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Touro College of Dental Medicine, Hudson River CIO, and Citrix: modeling the future of digital dentistry at scale

More than four years in, The Touro College of Dental Medicine, and its IT partner, Hudson River CIO Advisors have deployed a futuristic digital dentistry environment that has equipped its first class of graduates.

More than four years ago, the leadership team of the Touro College of Dental Medicine (TCDM) at a simple mission: “Get the first one right.” The “first one” meant the first Doctor of Dental Surgery (DDS) program that would provide training in state-of-the-art digital dentistry. This kind of futuristic environment would prepare students for the dental practice requirements of 2030. What’s more, the environment would be scalable and repeatable.

Early on, the school’s leaders met with Hudson River CIO Advisors (HCIO) to architect an IT infrastructure plan. The goal was to create a network where students would be able to access applications any time, on any connected device, inside or outside the building. Students, faculty, and patients would have the assurance that Protected Health Information (PHI) would be secure, and remain secure under all circumstances. Students would also have access to powerful 3D imaging display capabilities thanks to GPU-enabled servers. Previously manual processes were automated, allowing these future doctors to craft state-of-the-art dental restorations such as crowns, bridges, dentures and other accessories on-site, resulting in patients saving time, doctors creating more precise prosthesis, and overall costs going down. The net result is better care delivered in shorter time frames – a win-win for all involved.

Citrix technology: a cornerstone of the TCDM environment

”Due to the addition, integration, and implementation of digital technology and techniques, the academic clinical experience at Touro College of Dental Medicine has continually evolved. Not only did we implement the digital technology we originally envisioned, but we have leveraged our solutions to scale in ways we could not have anticipated,” explains Edward F. Farkas, D.D.S., M.A., Vice Dean of Touro College of Dental Medicine. “The combination of Citrix technology and our suite of companion solutions provides us with the most powerful diagnostic and restorative tools needed for our advanced learning environment. Our students will graduate with significantly more tools in their patient treatment toolkit, because of the digital integrations we perfected for them.”

TCDM implemented Citrix Desktops in combination with other advanced solutions. The HCIO team was charged with ensuring that the college’s technology infrastructure could keep pace with business needs, address a host of use cases, and meet the needs of patients. Even during unforeseen business disruptions such as the global coronavirus pandemic, the technology is agile enough to deliver the exact same environment to remote users, just as fast and secure as it was on-site.

A repeatable model that is right on many levels

The Touro College of Dental Medicine infrastructure was designed to serve the unique needs of the higher education sector. It is repeatable across diverse dental environments such as dental colleges, clinics, and Dental Support Organizations (DSOs). It addresses the challenges of organizations in need of digital solutions that deliver stringent security, easy scalability, and a consistent familiar user experience (UX) regardless of the endpoint used. The Citrix infrastructure fulfills all of these promises.

The solution designed by TCDM and HCIO serves a number of professional personas including students, clinical workers, non-clinical administrators, staff, faculty, and more. Also included are those who work in supportive administrative functions such as billing, insurance claims management, admitting, and other departments which, by nature, require strict adherence to established protocols.

The solution also is perfect for a number of other healthcare disciplines. “Think orthopedics, for example. That medical discipline is a great use case for this technology because of high patient volume and the requirement for consistently high uptime,” explains Shlomo Weintroub, business development.

Mike Schreibman, co-founder and managing partner, adds, “Orthopedic surgeons typically see between 45 and 60 patients a day. They arrange office visits 2-3 days per week and spend the balance of their time in the operating room,” he says. “Citrix technology automates processes, which is a godsend for managing this kind of volume. With digital technology, much of what is done, with the exception of physically touching the patient, can be accomplished from anywhere,” he says.

“For our IT team, in addition to system agility and ease-of-management, the thing that is most important is that it all just works. It is rare that anything goes wrong with the Citrix technology,” Schreibman shares. “We watch for anomalies. However, Citrix is a very quiet problem-free environment for us whether the student or staffer is on-premises or at home. There’s no difference,” he concludes.

It’s like a hybrid private cloud

The IT environment at Touro College of Dental Medicine functions like a hybrid private cloud model. Hardware is located in the HCIO data center, yet the infrastructure is unique and allocated only to TCDM. Whenever users at the dental college tap in, the solution serves up apps or data to their desktops as would be the case in a cloud environment.

COVID-19: 100% remote access in a snap

The coronavirus pandemic highlighted the value of the TCDM digital environment. As governments mandated coronavirus shutdowns, the college was able to shift to remote learning and teledentistry without skipping a beat. Even during the worst of the COVID-19 pandemic, the college was able to maintain an on-site emergency clinic with four dental chairs and a staff of ten. Emergency on-site clinicians, students, billing agents and other clinical or non-clinical staff all had secure remote access to records, X-rays, care plans, and each other regardless of the locations from which they worked. All the while, the Hudson River CIO Advisors’ remote management model meant that the IT engineering staff could all work remotely, enabling the facility to remain open.

