Healthcare organizations tell all: desktop virtualization adoption trends explained

Transcription

1 Healthcare organizations tell all: desktop virtualization adoption trends explained

2 For years, Imprivata has worked with and learned from our virtualization partners and hospital organizations around the world. And together, over the last five years, we have predicted that healthcare organizations would continue to adopt virtual desktop infrastructure (VDI). And we were right. This year, we decided to take a deeper look into the adoption trend, and chose to speak directly with some of our experienced healthcare customers who have adopted VDI. From planning to ensuring continued success, they told us how VDI has affected their organizations. Five-year trends The healthcare industry has been rapidly increasing its virtualization adoption in order to facilitate clinical workflows. We have tracked multiple VDI trends over the past five years, and have found that: Adoption of VDI technology in healthcare has increased steadily from 2011 to 2015, from 35% to 66%; by the end of 2017, adoption is forecasted to be 81% Adoption of VDI with single sign-on (SSO) is an essential combination; in 2015, 88% of surveyed respondents deploying VDI over the next 24 months plan to include SSO Reliance on PCs as delivery endpoints for VDI is being reduced, with thin and zero clients maturing; in 2015, 83% of respondents used thin clients, while 42% used zero clients Mobile endpoints will continue to play a major role in healthcare VDI over the next 24 months; smartphone adoption is forecasted to show a 67% growth by the end of 2017 All four trends indicate that the healthcare industry is rapidly moving toward VDI as a way to enable faster, more convenient access to patient information, which benefits everyone across a healthcare environment, from clinicians to IT.

3 Healthcare to healthcare sharing Mike Aitchison, Systems Operations Information Services Manager at Pomona Valley Hospital Medical Center, says that, In healthcare IT, there s a lot of sharing of information. We share how we do things. We share how we build things. It is in that spirit that we chose to interview eight healthcare organizations to understand how they implemented VDI, the results of those implementations, and any future trends they are watching or expecting and then to share those experiences and thoughts with you. Representatives came from: Beaufort Memorial Hospital; 197 bed acute care hospital located in South Carolina Jefferson Radiology; largest radiology private practice group in Connecticut Metro Health: University of Michigan Health; 208 bed general acute care osteopathic teaching hospital in Wyoming, Michigan, and throughout greater Grand Rapids Moffitt Cancer Center; 206 bed facility located in Tampa, Florida, and the no. 6 cancer hospital in the nation based on U.S. News & World Report NHS Lanarkshire; three district general hospitals serving the North and South Lanarkshire local authority areas in the UK Pomona Valley Hospital Medical Center; 453 bed, not-for-profit regional medical center located in Pomona, California University Hospitals Health System; 1,032 bed tertiary medical center with locations throughout northeast Ohio Walnut Hill Medical Center; 100 bed full-service hospital in Dallas, Texas In healthcare IT, there s a lot of sharing of information. We share how we do things. We share how we build things. - Mike Aitchison, Systems Operations Information Services Manager, Pomona Valley Hospital Medical Center VDI: An overview Why VDI? I realized there was a critical problem happening in our clinical space, says John McFarland, the Director of IT Business Management at Moffitt Cancer Center. We were starting to roll out physician documentation; we were getting ready for CPOE. And we realized that the existing process for physicians to access applications, as well as information, was too long. We weren t going to be successful at either deployment if things continued as such. For McFarland, VDI and SSO were the answer to his clinician productivity problem. Other healthcare organizations felt the same, and indicated that one of the driving forces for VDI implementations was enabling care providers to spend more time with their patients, and less time with technology. Josh Wilda, Vice President of Information Technology at Metro Health, implemented VDI in order to deliver an experience to clinicians that allowed them to treat patients, anytime, anywhere the patients needed to be treated, anywhere the desktop was. In order to maximize clinician engagement with patients, care providers need to be able to access EHRs and other clinical applications simply, quickly, and with consistent experiences across work environments.

