Sentara Healthcare, a health system based in Norfolk, Virginia, uses an Epic electronic health record that connects its 12 hospitals and various clinics on the same platform. This has enabled clinicians to access and exchange patient records more quickly.

"Epic is presented to clinicians via a presentation layer, which is purely web-based and allows seamless integration with existing EHR products," explained Matthew Douglas, chief enterprise architect at Sentara Healthcare. "We previously deployed our presentation layer through Citrix XenApp, which had a physical infrastructure, making it hard to upgrade and maintain."

THE PROBLEM

The main challenges Sentara faced surrounded scale and cost. As Epic has increased the frequency of code releases, Sentara had to scale up and add more servers to continuously meet the Epic demand for capacity. From a financial perspective, the health system was not realizing any cost efficiency as the system scaled.

"We needed a solution that would improve price transparency as well as system complexity," Douglas stated.

PROPOSAL

Sentara was one of the first organizations to deploy vendor VMware's RDSH using Epic. An RDS Host is a server computer that hosts applications and desktop sessions for remote access. Douglas said VMware was of considerable help throughout the migration process.

"We actually collaborated to bring this new offering to market, and developed a new presentation layer through the VMware Horizon Client Architecture," he explained. "This solution provides end users with access to both desktops and applications in a Horizon environment, and is available on desktop PCs, thin clients and mobile devices on multiple operating systems."

"I speak with IT leaders at other healthcare organizations all the time, at least weekly, and I always advise them to consider alternative approaches for remote desktop hosting."

Matthew Douglas, Sentara Healthcare

Over the course of about one year, the joint effort between VMware and Sentara Healthcare included more than 120 iterations and updates. At this point, the platform is very stable.

"Additionally, Sentara was able to reduce complexity by moving to a flexible VMware VSAN HCI environment from a Citrix physical server infrastructure with half the staff," he added. "This helped Sentara gain uptime and ease patching and maintenance. Ultimately, we were able to save more than $1M in licensing and reduced support and operations costs."

MEETING THE CHALLENGE

Through VMware Horizon Client, the presentation layer is fully virtualized, and Sentara has seen significant improvements in stability and performance.

"Horizon has given us the ability to scale and to meet Epic demand for more capacity, while also requiring fewer hosts than in a Citrix environment," Douglas reported. "The ability to consolidate data centers in multiple hospitals throughout the state has led to major economic savings.

"We also saw value in deploying vSAN, VMware's storage virtualization software, which ensured that we don't have to make major investments on storage space," he continued. "When the compute, memory and storage all is in one place, you see significant improvement in speed and response."

Further, VMware is a fully integrated solution with everything in one place, so Sentara does not have to spend on other third-party solutions, he added.

"Currently in healthcare, an EHR is the lifeblood of the health system, as it contains medical history, diagnoses, medications, immunization dates, allergies, lab results and doctors' notes," Douglas said. "For patients undergoing serious operations, cardiac arrest, etc., uptime and availability problems with these EHR systems can cost people their lives. Because of that, I designed our solution to focus on uptime, reliability and cost efficiency."

RESULTS

Since deploying VMware's solution, resilience and performance have increased, and helped Sentara to maintain close to 100% uptime.

"We've been able to scale out our environment to meet the Epic demand for more capacity," Douglas said. "We started out supporting 12,000 to 13,000 concurrent sessions, to now supporting 16,000 to 18,000 concurrent sessions. With our pending merger with Cone Health, we anticipate adding another 5,000 concurrent sessions in the near future."

Migrating and deploying Epic with VMware RDSH has helped Sentara save millions of dollars as the system has scaled, he added.

ADVICE FOR OTHERS

"I speak with IT leaders at other healthcare organizations all the time, at least weekly, and I always advise them to consider alternative approaches for remote desktop hosting," Douglas said. "Most healthcare organizations are thrilled that there is an alternative option that allows for choice in the market and negotiation power. At a time when so many providers are facing tighter budgets, the cost savings and price transparency completely level the playing field."

Beyond financial implications, alternative approaches to remote desktop hosting can improve healthcare organizations' security posture, he noted.

"Virtualized desktops minimize the impact of widespread security breaches, because images and data are hosted by the centralized server, instead of on the end user's machine, giving hackers fewer points of vulnerability to attack," he concluded. "There have been recent news reports about significant security breaches at provider organizations. Centralized, virtualized desktops would have mitigated the impact of at least some of those breaches."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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