The virtual desktops used in these remote locations still have the same look, feel, and access as they had at the college. All students, staff and faculty still have the exact same access and user experience from anywhere. The systems perform flawlessly. Both students with the appropriate authorizations and instructors are able to see X-rays and access patient records, prescriptions, and billing information. They use two-factor authentication just as they did prior to the pandemic lockdown. Protected Health Information (PHI) and sensitive data is just as secure during the lockdown as it was before.

A consequence of the pandemic: Teledentistry at TCDM

As pandemic-related mandates remained in place longer than most people originally anticipated, one surprise materialized: teledentistry. “Neither video teleconferencing nor telephony were among our original mandates,” describes Schreibman. “Now that we live in a world fraught with business disruptions, the Citrix platform, the thin clients and the GPU-enabled servers that we use allow us to support videoconferencing for TCDM,” he says.

Security: an essential component of the environment

As the IT team manages the TCDM environment, security remains top-of-mind. Schreibman mentions three areas in which the TCDM digital environment has extra security protection thanks to Citrix.

Third party reviewers continually assess the security and compliance of the TCDM IT environment and they see how stringently everything is monitored and maintained. At any given time, the security team is well-positioned to assure HIPAA compliance for all of its systems.

Imprivata technology provides additional security: tap and go technology enables users to tap a card, type in a pin and move rapidly between hundreds of thin clients. This login method significantly decreases the time required to bounce from patient-to-patient and enables the digital technology session to seamlessly move along with the user.

“Those who manage non-clinical functions at TCDM – billing, administration, front desk activities – also benefit from Citrix security. At any point, they can use the same secure tap and go technology to leave their desktop devices and move to a conference room or other location. There, they can easily resume the work session, as their desktop easily follows them” Weintroub points out.

Citrix App Layering also gives the team the ability to control access to apps and information. App layering separates the management of the operating system and apps from the infrastructure and also facilitates quick handling of upgrades and bug fixes. App layering ensures that users are not able to load new apps themselves. Access to clinical data is limited to those with the appropriate permissions: third- and fourth-year students, for example, but not first and second-year students. One more point is key – because data is stored in the data center and not on actual endpoints, PHI and other sensitive data remains completely secure and inaccessible to an unauthenticated party – even if a device is lost or stolen.

3Shape shapes TCDM’s curriculum and capabilities

A critical part of the solution at TCDM is 3Shape dental scanners, paired with 3Shape software. These digital dental technologies have found a warm and inviting home on the Citrix supported network. Performing dental CAD/CAM procedures on this software paired with Citrix is a breeze, even though the 3Shape environment was not initially designed to be enterprise-scale. The TCDM environment, hosted by Hudson River CIO Advisors, holds the distinction of having the largest number of concurrent 3Shape users in the world. “With Citrix running on GPU servers in a hyperconverged environment, 3Shape CAD/CAM software scales beautifully on-site and remotely. Because it’s running on Citrix, even a tablet or Chromebook can be used, with the same look, feel and speed of a GPU-enabled graphics workstation” notes Schreibman.

Schreibman adds, “TCDM students can take the scans they have made and produce surgical guides, posts or crowns, and then print them on the 3D printers or milling machines that we deployed. The whole process is accomplished on-premises, often in the same day. This certainly isn’t typical for dental offices around the country,” he says.

Graduates with training for the future

“Thanks to all of the technology innovations we’ve put in place, the students in the first TCDM graduating class are truly unique,” explains Dr. Farkas. “The tools these students have at their disposal – solutions facilitated by Citrix, Imprivata, 3Shape and more – are the apex of dental education technology. The infrastructure found at TCDM is unique and constantly evolving. Our graduates are prepared for the future of dentistry!”

”Our innovation positively impacts student recruitment, patient treatment, and burnishes our reputation. For a school that is only six years old, we have made an outsized impact on the dental educational landscape, and we plan to do much, much more,” adds Dr. Farkas.

About economics and ease-of-use

Economic benefits to TCDM have flowed from its investment in digital infrastructure. It’s no longer necessary to have teams of admins and deskside support people on-site to fix problems in real-time as they occur. Today, one person on-site is all that is needed to support the 800-user TCDM environment. The need for TCDM staff to manage servers, WIFI, and the network has been alleviated. Now, when one of the devices used in an operatory fails – a monitor, a thin client, or another low cost component – a simple swap-out of the device is all it takes.

It looks as if they got it right

“Consistency is one of the great benefits of the technology we’ve implemented,” summarizes Schreibman. “Desktops load anywhere. The experience is identical from device to device. The number of service tickets is nominal. The environment works well.”

"In most other university environments, for every PC that fails, or every time a software vendor rolls out an update, or an issue such as relocation or expansion occurs, it causes chaos. Thanks to Citrix digital technology and our arsenal of partner solutions, it’s just another day.”

In most other university environments, for every PC that fails, or every time a software vendor rolls out an update, or an issue such as relocation or expansion occurs, it causes chaos. Thanks to Citrix digital technology and our arsenal of partner solutions, it’s just another day.
Mike Schreibman
Co-founder and Managing Partner
Hudson River CIO Advisors



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