Denali Deploys Virtual Desktops To Give Doctors More Time With Patients

When solution provider Denali Advanced Integration helped prepare and deploy a virtual desktop infrastructure based on Cisco UCS for Seattle Children's Hospital, it depended as much on its ability to monitor doctors' daily workflow as it did its top-notch server and networking skills.

Indeed, a key part of the implementation was the assigning of a Denali expert on medical workflows to follow doctors and other staff on a daily basis in order to make sure users of the new virtual desktop system saw little or no change in their daily routine.

Seattle Children's in late 2009 decided to implement a virtual desktop infrastructure to enable its medical practitioners to move from one patient workstation to another without the need to boot up a PC and without worrying that patient data might be accidentally accessed by the wrong people.

The key factor behind the move to virtual desktops was the need to make it faster for doctors and other personnel to access patient information and related data, said Wes Wright, vice president and CTO at Seattle Children's.

"With the iPad, people have gotten used to instant-on," Wright said. "You can't get that with a PC no matter what you try. It takes four minutes to boot a PC up. But with VDI, we found we could go from turning on the device to doing work in 43 seconds."

Because medical personnel see so many patients, Seattle Children's medical staff move from device to device over 100,000 times a month, Wright said. "They moving from station to station, turning their devices on and off," he said. "Every minute, every second we could save our users impacts our costs."

Jake Hughes, chief technical architect at Seattle Children's, said in a worst-case scenario, a user might need to spend seven to ten minutes per patient dealing with IT.

"That includes waiting to log in, enter a password, and waiting for the apps," Hughes said. "That's out of a total of 20 minutes spent with a patient. It's pretty compelling when up to half the time spent with a patient is spent waiting for IT. And after Patch Tuesday, it can take about 12 minutes to turn a system on."

Hughes said Seattle Children's looked at both Citrix and VMware for virtual desktop technology, but decided on Citrix because of a long history of working with that company's XenApp application virtualization technology. Citrix also sweetened the deal by offering two free XenDesktop licenses for every XenApp license the organization had, he said.

In early 2010, once the decision had been made to use Citrix's XenDesktop, Seattle Children's starting doing a proof of concept on its existing Hewlett Packard c-Class server blade infrastructure. However, Hughes said, as the number of virtual desktops scaled, users noticed their performance slowing down.

Seattle Children's had looked at Cisco's Unified Computing System (UCS) in 2009, but decided to give that vendor a chance in the Summer of 2010 when Cisco offered a "Try and Buy" program, Hughes said. "We saw no degradation in user experience," he said. "That, combined with the cost, sold us on Cisco UCS."

What also sold Seattle Children's on UCS was Denali which, in partnership with Cisco, was able to deploy Citrix XenDesktop on UCS in less than a week, Hughes said.

Next: Stalking The Doctors To Model Their IT Use

Shawn Olson, vice president of network solutions at Denali, said his company worked with Seattle Children's to implement its UCS pilot system along with Citrix XenDesktop.

"As the customer did its tests, they found there were getting a lot more virtual desktops per server than with HP," Olson said. "With Cisco UCS's memory, it's easier to scale virtual desktop than on other platforms. It was interesting to watch how giddy Jake (Hughes) became when he saw how much they could scale."

Denali had done virtual desktops before, but the Seattle Children's implementation was its first on the Cisco UCS platform, Olson said.

The virtual desktop implementation went smoothly in part because of all the preparation done by Teresa DeLappe, process architect at Denali.

DeLappe, who before joining Denali was in the medical field, started working with Seattle Children's users to understand their workflow.

"When I came in to the project, my role was to engage on the clinical side," DeLappe said. "It wasn't to talk about the technology or the virtualization. It was to focus on how to deliver care to patients, and on how to enhance it. The best way to start was to look at the workflow, the number of clicks, and the users' relationships with the apps."

DeLappe, working with the medical center's executives, also learned that Seattle Children's biggest growth was coming in such areas as ambulatory and acute care. That gave her insight into how its users would change their IT use over time.

Understanding such mundane data as the number of clicks a user did, how many open applications they had, and the number of passwords they used was important to understanding workflow, DeLappe said.

"Once we understood the current state of the flow, we could identify any roadblocks new technology might create and then see how the future state of the workflow might be impacted by virtualization," she said. "We could then identify improvements for users, such as reducing the number of clicks they need in their process, or cutting out the need for multiple passwords. That could give them back an hour a day or some other time that they could then spend with patients."

It was also important to mold IT to how the users worked, and not the other way around, DeLappe said.

"Patient care is their primary purpose," she said. "If they feel a need to create a workaround to the workflow, they will do it. Our number one concern as we deployed the virtual desktops was the technology facilitate their workflow. We didn't want to deploy technology that inhibited their workflow and caused them to create workarounds. And they will create workarounds if they feel the need."

Lisa Blankenship, engagement manager and VDI program manager at Denali, said it was also important to understand how regulations such as HIPAA and JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) impacted the use of desktop virtualization.

For example, Blankenship said, with VDI, one user might accidentally bring up the last patient's records when visiting the next patient. "We had to make sure a physician could sign into only one workstation at a time," she said. "If they move to another workstation, they're logged off the previous one."

DeLappe's work was extremely important in deploying the virtual desktop infrastructure, Hughes said.

"She followed us into patients rooms, documented the work that was done, and even counted clicks," he said. "Other companies don't use workflow analysis, so they don't know where problems are until deploying a new system, or after. It's a major cause of problems."

Next: Choosing The Right Storage

On the storage side, Seattle Children's looked at several vendors before settling on Hitachi Data Systems' technology, including that company's VSP (Virtual Storage Platform), Hughes said.

"For storage, VDI is a unique workload," he said. "Most storage systems that provide SSDs on the front end will work. But for the performance we were looking for, Hitachi was our choice."

The HDS storage was implemented with the help of Advanced Systems Group, a Denver-based solution provider and long-term HDS partner.

Mark Teter, CTO of Advanced Systems Group, said that Seattle Children's uses SSDs in the HDS VSP to handle the boot storm, which is a time when multiple virtual desktops boot up at the same time, placing a strain on performance. The organization also uses the HDS VSP to handle archiving of images.

More important was the issue of patient safety, Teter said.

"In a hospital with over 1,000 desktops, if the infrastructure goes down because of the storage, lives could be at stake," Teter said. "That's why we selected HDS VSP."

The job at Seattle Children's is far from over. Blankenship said Denali is continuing to do workflow analysis and research as it finishes its work at the main hospital and starts getting ready to look at remote sites.

The medical organization is currently doing its third implementation of Cisco UCS, and will likely do more in the future, Wright said. And it will continue to depend on Denali to make sure it gets done right.

"Our VAR of choice is Denali," he said. "They take my team out of the integration, and lets us use our resources to help our business partners rather than just integrate technology. It's a joint accountability model. My department is accountable to our partners, and Cisco and Denali are accountable to us."