4 The Imprivata OneSign solution with VDA has made the client and user experience much more seamless, and there is no learning process for the user. - Mike Bailey, Senior Virtualization Engineer, University Hospitals Health System When the process by which a care provider accesses clinical applications and protected health information (PHI) is simplified and shortened, clinical workflows are more easily optimized. VDI can help to facilitate fast, easy desktop roaming, remove long desktop login times up to two minutes per login, per care provider and can enable healthcare enterprises to take full advantage of their SSO environments. Aaron Miri, former CIO of Walnut Hill Medical Center, says that a VDI implementation means that a doctor could easily go from med surg, or to the OR, to the ICU, and their session would follow them, drastically simplifying and shortening existing workflows. For IT, VDI creates an environment of easier maintenance and management of systems. VDI allows IT departments to retire and replace aging physical PCs, which lowers the costs and time of desktop deployment, and decreases overhead costs. And, from an administration perspective, says Miri, implementing VDI meant that the IT team wasn t tasked with sending out dozens of people to various parts of the hospital to repair or fix an issue. Plus, he says, VDI enabled the IT team to easily upgrade multiple desktops, and environments, at once. Enterprise security was also a huge concern among VDI decision-makers. With VDI, IT departments could easily maintain patch levels for security, as well as remove generic logins, which heightened security across the healthcare system. Two healthcare organizations shared that new hospital launches served as a driving force to implement state-of-the-art technology, including VDI. For them, VDI and single sign-on (SSO) together were the golden standard of technology. Importance of single sign-on Every IT representative interviewed said that they would recommend that healthcare organizations adopting VDI also adopt SSO at the same time. In fact, they said they wouldn t move forward with VDI without SSO. SSO and VDI are seen as a winning combination, as they completely enhance each other s capabilities. Healthcare organizations with both SSO and VDI implemented find that SSO and VDI function as complete complements to one another. Healthcare organizations who had SSO deployed before VDI saw that VDI truly unlocked the power of SSO something that holds particularly true with the introduction of thin and zero clients. For healthcare organizations who implemented SSO and VDI together, the same was true SSO and VDI complemented each other perfectly. Organizations found that SSO made the adoption of VDI easier for end users, as the value of VDI was easier to see with SSO. A simple badge tap to sign in also became a critical component of their VDI strategy. Mike Bailey, a Senior Virtualization Engineer at University Hospitals Health System, says the Imprivata OneSign solution with VDA has made the client and user experience much more seamless, and there is no learning process for the user.

5 Matthew Barrett, Director of Infrastructure and Security at Jefferson Radiology, described SSO as a driving force for VDI implementation. Jefferson Radiology coupled VDI and SSO together, which helped to win people over because care providers could immediately see the benefit of speed and ease. With both SSO and VDI, the time it takes a care provider to log in is drastically reduced. One healthcare organization reported that their legacy process on initial boot took three to four minutes, while the same process now only takes 20 to 25 seconds. Another healthcare organization reported that their process that included only SSO used to take 45 seconds; now, with both SSO and VDI, the process only takes two to three seconds. John McFarland, of Moffitt Cancer Center, explains why this difference is so profound: Most technicians will say, What, 45 seconds? That s fast. When you put that in the real world, when you think about subsequent logins, and when you think about the impact on the patient, waiting 30 seconds for that desktop to reconnect could feel like a lifetime. The ability to get back to your desktop in seconds rather than minutes really improves patient care. And, he says, the combination of SSO and VDI together really enabled that further. With SSO and VDI, login times were reduced from 45 seconds to 3 seconds Virtual desktop implementation Obstacles to implementation VDI extends benefits to many people across a healthcare enterprise, but those interviewed indicated that they still faced some obstacles to a smooth implementation. Getting management, clinicians, and IT departments on board and educated was described as a key obstacle to VDI implementations. I think it was important to get other departments involved, says Leeanne McElroy, the Senior Systems Delivery Engineer at NHS Lanarkshire. However, it was difficult to get them on board because other departments didn t immediately understand VDI. To solve this problem, every IT department needed to be shown the benefits of VDI. Even when IT was on board, some clinicians still needed a push in the right direction. Clinicians, especially those who weren t tech savvy, also needed to be trained on the new technology and workflows. To implement VDI, and implement it effectively, existing infrastructure must be robust enough to support its implementation. VDI leans on different infrastructure facets that need to be prepared ahead of deployment, and may be expensive. Healthcare organizations that were interviewed stressed the importance of not underestimating infrastructure resource requirements, including people, and ensuring that the existing EHR can integrate with the VDI environment. Willard Fosberry, Director of IT Infrastructure at Beaufort Memorial Hospital, says to make sure that you ve got your desktop admins and your technical staff prepared to keep the pools and their virtual 1-1 desktops in sync. You have to be ready to rapidly respond to changes with applications so that you can present your pools and your desktops directly for all of your end users. So having that technical staff ready, and what I call geeked up, is a must for any organization.

