Say So Long to PCs in Hospitals

The personal computer has done a lot of good for clinicians in hospital settings, but its days are numbered. Zero-client terminals are quieter, safer, and cheaper to buy and to maintain.

Look around the modern U.S. hospital, and you'll see fewer and fewer traditional personal computers.

That's a good thing. PCs helped bring technology to the masses and powered electronic medical records in a way that previous computing had barely dented. But that was then, and this is now, and as aged PCs get refreshed, they are being moved out for "zero-client" terminals that IT organizations simply plug in.

Behind the scenes though, is a complex set of technologies that allow users to continue to use the same desktop and apps as before. But things are different:

• Zero clients have no hard disks, and in fact, usually run only a small kernel of Linux software in flash memory, and thus require almost no updating.
• With no spinning hard disks, cooling requirements are minimal, so the hardware is longer-lasting and quieter.
• Virtualization technology, coupled with proximity technology that senses a user's name badge not unlike modern door access systems, allows a user's desktop to follow him or her around a facility while requiring the user to enter a user ID and password only once during a shift.

A recent annual survey by Imprivata, which makes the technology that authenticates those name badges to start sessions with virtualization software from Citrix, VMWare and Microsoft, just found for the first time that a majority of hospitals are using thin or zero clients instead of traditional PC clients.

That same survey found that two years from now, 98 percent of those surveyed will be using thin or zero client as part of their IT strategy.

Thin clients, a previous incarnation of this same idea for reducing the complexity and increasing the manageability of a PC, still required the kind of occasional software updates and patches that drive CIOs to distraction.

The latest zero client hardware won't be found at your local Wal-Mart, but CIOs know the channels where they can find these increasingly commodity-like terminals able to serve up a Windows desktop.

Virtualization is an idea almost as old as computing itself, having been popularized by IBM on its 360 mainframe in the 1960s. Even running virtualization on a PC is not novel anymore. But the move toward a totally virtualized desktop as a mass phenomenon, particularly in healthcare, is just now pulling into the station.

I first witnessed virtualization in healthcare firsthand watching a clinician log in with her name badge at a thin client when I was a Kaiser member eight years ago. But Kaiser wasn't the only trailblazer. Another provider who implemented virtualization on PCs starting in 2002 is Memorial Healthcare, a 150-bed hospital in Owosso, Michigan.

Memorial Healthcare moved strategically from thin clients to zero clients a year ago.

"As healthcare changes over the next four or five years with the Accountable Care Act and with industry pressures to reduce cost, virtualization is going to become a key component to creating efficiencies that right now we just don't have," says Frank Fear, vice president of information services.

Fear says one of the biggest advantages – and an occasional drawback – to zero clients at Memorial is this: Every morning, or whenever staff arrives for a 12-hour shift, they are creating a brand new virtual desktop. The previous desktop's state of appearance is never saved. The data is always safe in the data center, and not stored locally on the zero client.

The drawback – really just a different way of doing things – comes when a software patch must be installed. Under the traditional PC model, that meant enlisting the aid of the help desk to update each machine. Under the virtualization model, only the master image of the software being pushed out to the zero client needs to be patched. That requires a different skill set in the data center, but saves considerable time by essentially only needing to be performed once.

As the rules of the HIPAA Omnibus legislation breathe down healthcare IT's neck, with hair-raising tales of breaches starting with rogue USB drives and missing hard disks, the kind of centralized management represented by virtualization and zero client technology is a siren song.

And right behind that is next April's retirement of Windows XP, still in use on too many desktops in healthcare. Virtualization is the natural replacement for XP, although it requires the master image to be at least based on Windows 7 if the same Windows apps will be used, Fear says.

Laptops and tablets and phones aren't immediately touched by this virtualization wave the way the desktop is, although my cover story on tablets back in January found a number of healthcare IT shops allowing access to desktops through virtual sessions implemented on tablets.

But healthcare IT executives such as Fear are sleeping better at night thinking about the control, security, and management options that the new virtual desktops provide. Plus, the zero client hardware will outlast the older PC hardware and is even a bit cheaper to buy.

Deploying virtualization enables a lot of other intriguing possibilities. Radiologists who need more computing power have traditionally defined the level of computing power in a hospital's basic PC. But in a virtual world, those users who need more computing power on their desktops can get it served to them over the network, according to officials at Imprivata.

Zero client hardware nevertheless benefits from a decent level of commodity graphics that would have been in a high-end gaming PC just a few years ago.

When I hear the rising chorus of calls for more effective return on investment of healthcare IT, it's clear to me that job one for IT right now is getting inefficient, buggy, costly-to-maintain traditional PCs off to the scrap heap, and move in the direction that Kaiser and Memorial Healthcare and others have cleared. The writing is on the wall.