“The compute takes place somewhere other than the end-user device.”
It sounds simple enough, but, at the same time, his definition is loaded with countless possible structures and interpretations, much like an actual, meteorological cloud.
While many healthcare administrators see the benefit in using a cloud within their disaster recovery planning, most struggle with how best to incorporate and utilize cloud computing within their day-to-day operations. Some question the return on investment needed to create a private or hybrid cloud. Others raise concerns over the obvious security issues that one must face when storing critical health information in a network-based service.
To get a better understanding of cloud computing inside a dynamic healthcare environment, I contacted Wright and we discussed Seattle Children’s past and current experiences working within the literal and cyber clouds of the Pacific Northwest.
Background
Whether it is the work they conduct within their Craniofacial Center or how their physicians may access the multi-modality pediatric imaging studies archived at the University of Michigan Health System (UMHS), for years, Seattle Children’s Hospital has been on the forefront of utilizing cloud computing within their patient care models.
“I have been with Seattle Children’s and its research foundation since 2008,” says Wright. “Back then, we were well-positioned for running things in a private cloud. We were running Citrix XenApp where our applications ran on a server in the cloud. Next, we had our partners saving everything on the network drive and nothing locally. That was a huge step for us. Then we moved Infor, our ERP application, into the cloud, which is privately hosted by a company called Velocity. It runs all of our payroll and finance, our non-clinical work. That’s out in the cloud, and it has been for three years now. Right now, we are big into the private cloud, and we have one major application running outside of the organization. We have Software-as-a-Service models running in some of our other departments. Our transportation management system and our on-boarding are both Software-as-a-Service models run from the cloud.”
Being the CIO of both Seattle Children’s as well as Seattle Children’s Research Institute, Wright has to provide a balance of services for each set of stakeholders; not an enviable position for any IT administrator seeking to create a cohesive ecosystem. However, he says that employing a private cloud can reap many benefits for both sides of his organization. “On the hospital side,” says Wright, “once we showed them the speed and the mobility that the virtual desktop and the cloud bring, they were sold.”
“Over at the research institute,” he continues, “they have a lot of programs that I don’t yet have packaged in the cloud. Even though it may initially require a slightly stronger sales pitch on my part than it took in the hospital, I am confident that our cloud will be able to handle the much wider application diversity that is at the research institute, especially as we continue to provision VDI.”
Virtual desktop computing
Using a virtual desktop infrastructure, what many refer to as (VDI), allows for the creation of bespoke desktop environments containing end-user appropriate applications that are accessible through zero-client devices.
“We possess about 5,500 zero-client devices,” Wright explains. “These devices take four seconds to boot up, and when you log in they fetch a specific desktop for you. If you are a clinician, it will give you a clinical desktop that has a few more applications on it than the normal desktop. If you are a non-clinical worker, you will get the non-clinical desktop, which has mostly the productivity, time and ERP systems.”
To achieve this dual-desktop environment using their private cloud, Seattle Children’s looked to their long-time development partner, Citrix, for help. “They have been there ‘hand and glove’ with us,” says Wright. “In the medical side of the house, a lot of our major clinical applications are front ended with a Citrix XenApp server, which makes it easy for us to go with a Citrix XenDesktop.”
Calvin Hsu, Vice President of Product Marketing, Desktops and Apps at Citrix, is very familiar with Seattle Children’s cloud computing strategies, and he believes other facilities can benefit from their practices.
“Seattle Children’s uses software from Cerner and EpicCare; two major healthcare applications that are commonly used in the industry. The way that they deliver those applications is they take the client portion of it, the part that would normally run on the desktop or PC under someone’s desk, and they install that on a XenApp or XenDesktop server in their data center,” states Hsu. “Our software handles the connection to the end point, then through a set of technology we call HDX, we take the screen representation of that application and we optimize it. We then push it out over the network so that what shows up on their screen is the actual interface of that application, but it’s actually running somewhere in the data center. All in all, it’s a simple process that any facility can exploit.”
Unexpected benefits
| Wes Wright, Chief Information Officer at Seattle Children's Hospital |
By using their private cloud and creating two distinct desktops for its staff, Seattle Children’s has seen an increase in both productivity and end-user satisfaction. At the same time, Wright has seen a handful of unplanned benefits as well.
