Located in Port Clinton, Ohio, Magruder Hospital provides comprehensive healthcare through innovative solutions that improve health and enhance the quality of life for patients. The hospital recognized the potential of the latest healthcare systems to aid patient safety. “Technology can have a profound impact on patient outcomes by helping hospitals increase the accuracy of documentation, adhere to standards, improve medical process, safety and many other key areas,” says Chuck Dellick, Magruder Hospital’s Director of Information Technology. “We wanted to meet if not exceed the meaningful use requirements and be on the leading edge of the latest best practices.”

The challenge: enhancing patient safety through improved access to information

While Magruder had an electronic medical records (EMR) system in its emergency room, an order entry system in its two main nursing units and basic automation in its pharmacy, there was no integration across these systems. “We knew the sun was setting on our current platform. From the board level down, we decided we needed to come up with an entirely new solution that addressed the full range of our needs,” said Dellick.

As a resort community, Port Clinton’s year-round population is small, placing a premium on the hospital’s ability to budget creatively. Magruder has a longtime relationship with nearby Fisher-Titus Medical Center, sharing many IT resources. The two institutions decided to take a similar approach to their healthcare IT upgrade, with Dellick playing the role of integration architect for a project spanning both hospitals. For their healthcare solutions, the hospitals—collectively called the Ohio Healthcare Technology Alliance—turned to Cerner. “Cerner has been a tremendous partner, working closely with us to build a plan to address our needs now as well as in the future,” says Dellick. The cornerstone of the plan was the concept of the Cerner Smart Room, which incorporates technology and workflow solutions to ensure the right information is delivered to clinicians at the right time to achieve the best possible health outcome for patients. To enable anywhere, any-device delivery of information, Magruder chose Citrix for server based session virtualization. “Cerner has been proven to work quite well with Citrix products. We knew this was our best option,” stated Dellick.

The solution: using Citrix to virtualize and deliver Cerner solutions across two

“We went all in with Cerner, implementing 39 solutions as well as the Smart Room technology over the course of ten months,” says Dellick. “There isn’t much that we don’t own from them, which has been great for us, since we don’t have any vendor interaction problems.” The Cerner solutions are hosted remotely in Kansas City, and delivered to a shared server domain virtualized using Citrix XenApp. Sophisticated multi-tenancy security within Cerner, complemented by the inherent security of Citrix virtualization, ensures that each hospital sees only its own data, protecting patient privacy and supporting compliance with the Health Insurance Portability and Accountability Act (HIPAA). Published applications comprising the complete Cerner solution set are delivered via Citrix XenApp to thin clients in every patient room, as well as to devices in the hospital’s pre-surgery room. “We went from a situation where more than three-quarters of the people here never touched a computer to having every single one of our professionals interacting with the latest technologies every day,” says Dellick. The solution now serves 150 concurrent users at Magruder in addition to 400 concurrent users at Fisher-Titus Medical Center.

Magruder’s staff included people with a wide range of technological savvy, making it essential for the new systems to be easy to access and use. “With XenApp, people see the same applications regardless of their log-on device. That makes a big difference for their comfort and ease of use, and helps them leverage the full capabilities of our Cerner apps for the benefit of our patients,” says Dellick. The solution has also eased the hospital’s conversion from a paper chart system to an EMR system, allowing clinicians to focus on interacting with patients instead of managing the technology. Able to access their applications on any device, many doctors have incorporated tablets and smartphones into their practice, taking advantage of increased mobility to check patient records and other information as they move from office to bedside to operating room.

Cerner Instant Access provides a fast and simple process for biometric authentication while ensuring patient privacy and organizational security compliance are maintained. “Once people have logged in, they can access the same virtualized Citrix session on other devices around the hospital,” says Dellick. “I’ve done other go-lives where the most difficult problem was teaching people the log-in process.  We had none of those issues here.” Outside contractors such as billing specialists can also be provided with temporary credentials to the system quickly and easily without compromising security, privacy or compliance.

Advanced authentication modalities include integration with Sonitor real-time location system badges to enable presence detection. The workstation is unlocked automatically when a clinician enters the room, and locked automatically when the user exits. This presence detection security helps to optimize clinician workflow while also ensuring proper security, privacy and HIPAA compliance for patient records. The solution also helps Magruder meet the Ohio State Board of Pharmacy’s re-authentication regulations, which require an advanced form of authentication for every medication that is ordered, dispensed and administered.

The benefit: ensuring reliable application performance and business continuity

“The uptime with XenApp has been fantastic,” says Dellick. “Our Cerner solutions flow from the Kansas City hosting center to Magruder Hospital, then Fisher-Tutus, then back to Kansas City. Even with all the traffic among these facilities going at once, we’ve never had any bottlenecks.” When area flooding forced Magruder Hospital to evacuate its patients, Citrix made it possible to keep its emergency room up and running. “While high water had forced us to shut down our power, we needed to be able to access charts and information for people who came in with emergencies. We accessed our Cerner apps on a laptop with a cell phone acting as a network hotspot, and the speed was the same as if we were working on a regular computer. There was no problem at all accessing records, even without lights.”

The ease of deployment made possible by XenApp has helped Magruder Hospital complete its upgrade and manage the resulting environment even with a small IT staff. “I can’t imagine if we had to try to load all 39 applications onto every one of the workstations and point them to one server or another,” says Dellick. “We simply downloaded Citrix onto the machines and people could access all the applications they needed. It made installation time for the endpoints incredibly fast.” In spite of making a quantum leap in the scope of its IT environment, including more than doubling the number of endpoints, Magruder Hospital added only a single new IT staff member, bringing the total to six. “Our roles have changed—we don’t have to run around troubleshooting or chasing technical connectivity problems anymore, and we can concentrate on helping users make the most of our applications.”

Expanding affordable access to state-of-the-art healthcare systems

The Ohio Healthcare Technology Alliance continues to expand its impact. The group recently added another institution, Samaritan Hospital, to its domain. “All Samaritan had to do was localize the build and add their unique data such as users and formulary information. They went live in only six months with the same full set of Cerner systems Magruder Hospital and Fisher-Titus use—and this was after being told by consultants that they could only afford a second-tier EMR solution with limited functionality,” says Dellick. “We are looking to add more hospitals in our region to make sure even smaller institutions like ours can put high-end Citrix and Cerner solutions to work for the benefit of our patients.”