaller form factors are said to fit in a lab coat. Try it before you buy! Consider the devices battery life and screen size. Action: Try the different devices in conjunction with the short list of EMRs you’re considering. Some vendors have specific user interfaces for mobile devices or iPads that improve usability when using a multi-touch interface.
• Multi-user environments pose special challenges. If you have more than 1 clinical user or running a group practice, consider the fact that physicians will physically move away from a device and into the hallway or next exam room. Unless you choose portable devices, consider fast log off and log on modalities and session roaming. The latter can be achieved through application and desktop virtualization, where your application executes centrally and the “terminals” in the exam rooms and hallways just provide interactive access to the application.
• Offsite usage. Nothing is more annoying than not having access to a system when you need it. Ensure that your system has secure offsite access built in. In most web-based EMRs , you should be covered. More elaborate systems may require app or desktop virtualization where the apps and data stay securely tucked away in the data center (or data closet, depending on your size) and allow your users to connect securely over the Internet to the user interfaces of the apps. Action: Discuss those options with your “computer guy” and your EMR vendor.

I plan on sharing more specific virtualization best practices with you in the upcoming weeks and months. Please let me know if there are specific topics you would like to hear about.

Florian
Twitter: @florianbecker
Ask the Architect – Everything Healthcare
Tech Target Blog – Virtualization Pulse