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Better Patient Care: Virtually There WHITE PAPER Sponsored by: VMware

Global Headquarters: 5 Speen Street Framingham, MA 01701 USA P.508.935.4445 F.508.988.7881 www.healthindustry‐insights.com

Ju d y H a n o v er Au gu s t 2 01 0

IDC HEALTH INSIGHTS OPINION This IDC Health Insights White Paper identifies the key benefits from desktop virtualization in the clinical environment and presents case studies from three hospitals that are early adopters of desktop virtualization in the clinical environment. The landscape for U.S. providers has been altered by two laws, the American Recovery and Reinvestment Act (ARRA) of 2009 and the Patient Protection and Affordable Care Act (PPACA) of 2010. These laws have created unprecedented incentives for the adoption of clinical technology and new goals for delivering higher-quality care to more Americans at lower cost. This will require providers to adopt new technologies rapidly and at the same time streamline their processes, cut costs, and improve quality. To do this, providers will be forced to examine all areas of their business and technology infrastructure. One of the key technologies that IDC Health Insights has identified for making provider IT departments more efficient and helping to meet these goals is virtualization. The return on investment (ROI) for provider organizations has been well documented for server and desktop virtualization, but the clinical benefits that arise from the virtualization of the clinical desktop have only recently begun to be discussed. The research for this white paper included detailed interviews with IT departments at three hospitals that are early adopters of desktop virtualization for clinical applications. The observed clinical benefits from desktop virtualization in these organizations include: ● Improving efficiency in the IT department, enabling the delivery of higher service levels, better uptime, and higher availability and performance of clinical applications while maintaining staff levels ● Driving adoption of clinical applications by improving the usability and performance of legacy clinical applications ● Supporting provider mobility with wireless access, thin-client hardware options, single sign-on, and session virtualization In the rapidly changing environment created by the new incentives and regulations, IT efficiency and agility are critical to success for provider August 2010, IDC Health Insights #HI224536


organizations. The three organizations we spoke with are leveraging desktop virtualization with clinical applications to help their hospitals meet current demands and prepare for the future. IN THIS WHITE PAPER This White Paper is presented by IDC Health Insights and sponsored by VMware. The objectives were to gain insights into: ● The decision-making process for investment virtualization of clinical application by hospitals

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● The IT and clinical benefits experienced by three provider organizations that invested in VMware desktop virtualization solutions ● The importance of desktop virtualization in unleashing the value of electronic medical record (EMR) and other clinical applications To meet these objectives, IDC Health Insights conducted three indepth interviews with provider organizations that have adopted desktop virtualization of clinical applications in the 2009–2010 time frame; the interviews were conducted in March–June 2010. SITUATION OVERVIEW As the healthcare industry seeks to implement and drive widespread adoption of clinical computing, performance and accessibility of applications for clinicians are critical. In the hospital environment, solutions like desktop virtualization are increasingly playing a role in bridging the gap between available resources and satisfaction of enduser requirements. Incentives created by ARRA and the additional goals of PPACA are resulting in a surge of new EMR and computerized physician order entry (CPOE) system implementations, alongside expanded adoption of existing clinical information systems, analytics, and revenue cycle solutions. The growth in adoption of clinical information systems will result in a proliferation of point-of-care computing, dramatically increasing the number of client machines that need to be supported by IT organizations. Client or desktop virtualization provides a tool that can help provider IT organizations to: ● Deliver enhanced performance, uptime, and availability to providers using clinical applications

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● Drive efficiencies and improve service provided by IT staff implementing, managing, and maintaining clinical systems ● Improve accessibility and productivity for mobile users of clinical applications in complex care settings ● Create a foundation of a private cloud internally, virtualizing servers, applications, networking, desktops, and applications ● Manage healthcare information technology (HIT) efficiently by centralizing services in a single datacenter, thereby freeing up resources that were devoted to catering to individual endpoint devices ● Increase security by controlling information and keeping data off endpoint devices ● Lower operating expenses by redirecting IT resources from help desk calls to support new projects, EMR, and additional desktops for clinical applications — all without increasing staff SOLUTION DESCRIPTION Current commercially available software products encompass three types of virtualization: server virtualization, application virtualization, and, most recently, client or desktop virtualization. This white paper focuses on the features and benefits associated with virtualization of the client. Desktop and Application Virtualization

