Regional Medical Group Virtualizes Electronic Health Records with Windows Embedded

Wyse Thin Clients and Microsoft Virtualization Ease ManagementHillcrest Family Health Center, a network of 12 family and specialty medicine clinics, needed a better way to manage hundreds of computing devices. An Electronic Health Record system required constant patches and fixes, making support costly and time consuming. Roby Solutions, a local systems integrator, proposed a solution based on Wyse thin clients running Windows Embedded Standard to connect to Windows Server 2008 R2 running Microsoft Hyper-V Virtualization. Now IT resources are centralized for easier management; users can connect to their personalized, dedicated desktop from anywhere; and Hillcrest has reduced bandwidth infrastructure cost by approximately 35 percent.

“Windows Embedded fits into Hillcrest’s larger business strategy by providing a low cost computing platform that is very reliable and easy to use.”Michael Allison, IT Administrator, Hillcrest Family Health Center

OverviewCountry or Region: United StatesIndustry: Healthcare

Customer ProfileHillcrest Family Health Center is a "community-owned" health care organization located in Waco, Texas.

Business SituationHillcrest wanted an easier way to manage the IT resources of 12 geographically-dispersed medical clinics.

SolutionWyse thin clients running Windows Embedded Standard 2009 and Hyper-V Virtualization to connect to Windows Server 2008 R2.

Benefits Easy remote management Lower bandwidth costs Connectivity to peripheral devices Dedicated personalized desktop

Wyse V Class Thin Client

SituationHealth IT spending continues to grow rapidly in the U.S. Several factors are contributing to this growth. First, the revised Health Information Portability and Accountability Act (HIPAA) lays out new rules and regulations for disclosing security breaches, notifying patients whose records have been compromised, and accounting for patient record disclosures—as well as stronger mandatory civil penalties and enforcement mechanisms.

Secondly, there are Federal efforts to support the implementation of Electronic Health Records (EHRs) across the industry. EHRs are systematic collections of electronic health information about individual patients or populations. Due to recently enacted financial incentives and penalties linked to Medicaid/Medicare payments, healthcare providers are adopting EHR systems at a dramatically accelerated rate.

These market forces impact the Hillcrest Health System of Waco, Texas, which includes Hillcrest Baptist Medical Center, a fully-accredited, 236-bed acute care facility, and Hillcrest Family Health Center, a network of 12 family and specialty medicine clinics.

Hillcrest clinics are neighborhood-based, so medical care is available where it is needed. Michael Allison, IT administrator for the Hillcrest network of clinics, works with another IT manager to support approximately 350 employees, including 51 healthcare providers (e.g., physicians, nurses, and therapists), who use an estimated 400 desktop PC and Tablet PC systems.

“We have 12 clinics across a 40-mile radius, so performing hands-on technical support is time consuming and costly,” he says. “About a year ago, we saw that our PC hardware was getting old and moving parts like disk drives were starting to break down. We were getting calls from

people who heard strange clicking noises coming from their machines.”

Adding to the burden on IT resources was a multi-site EHR system that was purchased

and installed for the network of clinics in the mid-2000s.

“Our EHR system required that each clinic have its own SQL database running on a server, which needed administration on a regular basis,” states Allison. “The EHR application is updated frequently by its publisher. At least once a month, we had to shut down the clinics for an entire weekend and ‘touch’ each machine to install a hot fix or service pack.”

Hillcrest needed to find a way to run updates and perform maintenance on machines without touching them. “We wanted to consolidate software in a centralized location and manage hardware more effectively,” recalls Allison.

SolutionAllison evaluated multiple solutions for the clinics. First, he considered the “blade server” solution used at the hospital, Hillcrest Baptist Medical Center. But the clinics require many more end-user devices, making this approach too costly.

“I also evaluated VMware, but calculated there would be too much licensing expense for third-party software and desktop applications,” states Allison.

Finally, Allison considered Microsoft Hyper-V, the hypervisor-based server virtualization technology. He saw that Microsoft’s flexible licensing policies would allow Hillcrest to achieve the cost savings of virtualization through Windows Server 2008 R2.

“My next step was finding a partner who could help us with systems integration,” says Allison. “We wanted someone with deep expertise in

“The superiority of a Microsoft and Wyse thin computing solution meant it was the only solution that made sense for our EHR application and our entire IT environment.” Michael Allison, IT Administrator Hillcrest Baptist Medical Center

Microsoft virtualization technology. I found Roby Solutions through a reference from a trusted colleague. The fact that Justin Roby works here in Waco sealed the deal for us. It was really important to have a local implementation resource for immediate turnaround response to our problems.”

