How Health IT Gave Back Every Children's National Doc a Dozen Minutes Each Day

At a time when physician burnout has reached alarming proportions, this virtual desktop solution improves the clinician experience and enhances workflow.

In a sweeping initiative to improve the clinician experience, Children’s National Hospital set its sights on designing a virtual desktop that follows staff around the health system and reduces logins from minutes to seconds. About one year later, despite the COVID-19 pandemic, that's exactly what the Washington, D.C.-based health system accomplished.

A key health information technology enabler for Children’s National is its Bear Institute, a unique 2013 partnership between the health system and EHR vendor Cerner Corporation. In 2018, innovation leaders at Children’s noticed some degradation of its clinician workflow environment, and decided to redesign it from the ground up, according to Matt MacVey, vice president and chief information officer at Children’s National.

Speaking at the College of Healthcare Information Management Executives CHIME20 Digital Recharge event, MacVey described the goal as being to improve the clinician experience at Children’s National. By that measure, mission accomplished—clinicians got back 12 minutes of each day previously spent logging into their Children’s National desktops.

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The improvements also enabled those clinicians to access electronic health records (EHR) with maximum flexibility, thanks to a major infrastructure upgrade that replaced approximately 2,000 traditional PCs with "zero client" thin PCs, which access virtual desktops. Clinicians are now able to move from working on one such client to another in a fraction of the time it used to take. And during this year of the COVID-19 pandemic, this infrastructure also better supports remote work.

By leveraging Cerner’s resources, notably several system architects and project leaders who spearheaded the infrastructure upgrade, the Institute helped transform technology interactions.

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"Physicians were logging into their systems, [and] it was taking up to two minutes for them to log into the system," says Darin Prill, a Cerner senior director who doubles as chief technology officer for Children’s National and technology leader for Bear Institute. "We had numerous back-end problems with applications and printing, and it was causing a huge amount of physician dissatisfaction, as well as potential patient safety issues with delay of care."

Fortunately, the patient safety issues never materialized, but Prill says the health system never wanted to be in that situation. "Within the hospital, the physician is hopping from computer to computer, and they need instantaneous access to the medical record," he says. Prior to the infrastructure upgrade, such logins took two to three minutes for each initial login, and a minute or two for subsequent logins. Due to some earlier design compromises, the remote-hosted Cerner servers had introduced even more delays in application response.

As part of the upgrade process, project leaders convened a user experience governance committee, which included a variety of departmental directors and managers, medical staff, the chief medical information officer, and the chief nursing information officer, Prill says.

Imprivata single sign-on technology allows clinicians to roam from client to client and be recognized and authenticated merely by their badges being in proximity to that workstation.

"We set some pretty aggressive goals," Prill says. "The first, and most important of which was, 30-second login time with 10-second resumption time." To achieve this, the team specified a multisite active server design utilizing a so-called "active-active" data center—continuously-available compute clusters at two different data centers, which could still serve up virtual desktops even if one data center were to go offline.

The upgrade ultimately "shattered" the design goals, now serving up the initial login in less than 15 seconds, and no more than three-and-a-half seconds for subsequent logins, Prill says. "When we talk about initial login, that’s [going] to the terminal, swiping their badge, and being able to get into the Cerner EHR, so that’s [the] full workflow, getting them to the EHR."

Upgrade Delivers Additional Benefits

Faster logins were only one of the improvements Children's National experienced.

• Another benefit of going to zero client hardware is lowering administrative burdens and reducing the health system’s security attack surface, Prill says.
   
• Other server-side infrastructure upgraded during the project includes Citrix virtual desktop technology and the Cerner EHR software itself. "The hyperconverged infrastructure from Cisco really lets us scale," says Keith Haag, senior architect of server and desktop virtualization at Cerner, who also worked on the upgrade. "If additional compute or memory resources are needed, [or] storage, that can be added in a modular fashion."
   
• Children’s National also had some clinicians with more demanding workstation tasks – higher video performance for cardiologists and radiologists who needed snappy performance as they called up videos for their respective practices. "We did do NVIDIA GRID hardware-enhanced performance for some advanced desktops," Haag says.

Deployment: "We Didn't Want a Global Pandemic to Stop Us"

The team was one day away from starting the production pilot in its 7-East non-critical care hospital unit when the 2020 COVID-19 pandemic hit. "[It’s] our favorite place for pilots," says Ben Abramovitz, managing architect for Cerner at the Bear Institute.

Then, the health system told all non-essential workers to get out of the hospital, including the IT staff. "We had to rethink how we were going to pilot this," Abramovitz says. "We had just spent nine months building it. The general feeling was, we didn’t want a global pandemic to stop us."

The team switched the pilot to virtual, and deployed at the clinics first, since all nonessential visits had been stopped, Abramovitz says. Because there were still critical appointments going on, "we wore proper PPE and face masks, [and] had a large supply of hand sanitizer," he says.

Each clinic took two to three days to convert to the new infrastructure, and then the transition team would spend a day in between clinics doing rounding, making sure the deployment went well, Abramovitz says. Because on-site deployment staff were limited due to the pandemic, remote assistance from Haag’s team was essential to the rollout.

"We deployed to the entire hospital and all our ambulatory clinics in three months," Abramovitz says. "The net effect is every clinician at Children’s National got 12 minutes of their day back" due to the number of times clinicians log in each day.

One final benefit of the virtual desktop deployment: Faster, simpler logins for staff working from home during the pandemic. "It’s no longer a chore to get into the system," Prill says.

[Editor's note: This article has been modified to correct the spelling of Matt MacVey's name]