Client or desktop virtualization is a datacenter-centric computing model that borrows from the traditional thin-client model but is designed to give system administrators and end users the best of both worlds: enabling system administrators to host and centrally manage virtual and/or physical desktop machines in the datacenter while giving end users the traditional PC desktop experience to which they have become accustomed. In virtualized client environments, the software image of a physical desktop PC is replaced by a virtual PC running on a server. Each user accesses a unique virtual PC, complete with its own virtual CPU, RAM, and hard disk. Virtual PCs run concurrently on top of the virtualization layer provided by the hypervisor software, which also controls the computing resources (mainly CPU and RAM) allocated to the virtual PCs. Although multiple virtual PCs typically run on a single server, the crash of a single virtual PC is unlikely to cause other virtual PCs on the same server to crash. Users access datacenter resources via thin-client or full-client workstations. ©2010 IDC Health Insights

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Application virtualization separates applications from the underlying operating system and packages them with a virtual operating system in a completely isolated container. This allows users to run applications on the same desktop that may have conflicted before or run applications that use different Windows operating systems side by side on a single desktop. Applications can be virtualized and delivered into virtual desktops or traditional desktops. VMware Solution Description

VMware provides a number of solutions to accomplish virtualization implementations at the hospitals we spoke with. The VMware products in use include: ● VMware View provides a centralized virtual desktop and distributed virtual desktop that allow remote and local management of fully virtualized desktops. ● VMware ThinApp is a key component of VMware View and is also available as a standalone solution. This solution provides application virtualization to simplify application delivery and management. The three hospitals discussed in this study are using VMware View and ThinApp to deliver client virtualization solutions. BENEFITS Enterprises have discovered that the use of virtualization to support desktop workloads, like the use of virtualization in support of traditional server workloads, creates a range of significant benefits. These benefits include improved IT management efficiency, improved price efficiencies, and improved functional capabilities. The key IT benefits associated with desktop virtualization in the healthcare industry fall into the following areas: ● Enablement of thin clients. Because little computational execution occurs at the edge in a desktop virtualization environment, the computing architecture becomes less reliant upon the horsepower in endpoint devices. This creates an opportunity for IT to significantly drive down the cost of endpoint hardware either by extending the life span of existing PCs by repurposing them as client endpoints or by replacing aging PCs with a thin-client device, which typically operates across a life span twice that of a standard PC. ● Improved data security. The ability to move data from the edge of the IT environment into the datacenter inherently reduces the security risks to an IT organization. Centralization of data access can mitigate the risk of data leakage and theft and simplify compliance procedures. Page 4

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● Simplified data backup. Because centralized virtual desktops reside entirely within the datacenter, it is easier to ensure full compliance with backup policies. Furthermore, depending on how the platform is architected, the use of consolidated images and delta files may further simplify the abstraction and collection of important data, thereby simplifying backup processes. ● Simplified disaster recovery. Virtual machines (VMs) significantly simplify disaster recovery because central IT staff can easily revert virtual desktops back to their last known good states. Thus, IT no longer needs to provide spare endpoints that are up to date with the latest image. ● Time to deployment. In particular, when thin clients are used within a virtualized architecture, the process around deployment is significantly simplified because nothing is installed on the endpoint device. ● Simplified PC maintenance. When used appropriately, virtual desktops can be far easier to maintain than traditional PCs. Because of the unique characteristics of virtual machines, it can become quite simple to patch applications, provision/deprovision users, migrate to new operating systems, and perform auditing duties. ● Flexibility of access. Because corporate desktop environments are centralized, access to them can be provided to users who do not have access to their own PCs, in situations where users need secure access to clinical systems while working from home, on hospital floors, in acute care environments, or in other remote situations. This is particularly important for mobile caregivers who work in or move between hospitals, ambulatory care environments, and other settings. ● Simplified application delivery and management. Applications virtualized into single image executables can be centrally managed and delivered to many endpoint devices. Application virtualization also minimizes application testing and help desk support because the application is completely isolated from the operating system, ensuring the same application behavior independent of the operating system configurations. While IT improvements are certainly impressive in their own right, enhancing the quality of care and patient safety is a top priority for the healthcare industry. Desktop virtualization can be a critical component of strategies to achieve these goals and deliver clinical benefits in healthcare. The clinical benefits seen by the three organizations we spoke with are discussed in the case studies presented in the following section.

