Martin’s Point Health Care has two major lines of business: providing primary care services to patients at three centers in Maine and New Hampshire, and administering the U.S. Family Health Plan, which provides care to 23,000 military dependents and retirees, for the Department of Defense (DoD). Martin’s Point employs 400 people including about 25 primary care providers and 25 Information Services (IS) staff.

In 2005, the company launched a product to serve a new community – self-insured companies and their employees. The new product, PointPartners, integrates clinical practices, innovative health services and health plan management.

The Challenge: Implementing, Managing and Securing an EMR Solution

When Martin’s Point made the decision to replace paper health records with a Centricity Electronic Medical Record (EMR) system from GE, the IS team had two main concerns: how to effectively manage this complex enterprise solution; and how to provide high application performance over the wide-area network (WAN) without adding expensive T1 lines.

Further, as a healthcare organization and a DoD contractor, Martin’s Point faced information security challenges. “Our plan was to deliver Centricity to workstations in clinic examination rooms, as well as provide remote access to our providers delivering care in hospitals, home offices and on the road,” said Greg McCarthy, IS director. “In both scenarios, we had to make sure that patient information was secure – not just for HIPAA regulations, but also because DoD requires compliance with an even stricter standard called the Defense Information Technology Security Certification and Accreditation Process (DITSCAP). We needed to know who was logged onto Centricity at all times and create an audit trail of all their activities.”

To encourage providers to adopt the new EMRs, the organization wanted a solution that would simplify and speed up access to Centricity – but without adding IS costs and workload. “We had a VPN solution that we could have used for provider access, but it required each device to have the VPN software and configuration,” said McCarthy. “We could just imagine providers asking us to come to their home office and set it up on two or three PCs. Or, we could have given every provider a laptop, but that approach meant additional costs and support issues.”

Implementing the Citrix Solution

Working with CBE/ValCom, a Platinum Citrix® Solution Advisor, Martin’s Point implemented Citrix Presentation Server™, Citrix Password Manager™ and Citrix Access Gateway™ with Advanced Access Control, together with Microsoft® Windows Server® 2003.

“We spent a lot of time on due diligence, but it became clear that Citrix offered the most viable option for this environment,” McCarthy said. “Based on what we knew about the company and the fact that many of our staff had worked with the technology, it was obvious that the Citrix solution was the direction we needed to take.”

The solution runs on seven Dell servers. The organization has deployed Wyse thin clients in 84 clinic exam rooms; providers connect via the Internet using the Citrix Access Gateway and their own PCs and laptops. About 220 users including clinicians, admissions staff and patient support representatives access the Centricity system and/or NextGen, which is a scheduling and billing application.  

In addition, prior to the rollout of Centricity, Martin’s Point used the Citrix solution to deliver an application called Magician, which was used to scan the paper medical records, index the information and upload it into the EMR system.

Fast, Easy Access to EMRs Spurs Clinician Adoption

The willingness of providers and nurses to move from paper documentation to EMRs is critical to the success of the Martin’s Point Centricity project; in turn, ease of use and speed are vital to clinician acceptance. The Citrix technology makes it easier for caregivers to use the system, whether in a clinic setting, during hospital rounds or from home. The Hot Desktop and enterprise single sign-on capabilities of Citrix Password Manager, plus its support for two-factor authentication devices, help accelerate login/logoff processes while ensuring a high level of security.

“Without using Hot Desktop through Citrix, logging in would have taken about a minute and a half of the provider’s fifteen minutes with that patient,” said McCarthy. “We’ve cut that to about 10 seconds – a big gain in time for the providers.”

IT Controls Boost Compliance with Stringent Regulatory Requirements

To comply with the requirements of HIPAA and DITSCAP, Martin’s Point leverages the many security capabilities of the Citrix solution, particularly to provide access to Centricity for providers at remote locations. Citrix Access Gateway, a universal SSL VPN, provides secure access over the Web to applications hosted on Citrix Presentation Server, as well as such applications as PACS provided by a neighboring hospital that allows providers to access online radiology images. Further, the Advanced Access Control option allows the IS staff to define and control the actions each user can take with an application, depending on their access scenario. According to Sam Miller, systems administrator, “If the remote user has a company laptop, we would allow them to download, print – pretty much whatever they want. But if they are using an untrusted home PC, we can restrict them from saving a file or taking other actions.” This capability can also be used to control access by contractors.

Citrix Solution Benefits Both Users and IS

The Citrix Application Delivery Infrastructure has improved the user experience and relieved IS of many time-consuming administrative chores. Miller said, “If we didn’t have a Citrix solution in place, the application would be running on fat clients and we would really feel the performance degradation across the WAN. I expect we would incur high costs to put in additional T1 lines. Because Citrix technology doesn’t require much bandwidth, we can support all the applications with our existing infrastructure.”

For the IS team, Citrix technology also provides ease of management, reliability and scalability. When administrators push out an application or upgrade, they no longer have to patch 220 desktops, and the system easily scales up to meet future growth needs.

Access to Patient Data Provides Foundation for Business Growth

The implementation of EMRs using Citrix technology is helping Martin’s Point expand into managed care. The success of the PointPartners initiative to provide third-party administration for private employers will depend on providing the best care while keeping costs down. One of the keys is ensuring adherence to medical best practices; to achieve this, Martin’s Point plans to develop clinical protocols for specific diseases and reward their providers who follow them.

McCarthy explained, “We’ll be pulling data from the EMRs and putting it into some type of disease registry. For example, if someone has a specific type of diabetes, there’s a certain care regimen that should be followed and indicators that should be tracked and managed. We can easily retrieve that data instead of relying on anecdotal information from the providers, and look at trends and patterns to improve care delivery.”

Future Plans

With fast, secure access to its Centricity solution in place, Martin’s Point plans to pursue new ways to take advantage of EMRs. According to McCarthy, “We are planning to leverage Citrix access to let providers who are away from the clinic use Centricity to push out prescriptions via a fax server and send them right to the pharmacy.”

He concluded, “We were able to show a positive ROI for our Citrix solution, but the reason we implemented it was to create efficiencies that improve patient care, support innovation in healthcare delivery and grow our business.”

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