Citrix Cloud hybrid management modernizes the Prime IT environment

The first wave of digital technology deployments at Prime Healthcare improved the employee experience. The second focused on simplifying the digital IT environment with Citrix Cloud services, Epic EMRs, and new Citrix capabilities.

Imagine 22,000 users, 7,000 concurrent licenses, and 46 hospitals across 14 states. Now think about the IT management challenges that come with that. Named “The Fastest Growing Hospital System” in the U.S. by Modern Healthcare, the Prime Healthcare team spent several years working to deliver a consistent and easy-to-navigate employee experience. Citrix digital technology was the crucial enabler, giving IT the ability to easily onboard users and support rapid growth. Finally, two years ago, it was the IT team’s turn to address its own needs. Again, Citrix was instrumental in achieving the changes the team envisioned.

IT: the focal point for the second wave of change

The Prime Healthcare IT team worked hard to deliver an optimal employee experience. They also put a great deal of time and effort into the second wave of transition – this one focused on IT. The team designed a standardized digital environment that was easy-to-manage. They also needed to simplify the organization’s infrastructure to alleviate the complexity they had experienced with on-premises technology in years past.

For more than five years, Srinivasan Shanmugam, lead enterprise systems engineer and Citrix expert at Prime, had been in the thick of the action. He and his team spearheaded the employee experience project and now, they managed the pressing IT initiatives. “Consolidating disparate point solutions, upgrading operating systems, standardizing on one electronic medical record (EMR) and moving to  Citrix Cloud have been a few of our most critical projects,” Shanmugam says. “Automating previously manual tasks, moving legacy applications to newer operating systems, and reexamining infrastructure from hospital-to-hospital also have been top-of-mind,” he notes. “Ultimately, the IT team offloaded infrastructure components to the cloud. Engaging Citrix to manage the environment gave the IT team the time to concentrate on other business needs,” he says. “Now we can innovate thanks to new capabilities that are available in the most current Citrix cloud-based releases.”

A rich Citrix portfolio helped enable change

In order to appreciate the value that the team’s initiatives netted, it’s crucial to understand the Citrix portfolio that was implemented. Citrix Cloud is the framework in which the rest of the solutions run.  Citrix Virtual Apps and Desktops service, Citrix Gateway, and Citrix Workspace Environment Manager (WEM) were deployed as part of the IT transition. Additionally, Citrix Endpoint Management (CEM), Citrix Content Collaboration, Citrix RightSignature, and Citrix Secure Browser are part of the mix. Finally, Citrix networking solutions -- Citrix Application Delivery Management (ADM) and an on-premises version of Citrix Application Delivery Controller -- are key components of the environment.

A four-phase Epic transition staged for success

As Shanmugam provides details about the journey, he is quick to point out that the Citrix Cloud transition was carefully orchestrated – by design -- in four phases. Shanmugam describes the various stages in the transition this way: In Phase One, IT stood up Citrix Cloud connectors and then added the Citrix Virtual Apps and Desktops service as an additional site to the existing Storefront server group. “When users log in, they see both Citrix Virtual Apps and Desktops on-premises, and Citrix Virtual Apps and Desktops service resources in a single window,” he notes.

Windows 10 desktops and non-EMR apps were transitioned to the Citrix Virtual Apps and Desktops service in the cloud in Phase Two, giving Prime the advantages of hybrid management of their environment.

Because many hospitals came into the system through acquisitions, a host of EMRs were in use across various facilities. Hospitals that were not using Epic EMRs were migrated onto Epic in Phase Three.

Phase Three also included LHC testing, Cloud Connectors to Citrix Cloud internet connectivity, testing, and DR failover between resources locations. After Phase Three was complete, the team spent three months on end-to-end environment testing to ensure that everything functioned properly.

Then Phase Four commenced. “The focus of Phase Four was the most crucial – Epic migration to the (Citrix Virtual Apps and Desktops service) in the cloud. Once this transition was completed, the team created like-to-like delivery groups so that those users who had access before could have cloud access,” clarifies Shanmugam. “Our team then made sure that everything seamlessly launched. Once this was confirmed, relevant on-prem components were decommissioned.

Simplifying IT management and eliminating repetition with Citrix Cloud

Leveraging Citrix Cloud services for management of the environment, has made a number of things easier for the IT team. “In the past, we maintained two enterprise datacenters, each with two Virtual Apps and Desktops instances. That equaled four different Citrix Virtual Apps and Desktops sites. If we created a policy, we then had to duplicate it across all four sites,” explains Shanmugam.

“Citrix issued quarterly releases for Citrix Virtual Apps and Desktops products -- be it Long-term Service releases (LTSRs) or Current Releases (CRs) -- so we executed four upgrades every three months,” he shares. “Moving to the cloud enabled us to consolidate the four sites into a single site,” he notes. “This greatly simplified IT management. What’s more, with our subscription model: Citrix now is responsible for managing and updating the digital environment for us.”

Reducing manual effort and alleviating data loss with ADM service

With the time saved by having Citrix manage the digital environment, IT has been freed up to automate many day-to-day ADC tasks using ADM service. Twenty configuration jobs have been created to reduce manual effort. Other tasks also have been automated using ADM service.