6 At the end of the day, I see a virtual environment as being a workflow enabler for clinical practice. - John McFarland, Director of IT Business Management, Moffitt Cancer Center The easier you can make technology to use, the better it s going to be for adoption and the clinical practice, says John McFarland, of Moffitt Cancer Center. Organizations largely deploy VDI to make care providers lives easier, while ensuring patient care remains unaffected. Technology shouldn t have overhead in the workflow, which proved to be a problem healthcare organizations needed to solve for. Using SSO removed extra overhead in that experience, McFarland says, and it was absolutely critical to do. For larger healthcare organizations, being geographically dispersed posed an issue, too. With a need to deploy VDI in multiple, spread out locations, it was important to truly understand the resources, planning, and time that would be needed. Approaches to VDI deployment When healthcare organizations were interviewed, a pattern of three common approaches to VDI implementation took shape. As with all complex implementations, Matthew Barrett, of Jefferson Radiology says, planning is key, and you should take as much planning time as you can. Having a strong understanding of clinical workflows in a hospital system is critical to knowing how to best implement VDI. During their VDI implementations, many healthcare organizations worked with application managers and clinical leadership to understand what workflows were already in place. It was also important to understand what the desktop requirements were going in, such as profiles and icons, so that there were no issues when care providers switched locations. As John McFarland, of Moffitt Cancer Center says, at the end of the day, I see a virtual environment as being a workflow enabler for clinical practice. Understanding workflows at the beginning of the process will allow VDI to truly facilitate and simplify those that already exist. Clinical leadership can help to reveal and clarify existing workflows, and getting them involved early in the process can prove useful, as clinical champions can greatly impact the success of a VDI implementation. And, Aaron Miri, former CIO at Walnut Hill says, it s just as important to work with supporting departments, like labs those types of departments that touch every part of the hospital because those departments can trip you up. It s essential to work with those departments, Miri says, because it s easy to miss a workflow. Once workflows are understood, planning for a successful implementation is key. Better, more thought-out planning leads to an easier implementation. Many healthcare organizations worked with a strategic partner and project manager to plan their VDI vision, and ensure its completion. Half of those interviewed took more than six months to plan, with one organization taking as long as three years. It then took anywhere from six months to two years for healthcare organizations to deploy.

7 Part of the planning process included determining whether to implement VDI with a gradual rollout and a pilot program or as one big bang deployment. Every healthcare organization interviewed chose to gradually roll out VDI. Many started with their nursing populations first, as they had roaming workflows and tended to be the most dynamic. Paul Luu, a Systems Engineer at Pomona Valley Hospital Medical Center, says that nurses were the, people that would validate the system and provide valuable feedback on how their experience was. VDI deployment is a continuous, never-ending process, though it s important to continue to work toward more wide-spread adoption with higher percentages of virtualization across an enterprise. Current VDI use Virtual environments Virtual desktops are key to enabling quick and easy workflows across a healthcare enterprise, regardless of what kind of virtual environment already exists. Healthcare organizations interviewed used both Citrix and VMware virtual desktop infrastructures, and all of them are either using or will be using thin or zero clients within the next year. VDI isn t intrusive to physicians because they can access patient information anytime, anywhere. - Josh Wilda, Vice President of Information Technology, Metro Health Adoption A VDI environment is only as useful as care providers and IT make it, so their reactions and adoption are vital to success. All healthcare organizations reported favorable reactions from clinicians. Josh Wilda, of Metro Health, says that VDI isn t intrusive to physicians because they can access patient information anytime, anywhere. And we ve had physicians call us to thank us for giving them that access. Wilda shared that he knew of care providers who had used the power of VDI to their advantage, even during their personal time, away from the hospital: one was able to diagnose a patient while on vacation and waiting for a ski lift, while another was able to diagnose a patient from his living room during a Michigan State halftime break. Some healthcare organizations reported that there were departments that were not part of the initial rollout, but saw the benefit of VDI, and started requesting it ahead of their scheduled rollout. Paul Luu, of Pomona Valley Medical Center, says that care providers quickly saw the benefits of VDI. They could see that VDI helps them with roam-ability, saving time, having a consistent environment that works, and not needing to focus on technology, Luu says. Instead, they could be focused more on patient care. Most healthcare IT teams were receptive to VDI, and those who were initially skeptical were quickly persuaded once they saw the impact that VDI could have on the business especially the ability to easily fix issues without having to visit every patient room. Adrian Hargan, Systems Delivery Manager at NHS Lanarkshire, says that it s really important to get buy-in from your own staff, because their hard work drives the entire project forward.