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Desktop Virtualization at Three Healthcare Organizations

Case Study #1: University of Toledo

The University of Toledo (UT) went through a profound change four years ago when a 20,000-student university merged with a 300-bed teaching hospital. The opportunities presented by such a merger seemed endless. But with those opportunities came challenges; merging cultures, departments, and of course, technology was no easy task. There are more than 10,000 Windows desktops in the combined institution and over a dozen Information Technology support groups managing them. Josh Spencer, Team Lead for the Desktop Development group in Information Technology, provides desktop administration support such as application packaging, imaging, and desktop automation for more than half of these PCs. He identified a common challenge that plagues each of these groups: "maintaining stable desktop images and keeping them updated with the ever-changing software suites." A variety of methods have traditionally been used at UT, ranging from group policies to scripting upgrade routines to "sneakernet." According to Spencer, "This is particularly challenging because unlike some industries which require a handful of applications to do business, the IT groups at UT have to support hundreds of software titles." Any number and combination of applications might be required in student labs, in clinics, and in training rooms. The sheer number of applications and computers makes it difficult to keep the images current. The endless varieties of software combinations introduce instability.

There are more than 10,000 Windows desktops in the combined institution and over a dozen Information Technology support groups managing them.

Spencer's team has implemented VMware View and ThinApp in both clinical and academic environments to address these challenges. Ben ef its of Ap pl ic at i on Vi rt ua liz at i o n

Over the years, the Desktop Development group has implemented a variety of application packaging technologies in an attempt to reduce the age-old problem of dll and registry conflicts. While incremental improvements have been realized, the group has found that these technologies all fall short, causing a great deal of administrative overhead to manage application conflicts and a loss of productivity for end users. About three years ago, the group decided to try application virtualization using VMware ThinApp. This technology has two key components that made it a success: application isolation, which improved desktop stability, and application streaming, which reduced administrative overhead and increased uptime. According to Spencer, "Application isolation not only allows us to segregate the application and all of its dlls; we can actually include all supporting applications in the virtual 'bubble.' This concept introduces a level of stability never before attainable in our desktop environment."

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According to Spencer, "Application isolation not only allows us to segregate the application and all of its dlls; we can actually include all supporting applications in the virtual 'bubble.' This concept introduces a level of stability never before attainable in our desktop environment."

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Today, the Desktop Development group has approximately 40 virtualized applications in production, the majority of which are in the clinical environment. The clinical staff at the UT Medical Center use applications such as McKesson Star Navigator and Care Manager and Allscripts Vision. These applications have all been virtualized and are streamed to thousands of physical and virtual desktops throughout the institution. "We started with our most complex and problematic applications and saw the benefits of application virtualization immediately," said Spencer. Applications such as Allscripts Vision require a specific set of prerequisite software such as Java, .NET framework, and IBM Informix Connect. Managing each of these applications independently and ensuring that they remained at the appropriate level to support Allscripts Vision proved to be a challenge. Spencer noted, "We simply put all the prerequisite software in the bubble with [Allscripts] Vision, and we don't have to worry about what is or isn't on the host; the application just works." Another improvement in stability comes from the fact that once virtualized, applications that would normally require local administrative privileges to function can run as a standard user. Spencer's team is now deploying clinical desktops with restricted privileges, preventing unauthorized changes and improving uptime. Administrative overhead for deploying and upgrading applications has been reduced dramatically through the use of virtualized applications. Rather than using traditional install/upgrade methods, Spencer's team is streaming applications from a central server. This method reduces the need to make changes on the endpoint computers. Spencer said, "We no longer have to write a scripted upgrade routine for our applications. We simply update an executable on the central share and the work is done. We've seen our failure rates for an application upgrade drop from 5% to nothing; people sometimes don't even know we've done anything." Clinical applications that have been altered by application packaging of any kind are usually not supported. Spencer's team made the decision that the benefits from repackaging outweighed the risk of diminished support from vendors and uses a traditionally installed version of the application when contacting support. Ben ef its of D e skt op Vi rt ua liz at i on

