Virtualization's The Cure For Pacific HospitalVirtualization's The Cure For Pacific Hospital

At a time when his relationship with one of his primary suppliers was at a low, Matt Winn, IT director at Pacific Hospital of Long Beach, started casting around for a way to re-equip his 150 hospital, clinic, and doctors' office end users.

His regular supplier was Hewlett-Packard, and Winn had reached the point last fall where his questions and attempts to stage meetings had been ignored so often that he "wouldn't take a call from HP," he said in an interview yesterday.

That situation turned around as a new thin-client representative inside HP, a former Neoware staffer (HP acquired Neoware, a thin-client supplier, in 2007), recognized HP was losing a valued customer and took hold of the situation. That representative, who wasn't named during an interview, helped head off competitors and lead Pacific Hospital toward a virtualized end-user approach that saved money for the hospital on several fronts: energy consumption, capital expenses, and labor costs.

Winn started evaluating alternatives last November. His users were using Windows 2000 PCs that were hopelessly outdated to run an upgraded version of the electronic medical record (EMR) application, the hospital's patient-tracking system. With quality of care at stake, along with treatment data, prescriptions, length of stay, and other crucial information that was fed straight from the EMR app into the billing system, there was no room for a misstep. By the end of November, he needed his new end-user computing approach installed within a month.

Winn looked at the cost of going to new PCs for Windows XP or Vista and opted instead for a thin-client offering from HP and Citrix Systems. Instead of buying new hardware capable of running a much larger version of Windows, Winn expanded the hospital's reliance on XenApp, the Citrix central server that virtualizes applications. He went from one to four XenApp servers, and started hosting Microsoft Office, Fuji's medical Picture Archiving and Communications System, and the EMR application, among others. In all, 40 apps have been virtualized on XenApp.

Then, in less than 30 days, he equipped his end users with HP t5730 thin clients. While slender, they still pack a presentation punch with 1 GB of RAM and another gigabyte in a solid-state drive. Winn found early resistance to the thin clients because users were used to creating and saving their own files and playing music on their former Windows PCs. Needless to say, the HP thin clients showed up without disk drives or CD players.

"Once users got over the fact they couldn’t save locally and play music, they got used to the thin clients," he said. The fact that 22-inch, space-saving flat screen monitors replaced users' 17-inch cathode ray tubes helped. Back-office workers and nurses at nursing stations could put two documents side by side on the screens, speeding up their ability to compare information.

Users log in to XenApp by invoking their identities in Microsoft Active Directory to get their virtual desktops. Integrating Active Directory with XenApp simplifies desktop virtualization, said Winn. The virtual desktops run a copy of Windows XP under XenServer and can display user/application interactions faster than the old PCs could, despite the fact that such interactions are dependent on round trips to AppServer over the network.

"Users are extremely impressed with the speed of the applications," said Winn, and through folder redirection, they can still create and save files, only the files are stored on data center servers. AppServer is running on HP ProLiant DL380, dual-socket, quad-core servers that are "maxed out" with 12 GB of memory. They are 42% utilized, leaving headroom for growth in end users, said Winn.

Two Citrix AppServers run in Pacific Hospital's Long Beach location, and two at co-location facilities in Irvine, Calif., giving the hospital a way of recovering and restoring work, even if operations at one location were impaired. Virtual machines that are clones of the servers running at the opposite site are stored in each location, able to be called up and implemented if needed.

Winn said the changeover to virtual desktops on thin clients has led to several immediate savings. Each of the old-generation PCs with their large power supplies consumed 300 watts; the thin clients consume 50 watts, with some energy-saving practices implemented remotely. Winn estimates they're saving 83% of the electricity formerly consumed by desktops that were left on 24 hours a day.

Some of that savings is offset by the need for three more servers, but the net savings in electricity in the first year of operations will be $48,000. Winn hopes to expand thin-client use beyond his 150 users of the EMR application, with an additional gain in reduced power consumption the second year and a $99,000 reduction in the electricity bill. The third year will yield $110,000 in savings, he predicted.

Troubleshooting the virtual desktops is much simpler than problem solving on PCs. If a user downloads bad software from the Internet, it's purged when the thin client is shut down and a fresh, clean image of the user's desktop is loaded on restart. "We've cut way down on service calls. If someone complains they've starting to get pop-ups, we just tell them to reboot," he said.

In the past, a technical support person had to help end users in the outlying clinics, doctors' offices, and surgery centers by going there. Now most support can be performed remotely and a new user booted up in minutes. "Sending someone to Bakersfield used to waste a whole day," he noted.

The reduced end-user technical support has allowed him to retrain one end-user technician as an AppServer technician, retain two others, and lay off the two remaining tech support people. The move has resulted in immediate salary savings with no reduction in end-user service, he said.

The whole thin-client transition will pay for itself in two years and start driving ongoing savings to the bottom line, he added. When he first argued for the changeover and showed his figures to the CFO, "he made me go back and check and recheck the numbers. He couldn't believe it," Winn said. Ultimately, he got top management buy-in and support.

Winn also got a better relationship with HP. "When we started, we weren't sure who our account representative was, but we knew we weren't getting the service we felt we deserved," said Winn.

Now "an HP engineer has helped in setting up and supporting this transition." The situation "has turned around 180 degrees," he noted.

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