Magazine Article | November 27, 2013

Desktop Virtualization Takes Pain Out Of EHR Install

Source: Health IT Outcomes

Edited by Jennifer Dennard, Health IT Outcomes

By replacing 600 PCs with 1,100 cloud displays, Olympic Medical Center has created a virtualized environment that has improved clinical workflows, IT maintenance, and overall EHR utilization.

An EHR implementation is painful enough on its own. Add PC setup, troubleshooting, and upgrades to the mix, and you add untold time and frustration to the process. Olympic Medical Center (OMC), an 80-bed, acute-care community hospital in Port Angeles, WA, found that PC management was impeding its EHR progress. As a result, the provider made the decision to replace many of its clinical PCs with cloud displays that leverage desktop virtualization technology. Here, Sean Johnson, information technology manager at OMC, explains how this move has enhanced clinical workflows, improved integration with physician dictation software, and optimized EHR utilization.

Q: What hardware challenges caused you to consider moving from standard PCs to desktop virtualization?

Johnson: We were struggling five years ago with the support needs of our servers and PCs. It was becoming difficult to keep our Microsoft systems updated at an enterprise level. At the same time, we knew we were going to have trouble keeping up with changes in healthcare technology related to Meaningful Use (MU). A facility of our size does not have a large IT staff, and we quickly realized that we would need to move to a more virtualized environment if we wanted to participate in MU and keep our heads above water.

We first attempted to virtualize our servers in 2008, when the majority of our systems needed to be upgraded. We moved 75 percent of them over that year and virtualized the rest in 2010, coinciding with the implementation of a GE Centricity EHR in our ambulatory center. We wanted to improve the workflow of physicians using Centricity by moving to a virtualized environment and avoid performing reoccurring application updates.

Other facilities had started to move toward virtualization, but it was by no means a common practice at the time. When we first rolled out PC desktops for Centricity in the ambulatory center, we worked with VMware to virtualize 150 of those PCs and roll out 180 Windowsbased tablets at the request of our providers. They were excited about the potential time-savings the tablets could offer. We quickly found out, however, that introducing a PC as an underlying operating system on a mobile solution added more complexities than we had bargained for, such as security issues with USB devices and screen rendering inconsistencies.

In addition, the physicians at that time wanted to use Dragon speech-recognition software on the tablets, and we found that technology was not supported on a virtualized desktop running on a tablet. Our doctors had to cut and paste their dictated notes over to the virtual desktop, which negatively impacted their workflows. Many abandoned Dragon and returned to more traditional, and more costly, dictation solutions.

We were motivated to look at additional desktop virtualization options after some changes in upper management prompted us to adopt a systemwide EHR. Epic was ultimately selected as our EHR platform of choice, and we decided to implement the system in tandem with a neighboring health system — Providence Health & Services.

At that time, we realized it would be ideal to get rid of our older PCs and tablets and put full virtual desktops with monitors in every room. Those requirements, combined with the fact that we needed new, larger monitors for the Epic install, led us to start looking at a different virtualization option.

Q: How did you decide on the new solution, and what was the timeline for implementation?

Johnson:We looked at four companies that offered thin-client boxes that plug into monitors. Samsung was the first zero-client option we came across that put everything in the display. There were no extra boxes or ancillary pieces of equipment that could break. We really liked the all-in-one solution they offered, so we opted to purchase a few of their NC240 zero-client cloud displays for testing over a period of six months. We worked through a handful of pilots to make sure the Samsung units could handle a more complicated application load, which included the Dragon dictation software.

We concluded our small pilot projects and began a full rollout early in the summer of 2012. As mentioned, this coincided with our Epic implementation and a corresponding need for new PCs, so we ended up retiring 600 PCs and replacing them with 1,100 Samsung cloud displays.

Q: What benefits did OMC see as a result of transitioning to cloud displays?

Johnson: We’ve seen gains in productivity across the board. Moving to virtualized desktops saved us a tremendous amount of time during our Epic go-live with Providence. We had to set up training rooms throughout the organization that each needed between 12 and 20 zero clients. We were able to quickly set up those training rooms just by plugging everything in. We didn’t have to break a PC out of the box, put a new Windows OS image on it, wait a day and a half, and then make sure everything was fine. It was a much quicker turnaround. Traditional PCs would have taken a week or more, but we were able to set those rooms up in just a few days with virtualized desktops.

It has also resulted in easier and less time-consuming dictation, which has in turn advanced adoption of Epic throughout the organization. Whereas our physicians had previously abandoned Dragon, now they are using it seamlessly to input up-to-date notes into the EHR.

Moving to a virtualized environment also has saved my team troubleshooting time. For example, if an end user happens to corrupt their current Windows desktop, a log-off and log-on gets them a new, clean desktop. We’ve really benefited from having a standard image that applies to everyone. It makes for much easier troubleshooting. That is certainly helping our support response time and our ability to handle new releases systemwide.

I’d be remiss if I didn’t mention the cost savings associated with moving to cloud displays. They have a longer shelf life than their PC counterparts. I’ve heard they can last as long as seven years, though I’m only planning for five. I did a cost analysis last year of what it would have taken to support a new fleet of PCs compared to a new fleet of cloud displays and found the cost was roughly five to one. That’s a considerable amount of savings over a five-year period.

Q: What tips would you offer other providers looking to transition to virtualized desktops?

Johnson: Align yourself with your physician base so that you and your IT team have a solid understanding of virtualization and basic PC operations on an enterprise level. Don’t be afraid to tackle more challenging applications early on, as we did with Dragon, so that you have a solid understanding of what your particular virtualized environment is capable of handling. Gaining this perspective will prevent you from reaching the point of no return and potentially getting stuck with technology that isn’t the best fit for your organization.

Gathering feedback from early physician adopters is also a must if you want to understand how your physicians will use the displays and what they like and dislike about them. Our early conversations with physicians were critical in helping us understand the benefits desktop virtualization would bring to their workflows (e.g. workflows were faster, the cloud displays were easier to use than the older PCs, and they integrated seamlessly with the Dragon software). This feedback helped my team evangelize the technology to the rest of our physicians.