The University of Toledo used VMware View to build a private cloud infrastructure, providing students with on-campus and off-campus access to hundreds of virtual machines in dozens of unique configurations. Last year the university decided to implement 300 new virtual machines along with thin-client devices as part of an electronic medical record initiative in the Medical Center hospital. A variety of factors were involved in the decision, and several technological solutions were considered. In the end, VMware View provided the security, flexibility, and manageability the university needed to be successful.

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Prior to the implementation there were approximately 600 PCs in the UT Medical Center hospital. The Horizon Electronic Documentation project required an additional 300 PCs to provide bedside patient care. The work of deploying and managing these devices had to be done with no additional staff. Spencer's team worked with Clinical Informatics, Hospital Client Services, Server Administration, Network Engineering, and other IT groups to design a system that met the needs of the clinicians and that could be supported with existing human resources. Wyse thin-client devices with custom XP embedded images were deployed to wall-mounted arms in patient rooms, desktops in nursing units, and mobile carts. Barcode scanners were attached to most devices for use in bedside drug administration. The thin-client devices were programmed to connect only to the VMware View servers. The benefits realized from virtualizing the desktop environment at the University of Toledo Medical Center include: ● Removal of data from the endpoint device. Traditional desktop PCs allow end users to store sensitive information on the local drive, creating a potential risk in the case of theft. The thinclient/View model keeps all data in the datacenter and prevents anything from being stored locally. ● Reduced administrative overhead. Because applications on the virtual machines have been virtualized, allowing for more restrictive local privileges, desktop stability is greatly improved. On the occasion that a VM does need to be reimaged, the use of VMware snapshots has reduced what takes more than an hour with a traditional PC to less than five minutes. "Our technicians can simply use the Virtual Center console to revert a VM to the snapshot taken when it was created. In a matter of minutes, the clinician is back up and running," said Spencer. ● Lower-cost endpoint devices. Thin clients are a fraction of the cost of a typical PC and have a longer life expectancy. ● Energy savings. Spencer reported that an internal power study shows a considerable reduction in energy consumption for thin clients and supporting back-end infrastructure compared with traditional PCs currently used in the hospital. For the IT team at the University of Toledo, key learnings have included understanding how clinicians work, how they want to work, and what they need to be successful and then balancing all of that information with HIPAA requirements and the internal resources available to provide support.

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Case Study #2: Overlake Hospital Medical Center

Overlake Hospital Medical Center is a nonprofit community medical center that includes a 337-bed hospital and about 10 local clinics. Overlake uses MEDITECH for its inpatient clinical and administrative systems and plans to upgrade to MEDITECH Client/Server v6.0 in August 2010. The outpatient clinics run eClinicalWorks for practice management and EMR, and in addition to the 10 hospital-owned clinics, an additional 1,000 community physicians are supported for a total of roughly 3,000 end users. Director of Technology and Information Security Officer Joseph Wolfgram will deploy desktop virtualization to 900 desktops out of his 1,800 workstations in 2010 and expects to see substantial future growth and the need to add additional endpoint hardware to support EMR users including clinical documentation.

Overlake Hospital Medical Center is a nonprofit community medical center that includes a 337-bed hospital and about 10 local clinics.