8 One healthcare organization reported a savings of $15 million using VDI and SSO Complementary product usage Many hospitals with VDI use some form of a third-party product to address specific issues they have with their environments. Typical issues solved for are profile management, printing, and device management. Printing, in particular, tended to be an issue among healthcare organizations, due to increased roaming workflows. Printing is a totally different animal, Paul Luu, of Pomona Valley Medical Center says. There are so many levels of complexity, he says, from making sure the print drivers match those in the virtual environment, to ensuring spoolers don t crash. The challenging process has proved hard to simplify. Deployment saturation and ROI Healthcare organizations who were interviewed are supporting anywhere from 1,200 to 5,000 users. While not every organization keeps track of specific VDI saturation metrics, those who do report that they currently have between 90% and 97% virtualization adoption rates. Specific ROI measurements were rarely monitored by the IT departments at the healthcare organizations interviewed. However, Josh Wilda, of Metro Health, mentioned that in a year, we save 10 to 15 million dollars by having the clinicians spend more time at the patient bedside than logging in to the system and doing the work that a normal PC delivery would do. And, he says, we thought that was huge. Future paths What s next for healthcare Due to the range of VDI adoption and maturity of the healthcare organizations interviewed, what s next is not an easy question to answer. Their responses fell into four categories: Continue to face deployment challenges Look to increase the percentage of VDI adoption Happy with where they are Aspirational plans For those with aspirational plans, some trends and next steps they re looking toward include: Hyperconverged capabilities, which could support virtual environments in different ways, including being able to quickly scale a data center Remote access, which would help to support the portability of virtualization and access Enhancements to SSO, which could replace badges with biometrics Real time analytics, which would allow for more robust auditing and reporting

9 Web-based and cloud-based applications Of particular interest to those in the healthcare industry are applications, and how they are, and will be, supported in a VDI environment. When asked specifically about web-based and cloud-based applications, most healthcare organizations indicated that they aren t seeing a significant impact from those types of applications, nor are they working strategically to support them. Josh Wilda, of Metro Health, explains that his users are used to receiving an entire desktop, so there is limited need for web-based applications at his organization. Because of VDI, there s really no need for web-based applications, he says. When someone comes in and tells us that they want to use a web application, we just think, Why? You can do that from your VDI desktop. Some healthcare organizations find that it s hard to support so many apps, as they may have conflicting requirements. Mike Aitchison, of Pomona Valley Medical Center, explains that with so many apps up to 300, he says it s almost impossible to be able to support every requirement. We end up getting stuck to a specific browser and version, and to specific settings, Aitchison says. To me, that defeats the purpose of being a web app; a web app should be browser agnostic. It s bring your own device or nothing. You must enable the clinician to do what they need to do, to be able to roam effectively, and to maximize time at the bed side. - Aaron Miri, former CIO, Walnut Hill Medical Center Healthcare organizations provided differing views on the cloud and cloudbased applications in healthcare, however. Those disparate opinions likely explain the lack of widespread cloud adoption in healthcare for now, at least. Mike Bailey, of UHHS, explains one reason why healthcare may be hesitant to adopt cloud-based services and applications: I think it s a scary topic for anyone in healthcare to think about, because it would mean traversing your data across a WAN further than it needs to go. And then there s somebody else securing that data. Bailey believes that the cloud is likely the solution of the future, but it s tricky for healthcare to adopt immediately. Aaron Miri, former CIO of Walnut Hill, however, believes that healthcare should start embracing the power of the cloud: You re seeing key players like Epic leverage the cloud because of its usefulness, the utility of pushing out data everywhere, and the ability to aggregate data sources quickly and seamlessly. Miri stresses that hospital CIOs must get in front of that eventual migration, and understand that, if some component of it is not being leveraged, you re living in the dark ages. The need to support legacy applications that are not cloud enabled also stands in the way of widespread healthcare adoption of the cloud. Those legacy applications could continue to be used for the next ten years, or so, but there is an increase of cloud-ready applications being developed. It will take the big vendors and EHRs moving away from traditional application development to truly push the healthcare industry towards cloud adoption.

