Value-based care initiatives have pushed healthcare organizations to embrace more advanced technology as priorities have shifted from security concerns to how to access information securely, quickly, and conveniently.
Virtual desktop infrastructure (VDI) and virtual infrastructure solutions have become more prominent ways for healthcare organizations to consolidate health IT systems and save on infrastructure costs while increasing operational efficiency.
As health IT grows more advanced, patients expect clinicians to use technology that allows them to easily and securely access necessary information.
VDI supported by virtualized infrastructure consolidates processes and allows clinicians and IT administrators to cut down on the time spent logging in or monitoring systems, devices, and applications.
HITInfrastructure will review the basics of VDI, and discuss how some organizations have successfully utilized it to improve workflow and patient care.
What is VDI?
VDI uses abstraction to remote desktop operating systems to mobile devices. VDI separates the desktop environment and application layer from a user’s endpoint device. Users access their personal desktop via any thin client device on the network without having to go through a long login process.
The desktop operating system is hosted on a centralized server in an organization’s datacenter. Instead of logging into a cloud service, bringing up a personal profile stored on the cloud, and logging into each app individually, VDI allows end-users to use a simulated version of the desktop on their main computer or endpoint device they use for access.
Changes made to the desktop on the mobile device will be made when the desktop is accessed again later on the end-user’s main computer and vice versa.
Because the endpoint is only used to access and display the desktop environment, no data is stored on the endpoint, making it more secure by design. VDI and its mobile version, virtual mobile infrastructure (VMI) are popular among organizations implementing bring-your-own-device (BYOD) policies because the contained environment severely reduces the risk of a security breach due to a stolen device. This is because the VPN used to access the virtual desktop containing the data is protected by standard endpoint security protocols.
“We treat our VMI sessions almost like medical instruments,” Avast Mobile Vice President Sinan Eren explained to HITInfrastructure.com. “We assume that an endpoint device is untrusted at best, especially in a BYOD situation, and compromised at worst. We assume that it’s a contaminated area. Like a single-use medical instrument, we create a session for the particular application that the professional needs to access, like an electronic health record (EHR) application.
“We create a single disposable session, deliver the application to the endpoint, and when the medical professional is done interacting with the application, that session is completely disposed.”
How healthcare organizations can use VDI
Clinicians are constantly moving between exam rooms and accessing different patient records, often spending valuable time logging in and out of secure desktops. As value-based care initiatives take more of a hold, organizations are looking for technology that will save on infrastructure expenses and increase the quality of patient care. This often leads clinicians to VDI.
“The ability to allow rapid access to a desktop from various clinical areas is a foundational need for most organizations,” Faith Regional Health Services CIO and Vice President of Information Technology Brian Sterud told EHRIntelligence.com. “There are the same advantages in non-clinical areas; however, they are not nearly as exaggerated as time and efficiency doesn’t demand the same priority.”
Login times have plagued clinicians since healthcare organization began to widely implement EHRs. Clinicians spend a large amount of their time logging in and out of different systems and medical applications, preventing them from spending as much time with the client as possible.
Pivot3 Chief Marketing Officer Bruce Miline explained to HITInfrastructure.com that clinicians face challenges at the point of care whether it’s in an admitting room or a consult room, or logging into all the applications.
“Clinicians need to get all the patient information and to capture their patient data as they’re doing their diagnosis,”said Miline. “We found that clinicians were spending something 10 minutes per engagement logging into all the applications, because every time they went into a new room, they had to log in again as their persona on all those applications.”
Miline explained that healthcare organizations are demanding quick, simplified solutions that are easy to maintain and deploy.Southern New Hampshire Health (SNHH) has deployed an advanced VDI solution to cut down on login times so clinicians can better interact with their patients.
SNHH Desktop Configuration Engineer Scot Tymowicz told HITInfrastructure.com in a 2017 interview that his organization has wheeled computers in several areas, such as the clinical floors, the emergency room, and the ICU. Those devices are completely wireless.
“They have batteries in the bottom of the carts and they’re physical desktops like you would find at any desk,” Tymowicz explained. “The nursing staff and the doctors use these and move around the organization, go into a patient’s room and do their job.”