Before selecting VMware, Wolfgram conducted a technology evaluation and vendor selection process, as well as a formal proof-ofconcept process, and looked at multiple vendors. Overlake's criteria for selection included the ability to deliver a virtual desktop with a user experience identical to that of a local workstation, with no delays or pixelation, and the ability to offer full-screen, slow-motion video without pixelation or chop. After a successful proof of concept using PC over IP display technology on a virtualized client, he began a VMware standard evaluation, assessment, and deployment project. Today, about 100 users at Overlake use a VM every day, the new clinical system is being built on the VMs, and Wolfgram is deploying virtualized production servers and storage. All EMR training and eventually clinical documentation at bedside will use the virtual machines. Cl in i c al a n d Ad m in ist ra t iv e B en ef it s

Overlake plans to use VMware View to deploy MEDITECH systems for EMR and CPOE, as well as the eClinicalWorks practice management and EMR in its affiliated clinics. While the clinics currently use tablet PCs as their thin client, the virtualized system may deploy on the iPad in the future, which Wolfgram expects to be more reliable than the PCs currently in use. According to Wolfgram, "Any clinical application that we can move to a virtualized desktop, the plan is to move it there. I'm not aware of any specific technical limitations today that we've run across for any of our 160 applications we support." Like his peers at the University of Toledo, Wolfgram has run into licensing and support limitations. Wolfgram finds that license offerings from vendors lack options that are efficient for the virtualized environment, and he prefers to duplicate problems on a nonvirtualized machine to ensure they are not related to the environment before accessing vendor support. He uses NetApp storage and a "snapshotting" feature to move the applications from a virtual machine to a physical machine quickly.

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The benefits that clinicians at Overlake have seen from desktop virtualization include: ● User experience on virtual machine that is identical to user experience on local machine. In order for desktop virtualization to be successful, the user experience with the virtual machine needed to be identical to the user experience on a local machine. For example, start menus and scrolling on the virtual machine needed to behave identically to those on the traditional, local desktop. ● Video capabilities for training and patient education. Fullmotion video is delivered to the virtual machines without chop or pixelation, allowing clinical staff to complete annual training requirements that are delivered as video segments and to make videos available to patients. Although Overlake is not using telemedicine, videoconferencing tools such as Skype are being used to connect remote clinics and deliver information via video. ● Reduced cost. Overlake will realize cost savings by using virtualized servers and storage, in addition to using desktop virtualization to lower costs associated with thin-client workstations. ● Faster log-ins and mobility for clinicians. The upgraded clinical systems will provide advanced functionality and improve security, but at the same time they will require individual log-ins to replace shared workstations, which was expected to add to log-in delays for both Windows and the clinical systems. Mobile clinicians in Overlake's hospitals may need to log in hundreds of times during a shift, making these delays quite significant. The virtualized desktops will follow the clinicians, allowing for quick connections and disconnections, while the desktops and functionality follow the provider. ● Easier desktop management and faster software delivery. From the IT perspective, it will be easier to manage desktops, and staff will be able to deliver and maintain software more efficiently. ● Improved security. With a virtualized desktop, the data never leaves the datacenter, and patient data and sensitive information is not resident on the end devices. This will replace a slew of point solutions that are currently in place and maintained on local machines, such as local firewalls and encryption, creating a win for maintenance, support, and security. Ben ef its f rom D e sk to p Vi rt u al iz atio n

At Overlake, IT goals include virtualization of clinical workstations as well as administrative workstations. The number of virtualized clinical workstations is expected to reach 900 initially, but it could grow to 1,100 with the implementation of the new EMR and could reach 2,000 across 12 facilities with the added administrative workstations. Phase 1 of the effort will virtualize about 80 clinical and business applications that are delivered on individual user virtual desktops.

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The number of virtualized clinical workstations is expected to reach 900 initially, but it could grow to 1,100 with the implementation of the new EMR and could reach 2,000 across 12 facilities with the added administrative workstations.