“With a zero-client desktop, it runs at seven watts of power, whereas a PC will run at 70 watts of power,” says Wright. “We figure we are saving about $100 per year, per zero-client device, as compared to what a PC would have been. We have 5,500 of those devices in use, which equates to about a half-a-million dollars in power savings each year. That was a benefit that we did not really count on. We already knew zero-client desktops were cheaper than running a PC and easier to maintain than a PC, but what we did not necessarily know is that we could have calculated that utility cost ahead of time and that savings becomes pretty substantial when you start using more than 1,000 machines.”
In addition to tremendous power savings, Hsu says there are some IT operational aspects that improve as well. “For example,” he says, “when IT has to patch an application, it could potentially take days to complete using the traditional sort of PC management method depending on how many end points there are. Let’s say you are trying to schedule a sequence of patching events and do those over night when fewer people are working and not paying attention. Industry averages say you are doing great if 80 percent of those patches the next day work without failure. That means 20 percent have to be remediated. That then requires someone from IT going out to that end point, out to that employee’s desk, and trying to figure out what’s wrong. So from an operational standpoint, there is a tremendous amount of savings there, and that time saving can be easily translated to a dollar amount.”
Another benefit of using a zero-client and a private cloud involves PC refresh costs. “This is a compelling argument for some of the cost justifications relative to provisioning a cloud computing environment,” says Hsu. “Now that an application is not literally consuming the CPU cycles of a device, it means that the end-point device can be anything. So while the application may get upgraded, and it may have CPU or higher memory requirements than the previous version, since it is running in the data center, one can more easily load-balance resources. IT does not have to upgrade all the end points for that new piece of software. Instead of having, say a three-year life cycle of a PC, IT may be able to extend that to five years, six years or eight years. A change in hardware is not required until that device breaks, and when it breaks IT can replace it with any device they choose. It doesn’t have to be necessarily a powerful end-point machine and, again, we are seeing more and more healthcare facilities justifying the cost of moving to a cloud by calculating this savings created.”
Bring your own device
| Calvin Hsu, Vice President of Product Marketing, Desktops and Apps at Citrix |
The movement toward “bring your own device” (BYOD) is another facet that the private cloud at Seattle Children’s addresses with ease.
Wright explains, “Today, I brought in my Microsoft Surface computer so that I can use my personal apps. I can connect my Windows Surface to our network through the cloud using a virtual desktop. I can use Windows 7 for my corporate things and Windows 8 for my private, personal things. We can let our researchers do the same things on their Macbook Pros or whatever they have, and I do not have to worry about the two environments mixing because they are two different environments that cannot mix and match with one another.”
Their bespoke virtual desktops allow the staff at Seattle Children’s to bring to work whatever device they choose because Wright and his team have set aside a specific wired/wireless network for that purpose. But if you want to get the corporate resources, you have to use a corporate virtual desktop.
Wright says, “If the system is set up with the proper forethought and care, by that I mean you have to make sure that the different environments cannot comingle, BYOD is very feasible in terms of safeguarding data relative to HIPAA compliance standards. Someone’s personal device cannot get onto our corporate wired network. It’s a secured network that requires a certificate, so they cannot get there. We have set up a different network called the ‘personal device network’ that people can put personal devices on. I think as the cloud grows, it can’t do anything but help with BYOD as long as that separation of church and state remains.“
On the horizon
While Seattle Children’s has experienced many successes by leveraging their private cloud’s
operational capabilities, Wright says, they are far from feeling as though their journey is complete.
“As I mentioned before, we have two desktop images that serve as our virtual desktop images,” he explains. “These two images are essentially the same. One image has clinical applications. The other image has Microsoft Office products and that sort of thing. With Amazon Web Services’ announcement of hosting virtual desktops in the cloud, it got us thinking about our standard desktops, our non-clinical desktops. We could go to Microsoft and say, ‘We want to take advantage of not only your Microsoft Office 365 productivity suite offering which is in the cloud, but we also want you to host our non-clinical desktops as well.’ That would mean that in a year or two, I will log in to my network at Seattle Children’s and I will get my standard, nonclinical desktop from the Azure Cloud from Microsoft. In terms of IT, what that will allow me to do is take the resources that I have currently in place serving those nonclinical desktops and devote them to our clinical desktops. That will allow them to work a lot quicker than they do now, and we can move forward with our plans to create a patient desktop as well.”
With the advent of evolving technologies and services, the possibility of creating individual, virtualized desktops for every constituent of Seattle Children’s community is not farfetched. The entire industry can follow suit and achieve higher levels of success if it aggressively seeks out new vendor partnerships and carefully considers the new paths cloud computing can create for workers and patients.
