Sydney hospital ditches PCs, chooses zero clients on wheels

Speaking at VMware's vForum 2012 event in Sydney last week, Sydney Adventist Hospital (SAH) solutions architect for Information Services John Hoang led the audience through the way in which the private hospital uses virtualised and mobile workstations in a bid to move toward a paperless, digital hospital.

Hoang said that SAH had been "dreaming of what we would consider a healthcare nirvana — a complete paperless, digital hospital. One where we're able to capture all patient data electronically, deliver information to clinicians in a digestible matter, and do so in a manner that is synergistic to the way clinicians work."

Like many hospitals, physical space in which to work is a premium that IT departments don't have, and despite needing to provide clinicians with more end points, it quickly became apparent that simply installing more PCs wasn't going to work.

"We didn't have the luxury of building new desks or new workspaces where we could put new PCs in. We also had to deliver this accessibility without increasing the support team. We didn't have the luxury of employing more staff members just to support an increase [of] an extra 200 or 300 desktops," Hoang said.

Furthermore, all of SAH's technology was a mix of Intel and Microsoft products, from the front-end desktop systems right through to the back-end databases. As such, if SAH were to use different end points, they would somehow need to support Microsoft's products.

The Information Services team evaluated several products before looking at VMware's virtual desktop infrastructure product, View. This product would allow SAH to create a virtual instance of a Microsoft operating system almost regardless of the end point being used, without having to customise its existing apps for different devices.

"We didn't have to require a radical redesign of our clinical application. The 'up-skilling' of our staff was a very shallow learning curve. Unlike other technologies, where they had to do a dramatic shift from the way we work in the physical environment to a virtual desktop infrastructure, with View it was very modest due to the fact that the underpinning technology was ESX server. So all we had to really do for the engineering team was to up-skill ourselves with the connection broker and the composer modules of the View environment," Hoang said.

The up-skilling process should have taken the Information Services team two weeks to complete; however, during the process, SAH's operations manager came to Hoang with another problem. SAH's engineering team was developing a new application to be used in its intensive care unit (ICU), called Metavision, and while it was approaching the deployment stage, the team had realised that the tight physical space requirements meant that their previous strategy of deploying non-mobile PCs wasn't going to work.

Hoang had a cart from ICU in his office at the time, and while the idea of throwing a PC or notebook on there was bandied about as a bit of a joke, he realised that it would result in an asset-management headache in the long run.

"At the time, I rejected them all because having a physical PC would mean management overheads, especially since these were meant to be wireless and it makes it almost impossible to connect to manage patches and updates on these devices."

But after choosing to extend the up-skilling process for View to two months, and looking at Samsung's zero-client series of monitors, he realised that the idea wasn't as farfetched as it had initially seemed. Patching and application updates could be done by managing the virtual machines that the client-less carts connected to, solving any management issues.

Borrowing his own Apple Airport Express for use as a wireless bridge, and installing a battery in the base of the trolley, Hoang was able to quickly put together a proof of concept and provide SAH with a highly mobile workstation that clinicians could use without being in the way.

"Once we demonstrated that Metavision could be deployed via VDI and the zero clients, the rest of the project team came and evaluated it, and within weeks, they said they agreed and we deployed. We ordered 20 or so units and deployed that into ICU."

Power consumption was also addressed through the use of the zero-client monitors, with the carts able to be powered for over a day on a single charge. Hoang estimated that if a traditional PC were used, the battery would likely only be able to supply power for two hours.

Today, using View, SAH has now expanded to 200 end points, 60 percent of which are zero-client monitors and 40 percent Panasonic Toughbooks. An additional 20 zero-client monitors are in use throughout SAH as large-format displays.

According to Hoang, the virtualised rollout has not only reduced its management overheads and solved its physical space issues, but it is now also able to deploy new end points to a ward in a matter of hours, when it would previously have taken days, and provided the ability to easily scale up or down as required.

However, most importantly, Hoang said that the technology is getting out of the way of clinicians, letting them get on with their jobs.

"Clinicians — whether they be nurses, doctors, allied health professionals — they really don't enjoy being technologists. The group here, we all enjoy our gadgets, we're IT people so we like having toys to play with, but the reality is, in the clinical space, the clinicians are doing their job or they've chosen that career path because they enjoy working with patients. So the last thing they need is for [Information Services] to thrust technology on them that is a hindrance to the way they work and prevent them from spending time with their patients."