Virtual Desktops Follow Hospital Staff On Rounds

Norton Healthcare, the largest health care supplier in the Louisville, Ky., region, has adopted end-user virtualization as a means of giving doctors and nurses a desktop that follows them on their rounds.

The five-unit acute-care hospital chain and supplier of 11 neighborhood clinics is in the process of providing 1,000 thin clients to end-user end points, such as nursing stations, clinic treatment centers, and 50 physician offices. With three shifts a day, most end points have three different users every 24 hours, noted Brian Cox, director of IT customer services.

Norton implemented VMware's View in place of Citrix Systems Presentation Server because it wished to upgrade Meditech, its core patient tracking/medical record application. "Meditech changed the design of the client. It wouldn't work right on Presentation Server. One particular printing session would back up and overrun the system, with 20 to 30 other users calling in" to complain they couldn't access the application, he said.

Presentation Server virtualizes an application and sends application results down the wire in response to the end-user queries. Cox likes virtualizing the whole desktop -- applications combined with an operating system. His VMware View environment spins up copies of golden images (customized desktops) from storage in his Louisville data center and runs them on one of six ESX Server hosts. Each host can handle 160 to 180 virtual desktops, he said.

A few golden images take up "one-quarter to one-third of the space" on his storage area network compared with what he used to devote to end-user applications. In addition, each end user's virtual machine functions in a "sandbox," or set of parameters that limit what memory and other resources it can access. That way, "other users continue to work if one process goes wild," he said.

The nature of the image is determined as the user logs in and calls for a desktop. VMware View retrieves the appropriate image and links the user to a central server. The images are created by IT staffers using View Composer, VMware's virtual desktop modeling tool.

(Citrix Systems, in addition to Presentation Server, now offers virtual desktops through XenDesktop that are spun up from central images.)

With VMware view set up, Cox has been able to let doctors and nurses move around the hospital and still access their desktop from the closest thin client, often at the nursing station of a wing instead of having to go back to their own desks. Their desktops can be called up from any location and used to enter patient information or look up patient records. "That's very important. The sooner patient information can be entered after seeing the patient, the more accurate it will be," said Cox. Patient charts also are available over the system, so a doctor can see recent entries by nurses on blood pressure or pulse rate more frequently than if they had to go to the patient's room.

Giving health care providers quick access to their virtual desktops has become a priority. A new hospital, Norton Brownsboro, a 127-bed facility opening in Louisville in August, has been designed to have a thin-client niche between every two patient rooms.

The conversion to VMware View began in the fourth quarter last year and is about 30% completed, said Cox. Among the users are 16 to 20 contract medical coders who enter insurance codes for diagnoses and treatments.

They use the Wyse V10L thin clients because the hardware supports two monitors. The coders get more work done per hour by being able to display a patient record next to the form they're required to fill out. That small change makes it easier for coders to work from home, Cox said, saving employee time and medical office space.

Cox says virtual desktops on thin clients still require "tweaks" that VMware recommends, such as turning off the "preview" mode for messages in Microsoft Outlook or eliminating the slow, CPU cycle-consuming fade-outs of tips that pop up on the screen.

But a thin client represents "one-quarter of the capital expense of a full-scale PC." Cox realizes there's still a server expense that must be divided across each block of 160 to 180 desktops, but he maintains that adopting virtual desktops "positions us for the future in a tough economy."

The thin clients have no hard drives or CD-ROM drives to break down. He doesn't know their life expectancy, but with no moving parts he thinks they'll last a long time. If for some reason a user's desktop stalls, the process of troubleshooting consists of rebooting it off the central server. Remote users are restored to operation the same way as end users just down the hall, with no drive to a distant doctor's office to provide service.

"These are much easier to support. We don't have problems from these devices. There's nothing we've wanted to do that's not worked," said Cox.

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