10 Protecting patient information is extremely important. So ransomware is one of our biggest concerns right now. Because it wreaks havoc. - Paul Luu, Systems Engineer, Pomona Valley Hospital Medical Center Bring your own device strategies More than half of healthcare organizations allow bring your own device (BYOD) strategies, but enable them in different ways. What they all agree upon, though, is that they allow BYOD strategies specifically to support clinicians by giving them the ability to access real-time PHI from anywhere, on any device. Many healthcare organizations are taking a traditional approach to BYOD and are working to expand their usage of mobile device management (MDM) platforms, but John McFarland of Moffitt Cancer Center is approaching it from another angle, and is providing the same desktop experience on any device. We are going to serve the exact same desktop experience no matter what device you re using, McFarland says. So I think it s an all-around win because we no longer have to restrict the policy to a specific make and model. Aaron Miri, former CIO of Walnut Hill, adds that from his perspective, it s bring your own device or nothing. You must enable the clinician to do what they need to do, to be able to roam effectively, and to maximize time at the bed side. There are some difficulties associated with BYOD, though. Many applications are not mobile-friendly, and EHR-specific mobile applications offer no comparison to a full desktop experience. They re improving, but currently can t provide a full picture of a patient s PHI. Security and two-factor authentication Protecting patient information is extremely important, says Paul Luu, of Pomona Valley Medical Center. So ransomware is one of our biggest concerns right now. Because it wreaks havoc. To combat potential threats, like ransomware, healthcare organizations are looking to continue to enhance the security of their enterprises. Healthcare organizations reported using two-factor authentication to secure access outside the four walls of the hospital, or remote access. Others reported already having it implemented for the e-prescribing of controlled substances (EPCS), and are now evaluating solutions, such as Imprivata Confirm ID, for their remote access needs. Metro Health is even using two-factor authentication and VDI for vendor access. We actually get to control security that way, using Imprivata, so we don t have vendors just doing anything, says Josh Wilda of Metro Health. Aaron Miri, former CIO at Walnut Hill, says that two-factor authentication for medical devices could be a metaphorical surgical pause in a healthcare environment. In the OR, they do a double check to make sure that you are who they re meant to be operating on, and that they re sure of your health information, Miri says. Why can t we create a surgical pause in the clinical environment to make sure make triple sure that things like administering a narcotic, which could lead to a bad outcome, are double checked?