In the face of value-based care, fast and secure logins are critical to increasing the quality of patient care.
“We are noticing right now that the old environment took our users about two minutes from the moment they tapped in with their badge to a usable desktop where they actually hit the internet or open a medical application and start doing their job,” Tymowicz noted. “Now, we’re seeing login times of 28 seconds on the new environment.”
Virtualization also assists healthcare organizations in remaining HIPAA compliant. Tymowicz stated that passwords in most legacy healthcare environments are usually typed out by the user an average of nine times every login. It’s typed to access the desktop, access email, and access the medical applications needed for that session.
“Staff doesn’t want to have to worry about their passwords,” Tymowicz stated. “As HIPAA-compliance becomes more complex and medical regulations become more complex, IT’s job is to make sure that environment is secure. IT can’t do that if nurses are using sticky notes with their son’s birthday on it as their password right on the computer; that’s not a secure environment.
“What is a secure environment is IT enforcing a 10 or 20-character alphanumeric password, with dollar signs and periods and numbers that staff never has to type because all they have to do is wave their badge. We have a highly secure environment, but it’s extremely easy and seamless for the end-users. It’s a win-win for everyone. I made it easier for my end-users to get to their resources to do their jobs, and I win because it’s highly secure.”
When clinicians leave their mobile workspace, they can log out in a way that is HIPAA-compliant without exiting current deployed apps.
Understanding virtual infrastructure and hyper-convergence
Organizations looking to implement VDI or other virtualization solutions need an infrastructure advanced enough to support it.
“We’re seeing some really interesting demand for advanced solutions in healthcare now because of the cost pressures on data centers and the need for immediate very secure information,” Pivot3’s Miline said.
Healthcare organizations are not only looking to cut back on login times, but they are also actively seeking to cut back on infrastructure costs as well.
VMware Healthcare Industry Solutions Director James Millington explained how virtualization will often start as a consolidation project where organizations are looking across particular services and applications that they are running. Entities are also trying to consolidate a lot of the data bases in the backend in the data center.
“So the databases themselves could be spread across a large number of servers,” Millington told HITInfrastructure.com. “By virtualizing the servers, they're able to reduce the physical footprint, essentially sharing the resources of a single server amongst multiple workloads where prior to virtualizing, it might be one particular workload to one piece of hardware.”
Millington explained that hardware isn’t fully utilized and organizations are wasting CPU time. Hardware is a significant datacenter expense that many organizations can cut back on.
Each server puts a physical weight on an organization, because it needs to be housed, cooled, wired and maintained. Virtualizing servers reduces the physical footprint by allowing IT administrators to put multiple workloads onto a single piece of hardware, reducing the size of the data center.
Reducing hardware will cut back on infrastructure costs while simultaneously improving the quality of patient care with faster, more efficient systems. For example, SNHH uses a specific type of virtualized infrastructure, hyper-convergence, to combine health IT systems and support their VDI solution.
“What’s great about the hyper-converged environment is, we use a single sign on solution so our staff can tap their badge on the cart, get logged in to the medical applications they use, and start doing their job,” stated SNHH’s Tymowicz. “If they’re in the room with a patient, and there’s an emergency and they have to leave that room, they can quickly wave their badge over the computer to lock it and secure it which is a major issue for HIPAA compliance. They can exit the room and address the issue.
Tymowicz added that while a doctor is attending to an emergency patient, and needs to use another computer, the doctor can wave his badge on a second computer. From there, whatever workflow the doctor had on the other computer seamlessly follows him.
“If they needed to look up the second patient’s medical history, or something quickly, their session is already open,” Tymowicz stated. “All the time spent launching applications and logging in, is no longer part of the equation, slowing down the process.”
By implementing virtualization, healthcare organizations are able to support a more efficient and cost effective health IT infrastructure. Clinicians can give patients better quality care when they don’t need to spend so much time logging into secure systems, and IT administrators are able to have more control over their infrastructure when it is controlled from a virtualized datacenter