When Sunrise Health Region's massive medical records digitization and app centralization project went awry, a VDI deployment fixed its issues and jump-started the use of digital health records.
Sunrise Health Region (SHR), one of 13 health care regions within the Saskatchewan province of Canada, began its 3,000-seat virtual desktop rollout last year. Applications for digital medical records are hosted in a central data center shared by the entire province.
The project goal was to lower costs and make it easier for transitory patients and health care professionals to access records, regardless of where they are. Unfortunately, the result was massive delays with application login times and clinicians resorting to paper to track patient records.
Sheranga Jayasinghe, SHR's director of IT who oversees the delivery of services for 3,500 employees and approximately a 120,000 patient population, spoke with SearchVirtualDesktop about these problems and how it used a mix of desktop virtualization software to meet its centralization goals.
What problems were you attempting to solve with your VDI initiative?
It was the clinical successes that justified this for us.
director of IT, Sunrise Health Region
Sheranga Jayasinghe: We had several things we wanted to fix. The first was the application login times for our clinicians, which would take anywhere from two minutes to 13 minutes per application. A clinician would spend hours a day just logging into systems because of delays and because there were no standards for a common username and password across those different applications. That was taking time away from caring for patients.
Secondly, because of those login issues, there was very low uptake to use clinical applications and they were switching to paper instead to manage patient records.
Third, there was no central way to map printers to individuals within our environment. Finally, we were asked to implement a tracking system to cut down emergency wait times and we needed to track how much time a patient spent in the ER and what steps they would take while they were in our care. A system like that requires constant uptime and speed so the information is being entered and [kept] up to date. Our existing environment wasn't going to let that happen.
How did you decide on what virtualization tools to use? You have a varied stack instead of just going with a single vendor.
Jayasinghe: We spoke with one region that had already gone down the virtualization path, and rather than reinvent the wheel, we asked how they did it. Then we tailored what they did to our unique needs.
The front end was a challenge, because those guys went with VMware's View but View didn't support .Net smartcards for employees to tap into and out of sessions. Citrix's XenDesktop did, so we went with that.
We needed a zero client that could work with any environment and Wyse was the choice because it played well with Citrix. For user profiles, AppSense gave us the granularity we were looking for to manage our roaming profiles.
Application virtualization was a challenge because I wanted a solution that doesn't require my server or application team to spend time on [it]. I wanted to hand that off to a deployment team once it was up and running. We found that ThinApp with VMware needed about 10 golden images and it wasn't the path I wanted to go down. We support 300 applications that range from 16-bit to 64-bit, but we wanted one golden image for the OS. We found Unidesk was the easiest choice for us because of its layering ability.
Since the rollout began, have you run into any problems or challenges with integrating all those products?
Jayasinghe: By mid-2013, we wanted two-thirds of our employees on VDI, and to date we have close to 200 virtual desktops rolled out. Any new user gets a virtual desktop, and we haven't bought PCs for six months now.
However, we should be further down the line by now. But we had a cultural mindset to virtualize each stage and we thought the applications would take us a long time. We assumed the choke point would be our storage and dealing with that was further down the roadmap after we got the applications taken care of. But 90% of the applications were virtualized within two weeks of beginning that stage, and we needed to plan our storage upgrade faster than expected.
How are you handling the storage upgrade?
Jayasinghe: We're building a brand new storage environment and we are slowing the VDI rollout until the storage is done. We are going with a HP 3PAR environment. The biggest challenge for storage was determining how many IOPS we'd have at any given time because we want to have persistent desktops.
That follow-me desktop session gets disconnected, but is still active after employees log off. Everything in our environment will be a live state. We ran some analysis on the environment and came up with a baseline of 50,000 IOPS at any given time. We looked at how many [virtual desktops were] running on a single host and decided it was about 80 per blade, and that's how we sized our storage.
The size of the storage environment is a challenge because you don't know how many images you need to create, which can be anywhere from a 5 GB to 30 GB per image. That complicates things. Fortunately, because of Unidesk's layering, we knew our applications didn't need to be installed on the single golden image, so it was just 5 GB times 3,000 desktops.
Networking bandwidth must be a challenge, too.
Jayasinghe: That was being planned for at the same time, but separate from the VDI rollout. Video conferencing is becoming the norm for health care in Canada and our network couldn't support that, which is why we started going 10 GB across the board.
The network also has to support the VDI anyway, because those 3,000 users are all going to hit the data center over the course of the day. So, it works out nicely that we were already upgrading that part of our infrastructure.
Wouldn't it just be cheaper to buy 3,000 laptops for your employees? How do you justify the return on investment of a project like this?
Jayasinghe: VDI is a significant capital investment up front and our plan was a $5 million investment over five years. For us, the return on investment hasn't been justified by the dollars. We didn't do this to save millions of dollars, though we expect our operational cost to be less in the end.
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It was the clinical successes that justified this for us. We transitioned them first and the number of clinicians accessing digital records went through the roof. We went from 300 records in a week accessed to 2,000 in a week.
The biggest success is during a 12-hour shift; they would spend hours logging in and out. We cut that down to 5-10 minutes. We gave two hours back to the care providers to spend with their patients.
There have been smaller successes as well, like reduced power consumption from the zero clients and my server team isn't analyzing or maintaining the virtual applications. There are significant improvements we see that are intangible to the operational expenses.
What do you know now that you wished you did when starting this project?
Jayasinghe: Rolling out a VDI isn't just rolling out a VDI. We are introducing a new way for secure printing, single sign-on for applications, smart cards for quick and easy logging on; there are lots of new things for users to learn. We never thought it would be a challenge, but the integrations with the smartcards and applications were difficult and sometimes frustrating with the end users. It' a challenge and now we introduce the new component first, and training second.
We don't have any regrets with the platform because it has been extremely successful; other provinces have taken our template and begun tailoring it to their organizations.
So what comes next? Would Desktop as a Service or the cloud help?
Jayasinghe: Once we get over that storage hurdle it's rolling this out entirely by year's end for all our employees. Right now we are fighting fires and being reactive instead of proactive, so we anticipate that will be different once the rollout is complete. But we always have other projects to do and we still have to keep doing those projects while monitoring our infrastructure to handle this.
As for the cloud, there's interest but it's held back by health care regulations in Canada. Technically, we can use the cloud for running our applications, but we can't have the data center sitting in Alberta or Manitoba, it has to be located in our province. That means using Google or big public cloud services won't work for us, but local colocation centers would.
Image: Sheranga Jayasinghe