11 Thinking outside the box: Bringing VDI to patients Metro Health was one of the earliest adopters of, and leaders in, VDI and they continue to innovate and consider new possibilities. Josh Wilda discussed a vision for the future; one that includes VDI for patients. How cool would it be if we could start providing desktops to patients, he questions. Because you re a patient here, we would actually be able to give you a computer experience. He mentions that this would allow patients the social benefit of being able to keep up with their PHI inside and outside of the hospital. Advice: where to start and who to ask Where to start When those in healthcare are looking for advice, they look to who else others in the industry. Healthcare organizations want to learn from the experiences of other healthcare organizations. Mike Aitchison, of Pomona Valley Hospital Medical Center, says that he really enjoys that, among healthcare IT, there s a willingness to share information. Healthcare has its own little IT world, in a way, because in healthcare IT, there s a lot of sharing of information, Aitchison says. Some other IT worlds are a lot more private and aren t open to sharing their methods, but in healthcare there s a lot of sharing. It s important as healthcare IT leaders not to only look at what our peers are doing within the industry, but well outside of it as well, to start thinking about how we can revolutionize healthcare. - John McFarland, Director of IT Business Management, Moffitt Cancer Center Willard Fosberry, of Beaufort Memorial Hospital, mentioned that he also looks to trusted partners and vendors for insights and direction. We have been keeping an eye on Imprivata for a long time, Fosberry says. They seem to kind of get it in the clinical world and we have always considered them leaders. While healthcare organizations tend to look for answers within the healthcare IT space, some mentioned that they sometimes look outside of healthcare to supplement what they know already, take cues from other industries, and to think outside of the box. John McFarland, of Moffitt Cancer Center, says, it s important as healthcare IT leaders not to only look at what our peers are doing within the industry, but well outside of it as well, to start thinking about how we can revolutionize healthcare. Aaron Miri, former CIO of Walnut Hill, agrees. If you are truly trying to push the envelope, Miri says, look at Disney, look at Ritz Carlton, look at the Apple store, and look at the financial industry. And then look within your four walls. Because if you want to be next level, you have to think next level. Final thoughts Healthcare organizations overwhelmingly recommend VDI, as it enables faster, more convenient access to information in healthcare environments. In fact, they say that VDI is a must do. Josh Wilda, of Metro Health, offers: The advice that I have is don t be afraid to take the leap. But don t try to take this very innovative technology and just find a use case for it. If you do that, you re going to fail. I think the biggest piece is to really think outside the box, really think from the standpoint of where are our patients going to be. That s also when you have to think about where you can deliver this experience in a fast and easy way.

12 About Imprivata Imprivata, the healthcare IT security company, enables healthcare securely by establishing trust between people, technology, and information to address critical compliance and security challenges while improving productivity and the patient experience. For further information please contact us at or visit us online at Offices in Lexington, MA USA Uxbridge, UK Melbourne, Australia Nuremberg, Germany The Hague, Netherlands Once the decision has been made to implement VDI, planning is of the upmost importance. Matthew Barrett, of Jefferson Radiology, brings the point home: I would say planning is key. Take all the planning time you can. More planning is always better for you, especially with this, because you have one shot to get it right, to get it accepted. Take the time to profile the work stations, and to profile the applications. Take the time to ensure the stability of your system, because that is critical to your success. It might look great, it might work for 30 minutes. But it needs to work all the time, says Paul Luu, of Pomona Valley Medical Center. It s like turning on a faucet; you expect water to come out. That s what nurses expect from VDI. So we depend on our vendors and the stability of our infrastructure to work together. After the planning has been perfected, the next step is to get care providers and IT on board. Without nursing, physician, and IT leadership, the project may not reach its full potential. If you can actually show something to them to actually ease their day-to-day interaction with the computer and the patient, says Willard Fosberry, of Beaufort Memorial, that goes a long way to creating a successful solution for any healthcare organization. Implement SSO with VDI the combination truly unlocks the strengths of each separate solution. SSO and VDI together was a game changer for us, says Mike Aitchison of Pomona Valley Medical Center. Leeanne McElroy, of NHS Lanarkshire, says that tap-and-go, which enabled VDI adoption, has been a big savior for us. And Aaron Miri, former CIO at Walnut Hill, offers: VDI, to me, is like a boat without sails unless you have Imprivata OneSign Single Sign-On implemented with it. I highly encourage organizations to adopt SSO and VDI and go forward. It s been a win for me, and the hospital was successful and profitable because of technologies like those offered by Imprivata that just worked. Copyright 2018 Imprivata, Inc. All rights reserved. Imprivata and Imprivata OneSign and Confirm ID are registered trademarks of Imprivata, Inc. in the U.S. and other countries. All other trademarks are the property of their respective owners. OS-WP-Virtual-Adopton-Trend-0318