©2010 IDC Health Insights


Overlake's clinical IT environment includes about 90 applications that will be virtualized. Applications that will be virtualized later include financial systems and departmental systems for emergency and surgery. Some legacy clinical applications will continue to run outside the virtualized environment as Overlake considers the value proposition for virtualization. According to Wolfgram, a few clinical applications have "really strict access control criteria and run on proprietary hardware, so many of our clinical systems that are like that, we have no plans to virtualize it, even if we could technically make it work, it doesn't make sense, too much effort." Physician buy-in has been a focus at Overlake. According to Wolfgram, "For the EMR, the MEDITECH upgrade, we've got a physician champion, and we are working very closely with him to make sure he's exposed to our piloting. He was in on the proof of concept. He's giving us guidance in terms of what our physicians are expecting to see out on the floor — are the connects and disconnects fast enough, is it running across enough platforms including mobile devices like the iPad, that sort of thing. So we're in the throes right now of gaining buy-in from the physician community." Physicians' concerns about the workflow changes from the EMR clearly outweigh those about the virtualized environment. "They actually see the virtualized desktop as something that's going to be saving a lot of pain for them because without it, there would be a lot of really slow log-ins that would need to take place," said Wolfgram. One of the lessons learned about virtualization at Overlake included understanding the costs. In the virtualized environment, it was important to have high-speed servers, a high-bandwidth network, and significant available storage, which added to the costs of hardware — mainly servers, disks, and networking equipment — to support the virtualized environment and achieve the required performance levels. A local implementation partner at Overlake also played an important role. Wolfgram emphasized that "it's critical to have an implementation partner that has done virtualized desktop deployments in production and in a healthcare setting. There are things that are unique to this environment, and you want an organization that has had experience, not just the education of virtualized desktop implementation, because there are a lot of technical details that don't exist in the traditional desktop environment that really matter in a virtualized environment … having an implementation partner that has kind of blazed their trail before you that's helping you avoid potential problems, I think that's critical." Clinical benefits from virtualization at Overlake have included: ● Faster log-in times for providers. The ability to log in quickly and easily improves the productivity of providers who must log in from different locations many times during the workday. ©2010 IDC Health Insights

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● Continuous sessions. Provider sessions are continuous when the providers change locations because they can reconnect to an existing virtual machine in a new location and pick up where they left off, improving productivity. ● Remote access. Compared with existing systems, the virtualized desktop provides a significant improvement to the performance of the clinical applications when accessed remotely. Providers may access their desktops from any location with the Internet and a Web browser, and the access is faster and less complicated. ● Improved security. Security on the thin-client devices used in the hospitals as well as for remote access has improved as a result of centralizing data and information. ● Ease of use. Accessing systems is less complicated, response times are faster, and thin-client devices are allowing providers to access clinical data in a more mobile fashion. Case Study #3: Phoebe Putney Memorial Hospital

The IT department at Phoebe Putney Memorial Hospital is responsible for systems at 3 hospitals and about 15 clinic sites throughout southwest Georgia. The three hospitals include Phoebe Main, a 450-bed acute care hospital; the newly acquired Phoebe Sumter, with 74 beds; and Phoebe Worth, a 25-bed critical access hospital. In addition, the IT team is adding responsibility for hosting a MEDITECH system at the Southwest Georgia Regional Medical Center in Cuthbert, Georgia. The hospitals have different administrative and clinical systems, and given the varying sizes of the hospitals, they have different goals and requirements for their systems that prevent the standardization of clinical and administrative systems.

The IT department at Phoebe Putney Memorial Hospital is responsible for systems at 3 hospitals and about 15 clinic sites throughout southwest Georgia.

