Jefferson Radiology, a private company based in Hartford, Connecticut, provides radiology services including MRI and CT scans, ultrasound, mammography, nuclear medicine and general X-ray through eight outpatient centers. Its 42 staff radiologists also provide services on a referral basis for hospitals and physician practices in the region. The company has 325 employees and an IT staff of 14.

The Challenge: Improving Delivery of a Radiology System to Referring Physicians

Jefferson Radiology uses a Radiology Information System (RIS) for workflow and a Picture Archiving and Communications System (PACS) from GE to manage, store, view and evaluate radiology test results. This system is also used to share diagnostic images and information with referring physicians and patients. The company was using a client/server architecture to deliver the GE applications to its customers over a VPN. However, a number of issues made this approach problematic.

Matt Barrett, senior systems engineer, said, “The application uses an Active X control to allow physicians to view the radiology images, and it’s an eighteen-megabyte plug-in to Internet Explorer. Every time we updated ImageCast, they had to download a new control. But many customers don’t have admin rights, so we had to send an IT person to make changes to the desktops, and that was very time-consuming.” Even after it was set up, the viewer often would not load consistently, frustrating physicians and their staffs.

Further, hospitals and physician practices were reluctant to have Jefferson’s IT team disrupting their routine with frequent application upgrades. And some customers had constrained networks that resulted in poor performance, or older machines that could not support the GE Centricity RIS-IC and ImageCast applications.

Not only were these issues putting a burden on Jefferson’s IT staff, but more importantly, they were hampering business expansion. According to CIO Mark Weathersbee, “Our customers are extremely busy, and if a radiology application is not user-friendly, fast and reliable in getting them the information they want, they’ll choose another service.” Even worse, Jefferson was losing some potential customers because the application could not be delivered satisfactorily over their bandwidth-constrained networks.

To attract and retain customers, Jefferson sought an improved application delivery solution. Requirements included reducing IT administration, solving the problems of slow network performance and desktop incompatibility, providing high-quality images, and speeding up access for physicians with a single sign-on.

Implementing a Citrix Application Delivery Infrastructure Solution

Both Weathersbee and Barrett had worked with Citrix Presentation Server™ at previous companies. With the latest release of the product, which offered higher-quality image resolution, faster refresh rates and streaming video, they decided Presentation Server was the application delivery solution they needed. To obtain additional capabilities, including SSL VPN connectivity and single sign-on to password-protected applications, Jefferson implemented Citrix Presentation Server, Platinum Edition with Microsoft® Windows Server® 2003. According to Weathersbee, the installation was very smooth. “I was very impressed that we could bring in Presentation Server in one week, do a bit of configuration and be completely ready to go.”

About 400 customers – doctors, nurses and administrative staff – currently use the solution. “Physicians use it for consultations with colleagues and patients. It’s much easier to explain an injury or disease to a patient when you can point things out on an image right there in the exam room,” Barrett noted.

In addition to the GE applications, the IT team is delivering TeraRecon 3D imaging software, an advanced visualization system that turns two-dimensional scans into three-dimensional models, with Presentation Server. Barrett said, “We are currently delivering this application to our own radiologists, and will be offering it as part of our 3D Imaging service. The benefit is that users do not have to install a client on their PCs. We just add it to the Citrix application pool, and our doctors have yet another technology made seamlessly available.” For internal use, Jefferson is delivering Microsoft® Office and Numara Track-It helpdesk software.

The IT team is in the process of implementing the SSL VPN for secure application delivery. “For all new customers, we are using the Citrix SSL VPN. And as we are able to get into the offices of existing customers, we will replace the current VPN,” he said. This will also give employees, including transcriptionists, the ability to securely connect to applications from home. In addition, the company is currently using single sign-on capability and plans to begin using self-service password reset.

Improving the Physician Experience

The Citrix solution is enabling Jefferson Radiology to improve the overall application experience for its referring physicians and staff. “One key improvement is single sign-on,” said Barrett. “Doctors only have to log in once to get access to all the password-protected applications they are allowed. Citrix allows our doctors to securely access patient information faster, which is crucial to high-quality care.” Another enhancement is faster application performance. “In many cases, a physician has only about five minutes to see a patient. It’s a big deal to them that, with Citrix, our radiology applications load faster. Even cutting a few seconds is invaluable because they have more time with the patient.”

Strengthening Security and Compliance

Jefferson Radiology ultimately plans to expand the use of single sign-on to internal users to improve data security and HIPAA compliance. Barrett expects about 10 applications will be enabled with single sign-on. “A lot of people can’t remember their passwords for so many different applications. We want to avoid sticky notes on keyboards with lists of passwords.”

Weathersbee expects single sign-on to help with HIPAA compliance. “Giving people just one password that changes frequently will improve security overall.”

In addition, SmartAccess policy-based controls provided as part of Presentation Server, Platinum Edition will help Jefferson protect confidential patient information – part of HIPAA compliance requirements – by applying granular policies that control both access to data and actions users are allowed to perform. SmartAccess also allows administrators to define different access levels for various groups, such as employees versus customers.

Accelerating Upgrades from Hours to Minutes

With upgrades now performed on the server instead of the desktop, the IT team no longer has to interrupt doctors with administrative chores. “Previously, we were hindered in upgrading our application because of having to visit each desktop, and we were afraid it would only get worse as our customer base expanded. By virtualizing the application on Presentation Server Platinum, we no longer have to touch that desktop. It has accelerated upgrades from hours to minutes, literally,” Weathersbee explained. In addition, by keeping processing on the server, virtualization avoids incompatibilities between the radiology applications and customer machines.

The Citrix solution is streamlining IT administration in other ways. Self-service password resets will help reduce helpdesk calls. Session shadowing makes it possible to support users from the datacenter. And with the SSL VPN’s self-installing Web client, the team no longer has to install and configure a VPN client, or implement quarterly updates, on 400 computers.

Barrett said, “As we expand, I would estimate that the savings in time and effort for our IT staff could total $50,000 per year.”

Attracting New Business

Delivering GE Centricity RIS-IC and ImageCast and other radiology applications with a Citrix Application Delivery Infrastructure solution is helping Jefferson Radiology expand its referral business. “Citrix is a key strategic factor in our business model going forward,” noted Barrett. “It is going to allow us to retain current customers and help drive new business because we will have a better solution than our competitors.” One important feature for customers is Jefferson’s ability to deliver applications to Macintosh workstations with Presentation Server, overcoming an important barrier to entry for the business. Previously, because the RIS and PACS applications are supported only in a Microsoft Internet Explorer® environment, they could not be delivered to non-Windows® desktops.

Weathersbee added, “The referring doctors have been overwhelmingly positive about the speed and ease of use improvements Citrix has provided. And it is opening new opportunities for us. For example, a major physician group previously wouldn’t talk to us because their network issues made it impossible to deliver the applications. They are now very open to having us come in with the Citrix Application Delivery solution. And this group represents easily five million dollars worth of business annually.”

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