“Another plus was that we were using two data centers to maintain high availability (HA) while we upgraded our ADM appliance,” Shanmugam notes. “The cloud version of ADM is consistent and stable. With the cloud version, we have not experienced any data loss -- a problem that had arisen with the on-premises technology.”

An agent of change: the pandemic brings three significant positive IT outcomes

While it’s counterintuitive to think that a pandemic could bring about positive IT benefits, in the case of Prime Healthcare, that’s exactly what happened. Just before pandemic hit in March 2020, Prime had made the move to Citrix Cloud. Once the COVID-19 business disruption hit, this made it much easier to add three capabilities that became essential.

The first was enabling remote access for IT professionals as well as for anyone whose job did not require direct patient contact. To accomplish this, the team deployed terminal servers at each of its hospitals and published an RDSH desktop from there. Approximately 15% - 20% of the user base was empowered to work from anywhere.

Telehealth for clinical use cases was the second requirement brought on by the pandemic. “Three hundred additional iPads had to be enrolled in mobile device management (MDM),” notes Shanmugam. “We also had to roll out video conferencing for use by clinicians and patients’ families,” he says. “With Citrix Endpoint Management, we expanded the device platform from a portfolio of 95% Apple endpoints to a collection of devices including Android Enterprise and Chrome OS technology -- something that wasn’t possible on-premises,” Shanmugam clarifies.

“For telehealth, specifically for patient-to-doctor remote consultations, Prime Healthcare now is able to capitalize on technology from Citrix business partner Microsoft. With Microsoft Teams, doctors can use this app from an iPad or a desktop enrolled in Mobile Device Management (MDM),” he continues. “Microsoft Teams has a workflow for healthcare apps, so it’s become our standard.”

Implementing RightSignature from Citrix was the third capability resulting from the pandemic. When executed in compliance with e-signature laws, electronic contracts have the same legal validity and enforceability as paper documents. For financial use cases, Prime has been a proponent of e-signature document flow for years. With the pandemic, a host of new use cases materialized -- HR onboarding, access requests, and offboarding were among the new requirements. This drove the need for more software licenses.

RightSignature savings thanks to entitlements

The cost of purchasing more e-signature licenses spurred the team to change its product mix. “RightSignature is one of the entitlements that comes with Citrix Workspace. Our team was able to significantly reduce costs by alleviating a large number of Adobe Signature licenses in favor of the Citrix solution,” shares Shanmugam. “Equally important, RightSignature reduced the time required for document flow.”

RightSignature e-signature software is secure, legally binding, and industry-compliant electronic signature software. Every RightSignature document is secured with a full audit log and biometric data capture, and 256-bit encryption Features are included.

Citrix cloud technology: a DR backup

Shanmugam notes another benefit in the area of disaster recovery (DR) technology. “The hospital system has a zone concept comprised of two data centers running in an active/passive mode. We have configured Citrix Virtual Apps and Desktops service so that the traffic is sent to one zone all the time. The other zone serves as a backup,” he clarifies.

On-premises DR exercises had to be accomplished manually when each resource location actually was used as a resource location. The transition to Citrix Cloud and Prime’s private cloud now means that if one data center goes down, the apps automatically failover to the other zone. Citrix Workspace provides the backup URL, Citrix Gateway and Storefront bring the primary Access Layer for end users.

Empowering users without granting admin rights

Shanmugam continues to step through a list of new capabilities: “Citrix WEM service, the Citrix performance management and user environment management (UEM) tool for Virtual Apps and Desktops Enterprise, protects the environment,” Shanmugam explains. ”In some cases, users may need to run an executable file with elevated rights, but now, we do not have to grant admin rights. We create a rule in WEM, and when the executable file is launched, it will be run in elevated mode.” He adds a final point: “Using WEM services also simplifies management.”

Integrating Citrix cloud connectors fast-tracked MFA

Shanmugam describes a final positive that the cloud environment brings: “Citrix Cloud Migration helped fast-track multifactor authentication (MFA) implementation and other projects. With the Citrix Cloud migration, we had the time to fast track MFA implementation across the enterprise for remote users accessing Citrix Gateway and Content Collaboration.”

The end game: empowering IT

Shanmugam finishes the story by adding even more clarity, “Ours is a trade up and transition story. While we don’t have workloads in the cloud, we did move all of our Citrix management to the cloud.” He adds, “With the Citrix Cloud hybrid model, Prime Healthcare gets the simplicity, scalability, and ease of management of cloud services, while at the same time being able to continue to run desktops and applications in on-premises datacenters."

He adds one more comment: “Implementing Citrix cloud technology and engaging Citrix to manage our digital solutions has truly empowered our IT team. Now we have the time to devise creative new answers to the challenges we face,” Shanmugam summarizes. “We’re essential to the growth of the business, and we’re also critical in the push to enable our doctors to be more focused on delivering better patient care.”

Implementing Citrix Cloud technology and engaging Citrix to manage our digital solutions has truly empowered our IT team... Now we have the time to devise creative new answers to the challenges we face. We’re essential to the growth of the business, and we’re also critical in the push to enable our doctors to be more focused on delivering better patient care.
Srinivasan Shanmugam
Lead Enterprise Systems Engineer and Citrix Expert
Prime Healthcare

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