Phoebe Main has the McKesson Horizon Inpatient Suite and Horizon Ambulatory Care installed at its clinics. At Phoebe Main, CPOE implementation is two-thirds complete, putting the hospital well on the path to achieving meaningful use and qualifying for ARRA incentives. The Phoebe Sumter and Phoebe Worth hospitals will be migrated from Healthland to MEDITECH Client/Server v5.6, and the newly acquired Southwest Georgia Regional Medical Center will also be migrating to the upgraded version of MEDITECH, which will allow it to access clinical applications including CPOE. All of the IT systems for the hospitals will eventually be centralized at Phoebe Main, with applications distributed to individual sites using server virtualization and VMware View for desktop virtualization. Virtualizing the servers has allowed the IT team to put 28 servers on 6 physical boxes, saving considerable space and money. The three rural MEDITECH hospitals will have a total of 800–900 users; about 100 people are using VMware View right now. Each patient room at Phoebe Sumter will have a thin client using Page 12

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VMware View, and this hospital could eventually have 200–300 VMware View seats. At Phoebe Main, 5–6 of the McKesson application servers were virtualized when the hospital upgraded to version 10.1. In addition, home-based transcriptionists and coders and the oncology department are using virtual desktops. A rollout planned for this fall will include Horizon Expert Documentation as well as wired Wyse thin clients in hospitals for nursing documentation. Horizon Expert Orders physician documentation is planned for rollout next year. Cl in i c al a n d Ad m in ist ra t iv e B en ef it s

About two years ago, the IT team at Phoebe Putney first looked into virtualization for its home transcriptionists when it needed to replace an aging Citrix implementation. The team looked at multiple options and considered the costs of training and hardware, alongside ease of use, installation, and support. It determined that centralizing support with the VMware solution offered the best option to support the current needs of the remote users and the future needs for clinical applications and growth in the hospitals. Additionally, a resourceintensive oncology application it was running in many remote clinics did not support Citrix but could be optimized on VMware View. The requirement to support the oncology application across a limitedbandwidth link was a key factor in the decision to use View. The Phoebe Main hospital will eventually have 400–450 thin clients in patient rooms to support Horizon Expert Documentation. The IT team expects it to be easier to have the solid state thin client in the rooms and run the operating system on the back end using View. Benefits to nurses from using virtualized clients are expected to include: ● Reduced downtime. The thin clients will replace PCs and be locked down and less likely to break or malfunction. Patches can be done on the back end to the operating system, and users don't need to worry about rebooting when patches are installed. ● Faster log-ins. Nurses will see improved speed of access and be more efficient due to the addition of single sign-on and multiaccess log-in. ● Improved mobility. Users will have the ability to pick up open sessions when they change locations, making them more efficient. ● Expanded functionality. Nursing documentation functionality has been implemented at the bedside using the virtualized thin clients. The hospital also has a medication administration system installed, and nurses are able to scan medication barcodes and document administration of medication using the thin clients. In the future, the thin clients will also be used to implement CPOE for physicians.

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Ben ef its f rom D e sk to p Vi rt u al iz atio n

Clinical testing has been done within departments and clinical informatics using the thin clients and nursing documentation applications. Although the system has not been rolled out on floors yet, according to Michael Elder, Director of Technical Services, "…clinical informatics has given us thumbs up on all the applications, the speed, the efficiency of the unit … the application is working well, printing is working, everything seems to be a go for that. So far the applications are working well; the efficiency of it, speed, ease of use — all that's really good. Integrating that single sign-on solution with it too is a big part of that and all that seems to be working without any problems." The IT team expects the providers to appreciate the speed, response time, and mobility advantages of the virtualized solution. In addition, the IT team expects to virtualize the physician portal that doctors use to access PACS images and EMR data remotely, which will eliminate the need to send technicians to provider offices to perform updates to the software, which is currently installed locally at provider offices. To date, the system has made early users, the home-based coders and oncology clinics, more efficient. Home-based coders and transcriptionists report that even when working from a setting without high-speed Internet access, they have been able to work efficiently and experience less downtime using View. For the IT team at Phoebe Putney, key learnings have included the need to educate users thoroughly about the process for using the virtual desktop sessions in order to keep things running smoothly and to test systems thoroughly before going live. The IT team also reports significant ROI from the use of virtualization. In addition, the hospital is reaching out to other hospitals in the region that are not part of the health system to see if they want to partner to share resources and access the hosted MEDITECH implementation. FUTURE OUTLOOK IDC Health Insights expects to see extensive adoption of all types of virtualization, including client virtualization and application virtualization over the next three to five years. Growth in use of virtualization will occur as healthcare organizations increasingly see the benefits of virtualization and its ability to help them meet the demands for efficiency and productivity that are resulting from new healthcare reform and IT initiatives. Providers will begin to observe their peers putting in place virtualization implementations; conducting successful proof-of-concept projects; and putting virtualization into production with new EMR/EHR, ordering, and other clinical systems. IDC Health Insights also anticipates that the use of virtualization as an infrastructure used to manage desktop environments will continue to

