A Healthy Approach
At Veterans Affairs Department hospitals from California to Virginia and in most states in between, federal healthcare workers are thinking thin — and they’re not just looking out for their patients’ waistlines. They’re using thin-client computing, a concept that’s been around since the mid-1990s but is on the cusp of a major comeback, thanks in part to wide adoption of virtualization and cloud computing.
Like thousands of private enterprises, many federal agencies are electing to keep more of their processing horsepower in the data center, allowing deployment of lightweight clients that are cheaper, easier, faster and more secure than the traditional desktop and notebook systems.
An estimated 15 percent to 20 percent of VA’s more than 325,000 computers are thin clients, says Jeff Lush, executive chief technology officer for enterprise infrastructure engineering in VA’s Office of Information and Technology (OI&T). He’s hoping to expand that number considerably, not merely because of cost savings, but also because it will enable VA to provide its customers (veterans and their family members) with better care.
“I’m a veteran myself,” Lush says. “When I see my caregivers at VA, they pull up an electronic medical record about me. The time it takes for that application to populate the information in my medical records directly impacts my satisfaction as a VA customer. I don’t want it to take five minutes; I want it to be instant. To guarantee that level of performance at the endpoint, you need to be in a thin-computing environment where you can allocate resources quickly and efficiently.”
Thin-client infrastructures typically work by processing applications on the server, delivering screen shots of each application to low-cost PC clients, collecting keystrokes back from each machine and delivering more screens as needed.
Because the clients lack hard drives, agencies can greatly improve the security of data at rest. And with little more than a screen, a CPU, memory and a keyboard, the machines themselves are small and inexpensive.
Worthwhile Prescription
“Thin-client computing is generally 25 percent of the cost per seat of traditional PC workstations,” says David Bates, deputy director of VA’s OI&T National IT Training Academy. “IT staff are able to provide higher availability, and there’s less time spent troubleshooting problems associated with a typical workstation environment.”
With no local storage, he adds, VA doesn’t have to worry about data leaks or secure hard-drive disposal when the machines reach end of life.
More than 50,000
Thin clients deployed within the Veterans Affairs Department
Source: VA Office of Information & Technology
This also makes it easier to protect the privacy of medical data, as required by the Health Insurance Portability and Accountability Act, adds Bob O’Donnell, vice president for clients and displays research at IDC. IDC projects U.S. sales of thin clients will double over the next few years, reaching nearly 2 million units by 2013.
In a medical environment, thin clients are becoming more a necessity than an option, O’Donnell suggests. “The issues around security and HIPAA almost force your hand,” he says. “With HIPAA, there are not supposed to be any stored medical records on any client devices. That’s the perfect prescription for thin clients. Markets where the need for security is extremely important — such as financial institutions, the military and the government — are all great markets for thin clients.”
Historically, thin clients have received a bad rap for being unable to run custom applications and for poor video performance. Through product evolution, most of those problems have largely gone away, Lush says. Medical imaging still requires more horsepower than a thin client can typically muster, but virtually all other apps work flawlessly, he says.
Special Care Factors
Managing a thin-client environment can still prove daunting, O’Donnell says. Organizations that go thin will need to work through both cultural and technical issues, he says.
“It’s really hard to transition from a traditional IT environment to a thin-client environment,” he says. “That’s where a lot of people get hung up. Deploying this stuff requires specialized skills and different processes. It all comes back to people and their jobs. Most IT groups have separate teams for desktops, servers and storage, with clear boundaries between them. When you have a thin client, who owns it — the server guys or the desktop guys?”
Lush acknowledges that VA does not yet have the underlying infrastructure to deploy thin-client computing throughout the entire department. And the cultural change required for an organization of its size will be formidable. That said, the shift is not insurmountable, he says, and it makes sense.
“We have an estimated 325,000 to 375,000 end users supporting about 23 million veterans,” Lush says. “The VA is mind-bogglingly huge. So adopting any new technology is a difficult task. The challenge is integrating it into our existing infrastructure and educating the recipients of the technology, as well as those making the decisions. Without that, even the best technology in the world is destined to fail.”
The Mobile Clinical Assistant Will See You Now
At Veterans Affairs Department health facilities, thin clients are mostly used for patient intake and processing. But more and more of these computers are making their way into examining rooms and operating theaters. Why? Because you can’t just put a traditional notebook, netbook or even handheld into a medical environment and expect it to survive for long. (Two words: bodily fluids.)
Thus the emergence of the so-called mobile clinical assistants — small but rugged computers such as Motion Computing’s Motion C5, which can survive drops of 3 feet and be hosed off and cleaned with standard hospital disinfectant.
Unlike standard thin clients, the Motion C5 is a fully powered Microsoft Windows computer with a multicore Intel processor, local storage and added features such as a barcode scanner for reading the labels on medicines and a webcam for documenting patient procedures. The 3-pound machine is portable enough to carry in one hand but can also be mounted on a battery-powered dock.
In healthcare scenarios, the C5 works as a kind of hybrid between thin and fat clients, says Mike Stinson, vice president of marketing for Motion Computing.
“A healthcare provider might be running four or five applications locally on the C5, with the application containing the patient data running thin via Citrix,” he says. “In that way, no patient data is kept on the system, making it secure and HIPAA-compliant.”
And just as you can’t put the typical computer into a clinical situation, you also can’t install a typical wireless network and expect it to work well, adds Stinson.
“Thin-client computing in a medical environment requires a different kind of wireless network,” he says. “You need to be connected everywhere — in the recovery room, the patients’ rooms and the hallways in between. You don’t want to be continuously logging in and out as you move. If it takes clinicians three minutes to log in every time they get dropped, they’ll simply stop using the system. You’ll need someone to come in and validate your wireless network design, look at where your coverage is and how you need to tweak it.”
