Genesis Health System services a 10-county region encompassing the Quad Cities (Davenport and Bettendorf in Iowa and Moline/East Moline and Rock Island in Illinois) and surrounding communities. The health system and its affiliates offer a full continuum of care including hospital care, home health and nursing home care, hospice, and rehabilitation and long-term care. Genesis Health System encompasses more than 665 licensed beds, 600 physicians and 5,000 staff members.

The Challenge: Providing Flexible Application Delivery to Mobile Clinicians

Genesis Health System began using Citrix application delivery technology more than 10 years ago, in a limited implementation. Two milestones prompted the Genesis IT team to begin delivering applications with Citrix Presentation Server™: implementation of the Cerner Millennium healthcare information solution; and a merger with the Visiting Nurses Association (VNA). “Cerner was the first application we decided to deliver exclusively through Presentation Server,” said Joe Murray, systems administrator. “And the VNA was our first entity to use only Citrix-delivered applications.”

As the organization grew, it became increasingly important to give doctors and other clinicians the flexibility to work with the same applications across different workstations and locations. “We have many employees who travel between sites, such as a doctor going from the office to the hospital,” said Murray. “If the applications they needed weren’t loaded on the nearest PC, staff couldn’t work effectively. So we expanded our Citrix Presentation Server implementation to host applications such as GroupWise and Microsoft Office and deliver them to the doctors’ offices.”

With the launch of Cerner Millennium and the expansion of the Presentation Server environment, the IT team acknowledged the need for greater visibility into the end-user experience with applications. “We didn’t have the ability to identify what was causing a crash or to see the error messages users were getting without actually standing by someone’s side for eight hours,” Murray noted. “Since we are paying our doctors and nurses to deliver care to patients, and not to work on computer problems, we needed a solution to help us troubleshoot and prevent issues that were interfering with clinicians’ use of these applications.”

Expanding a Citrix Application Delivery Infrastructure Solution

To support and enhance delivery of applications across the organization, Genesis’ IT team upgraded to a newer version of Citrix Presentation Server with Microsoft® Windows Server® 2003 running on 110 HP servers, and also implemented Citrix EdgeSight™ on all Presentation Servers for application performance monitoring. Currently, the organization delivers nearly 300 applications to about 3,500 workstations, including Wyse thin clients and HP laptops on carts. Users connect to the Citrix Presentation Server environment via any standard browser using the Web Interface capability. In addition to physicians and nurses, users include administrative staff and home-based medical transcriptionists.

Improving the Clinician Experience

The Citrix solution is enabling Genesis Health System to improve clinicians’ experience with Cerner Millennium and other delivered applications by streamlining access, enhancing mobility, and preventing or quickly resolving issues. “With the ability to use applications from any device in any location with a consistent experience, our clinicians are reporting they are more productive,” said Kevin Stanfield, client device administrator. Added Murray, “Going back 10 years, the reason we have stayed with Presentation Server is because it allows our users to get their applications and deliver patient care from anywhere.”

By upgrading Presentation Server, Genesis gained important functionality such as Citrix SmoothRoaming, which enhances the user experience even more. Murray explained, “We call this capability ‘suspend and resume’ because it enables physicians and nurses who travel between campuses to disconnect from their application session and reconnect on another machine without having to log back in. They think it’s great.” SmoothRoaming also helps enable the use of wireless devices. If there is a problem such as a dead battery, the employee can simply pick up another wireless device and resume working where they left off.

The addition of Citrix EdgeSight to the Genesis IT system is also contributing to a more-satisfying user experience by enabling the IT staff to proactively identify and resolve application performance issues. “Because we use shared workstations, if there was a problem the user often would just shut down and move to another machine, so we wouldn’t hear about it. Now, EdgeSight lets us uncover issues that users were clicking through or ignoring,” he said.

Murray said, “We’ve been able to identify the cause of at least two crashes with Cerner Millennium using EdgeSight. In both cases, we targeted a service pack as the problem. As a result of what EdgeSight was telling us, we rolled the service pack back and the issues stopped occurring. Added Stanfield, “I am also investigating a crash with our employee health application by looking into such questions as ‘What are the users doing?’ and ‘What is leading up to the crash?’ We’ve also pinpointed situations where an application was dominating the CPU.”

Murray continued, “We also use EdgeSight for bandwidth-related issues, including ICA latency reports. When people call to report slow performance or a locked-up application, we have been able to identify network latency as the problem. Then we drill down even farther. EdgeSight gives us visibility at the application layer we’ve never had before.”

Strengthening Security and Compliance

Visiting nurses at Genesis Health System use Panasonic Toughbook laptops for charting in patients’ homes. By delivering applications via Citrix Presentation Server instead of installing them locally, Genesis can ensure no confidential data is stored on portable devices that could be lost or compromised. “From the standpoint of compliance with HIPAA, Citrix has benefited us by keeping application data in the datacenter instead of being exposed on the device,” said Murray.

Supporting Growth without Adding IT Resources

Citrix Presentation Server and Citrix EdgeSight have simplified IT administration, enabling the IT staff to support more users and locations without adding resources. One of the top benefits is easy delivery of applications to more than 3,500 devices. Murray said, “One person can publish an application across the entire organization with Presentation Server. In comparison, if we were still installing the software locally through our previous management tool and something went wrong on a PC, we’d have to make a site visit. Citrix also enables us to replace a workstation in an hour instead of taking a full day to install and configure a new machine. The time savings really add up when you consider we replace 50 or 60 workstations per month.”

In addition, centralized administration and monitoring have reduced helpdesk calls. Stanfield recalled, “Before Citrix, we would take turns being on call. I remember taking about 50 calls a week and having to come in during off-hours. Now, unless there is a problem with physical hardware, our technicians can handle the issue remotely from home.”

He continued, “Over the past three or four years, we’ve brought on two visiting nurse offices and close to 60 doctors’ offices. We’ve basically doubled in size but the IT staff has stayed constant. There’s no doubt that Citrix has played a big role in keeping us streamlined.”

Future Plans

Genesis Health System has purchased Citrix Presentation Server, Platinum Edition and plans to leverage its application streaming, SSL VPN and SmartAccess policy-based control features. In addition, the IT team is looking forward to using the improved video compression functionality of the new product to deliver its Web-based Picture Archiving and Communications System (PACS).

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