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Growth in use of virtualization will occur as healthcare organizations increasingly see the benefits of virtualization and its ability to help them meet the demands for efficiency and productivity that are resulting from new healthcare reform and IT initiatives.

©2010 IDC Health Insights


expand with the growth in the capabilities and maturity of virtual desktop platforms, alongside the compelling clinical benefits and ROI. Early adopters of virtualization technology in healthcare will continue to provide a proving ground for horizontal vendors that are moving into the high-growth healthcare market. An increasing number of centralized virtual desktop (CVD) platforms will become available to healthcare organizations, driving competition in pricing as well as products and features, including industry-specific functionality. The willingness of legacy application vendors to support healthcare information and clinical systems in a virtualized environment may limit growth initially. However, it is expected that clinical vendors will improve support for virtualization as the demand from providers grows and as the ability of virtualization to provide performance, application and data security, and complementary features that are not accessible or difficult to improve in their legacy applications becomes clear. Additionally, inpatient and ambulatory healthcare IT vendors will begin to facilitate virtualized implementation, creating more seamless, simple, and comprehensive platforms. ESSENTIAL GUIDANCE Desktop or application virtualization may not be right for all organizations or for some user populations in healthcare. Virtual desktop infrastructure does add a layer of complexity to the existing infrastructure that might deter some organizations from going ahead in a short time frame. Clinical application vendors have hindered the advance of virtualization across the industry — as many have been slow to embrace virtualization or to support and/or certify the performance of their products in a virtualized environment. However, this is more of an issue with server virtualization than with desktop virtualization, and IT executives in provider organizations have responded accordingly. Care should be taken when implementing desktop virtualization to ensure that it is an efficient approach for utilizing all of the application services that a specific user, or class of users, is accustomed to accessing. Applications that are graphic intensive, for example, may not perform as well in a virtualized desktop environment. While server virtualization may require a larger environment and number of servers to reap benefits, desktop virtualization is not subject to the same constraints. Application virtualization and repackaging may complicate accessing vendor support for healthcare applications, but the benefits may outweigh this risk for many healthcare organizations and applications; as with any new technology implementation, an assessment of the benefits and risks for the organization and its IT infrastructure should be considered. The majority of provider organizations support desktop environments sufficient to justify the investment and see considerable economic and operational benefits. Š2010 IDC Health Insights

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CONCLUSION With stimulus funding in the mix, the outlook for investment in clinical applications is strong. Although hospitals have been slow to adopt EMR and CPOE technology and current adoption of comprehensive EMR and CPOE is estimated to be below 20%, various industry estimates predict that 50–60% of all U.S. providers will take advantage of stimulus funding to install EMR and CPOE by 2016. This will bring EMRs into use by the majority of providers and dramatically increase the responsibility of hospital IT departments for supporting clinical desktops and applications. Tools like desktop virtualization and application virtualization will be required in order to support these additional desktops while maximizing the productivity of both IT and clinical resources. The benefits that accrue from desktop virtualization projects include cost savings that will help stretch IT resources and capabilities, productivity enhancements for providers that will help ease the change required to move to electronic clinical processes while keeping providers mobile, and security measures that will help control data access in the expanding clinical computing environment.

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Better Patient Care: Virtually There  

This IDC Health Insights White Paper identifies the key benefits from desktop virtualization in the clinical environment and presents case s...