As one of the largest nonprofit outpatient healthcare providers in California, Sansum Clinic handles 650,000 patient visits per year. That's a lot of frequently changing data about prescriptions, exams, tests and billing, and until recently, a lot of it was on paper.
To treat the problem, the clinic has spent more than two years putting in an electronic medical records system. The question was how best to help busy doctors, nurses and other caregivers ease into using the new system.
The politics of a project are just as important as the technology. "Nothing is more personal to a user than his PC," says Dick Csaplar, an analyst at Aberdeen Group. "A couple of loud users with executive ties can shut down a program."
Sansum chose thin-client devices running desktop virtualization software from Citrix. The devices are simple for IT to manage and in some ways look like a typical desktop computer, says CIO Tom Colbert.
"There's nothing on the device except the Citrix software," says Colbert. "You just log in and are provided with the applications that your user profile says you can access."
Each exam room has a terminal that boots up a virtual desktop, allowing medical staff to document patient visits electronically, updating centralized, real-time information. IT installed 400 new terminals in Sansum's exam rooms and replaced 600 PCs with thin clients.
Csaplar says Sansum was smart to choose thin clients, which run a stripped-down but upgradable operating system, over zero-client devices, which use operating systems embedded in the firmware. The minor software upgrade requirements of thin clients are worth it to preserve the option of being able to use new software features, he says.
The project started in 2010 and was fully implemented last year. So far, Sansum has cut medical transcription costs more than 90 percent. Gone are illegible medical notes. And since all clinicians access the same patient information--such as a list of which medications a person is taking--data is now more accurate.
Virtual Desktop Success
Desktop virtualization isn't without its challenges. For example, some companies find that lower device costs are offset by increases in storage and bandwidth costs, Csaplar says. Sansum offset some expenses via the American Recovery and Reinvestment Act of 2009, a federal program that, among other things, offers financial incentives to healthcare organizations that meet certain criteria.
Going virtual, though, requires meticulous infrastructure planning, Colbert says. Sansum evaluated its bandwidth down to the circuit level, building in alternate pathways or planning local copies as backup.
The organization also planned multiple test cycles to address desktop virtualization's more complex configuration requirements. "We had situations where the printing configurations on each device would disappear while we were doing our nightly refresh," he says.
Then there are the political shoals. Colbert secured user buy-in early, conducting demonstrations for staff to explain how the new devices would work. "You have to let them know very specifically what's coming, when, and who it will affect," he says.
The ultimate mark of success comes from former skeptics. "Even though many staff members hated the idea of giving up their PCs at first," he says, "a lot of them wound up liking it."