Justin Roby, Owner of Roby Solutions, is a Microsoft Certified IT Professional and Microsoft Certified Technology Specialist in more than a dozen Microsoft technologies, including Windows Server Virtualization. “The Hillcrest project is a great example of how a healthcare organization can use Microsoft Virtualization to make system management as simple and cost-effective as possible,” says Roby. “We started the process by compiling a list of all the applications Hillcrest wanted to run. At the top of the list was the EHR application, which has approximately 160,000 patient records. We also had to integrate three different hospital systems, including a legacy 16-bit application. Other key applications included the Microsoft Office suite, Java, Adobe Flash, and a Virtual Machine.”

Roby continues: “We built a proof of concept to make sure each of the legacy applications could be supported on Windows Remote Desktop Services. Then we scaled the Windows Server 2008 R2 infrastructure to match the requirements of consolidating multiple independent servers into one centralized location.”

For the end-user devices, Roby specified Wyse V10L, Wyse R90LEW, and Wyse C90LE thin clients running Windows Embedded Standard 2009 connecting to Windows Server 2008 R2 over Hyper-V. Based on Windows XP Professional, Windows Embedded Standard 2009 is a componentized operating system for dedicated devices.

“We chose Windows Embedded Standard 2009 technology because of

its full support for the latest version of Remote Desktop Protocol (RDP), support for Active Directory Management, low licensing cost, and great overall performance,” explains Roby. “Windows Embedded fits into Hillcrest’s larger business strategy by providing a low cost computing platform that is very reliable and easy to use.”

The Wyse thin clients are compact, energy efficient and productive desktops with the dynamic user-experience of a PC. Wyse thin clients have no moving parts. Their service lives are extended beyond those of comparable PCs and the noise from fans and hard drives is eliminated.

BenefitsWindows Embedded technology delivers important value to Hillcrest. Technical benefits include a personalized desktop experience, built in connectivity, and a rich ecosystem. Business value includes easier HIPPA audits, reduced support and bandwidth costs, and new service options for patients.

Personalized Desktop ExperienceMicrosoft Remote Desktop Connection Broker and session redirection allow end users to see a dedicated view of their personal desktop, including all of the icons, folders and documents, arranged exactly how they last left them.

“The desktop experience is very important to our users, especially the doctors,” says Allison. “They appreciate the familiar Windows interface and the ability to use voice recording with Dragon Naturally Speaking software. Normally, this is a tricky application to run in a virtualized environment since it requires a user’s personal voice ‘profile. The roaming profiles feature of Remote Desktop Services, however, handles this easily, allowing users to record from any of our Wyse thin clients.”

The Hillcrest system uses RDP Gateway to establish SSL connectivity

“We achieved cost savings from productivity gains due to increased uptime, as well as ROI due to less time being spent on servicing desktops.” Michael Allison, IT AdministratorHillcrest Baptist Medical Center

Wyse C-Class Thin Client

to clients outside the company’s network. Healthcare providers can securely connect into the system from any Internet connection without using complex, slow Virtual Private Networks.

“Our doctors can literally see their work desktop at home, so they can conveniently finish entering notes into patient charts in the evening, instead of spending more hours in the office,” states Allison. “This was one of the features that sold our organization on the idea of Microsoft Virtualization.”

ConnectivityWindows Embedded Standard provides seamless built-in connectivity to the Microsoft Hyper-V Presentation Virtualization environment, with extensive peripheral device support

“The paperless office is not a reality in healthcare today,” remarks Allison. “Our clinics still need to scan all kinds of information. Front desk personnel use the Wyse thin clients to scan Medicare, Medicaid, and insurance cards with newer handheld scanners connected via USB. They also use USB webcams for taking patient pictures. In the back office, the Wyse thin clients also support heavy-duty legacy scanners connected via SCSI for scanning referral letters, lab reports, and more.”

He continues: “Microsoft RDP 7 has a full feature set to support all our peripherals. Windows Embedded also makes it easy to redirect devices and drives. This speaks to the strength of connectivity between Wyse V10 thin clients and Windows Server 2008. Windows picks up these remote scanning devices across the virtualization system with no configuration required.”

Richness and Depth of Microsoft Ecosystem Hillcrest also benefited from the richness and depth of the Microsoft developer ecosystem, which allows customers in small metro areas—such as Waco, Texas—to find local qualified

and certified experts in advanced technologies like Presentation and Desktop Virtualization.

Business BenefitsHillcrest has achieved several notable business benefits since implementing the new virtualization system. For example, it is easier to conduct HIPAA compliance audits.

“Before we had multiple remote databases, but now the database is centralized, so we can audit all charts for every provider at once,” says Allison. “Plus, I can keep track of everything from my desktop and manage it all in one place.”

Another benefit is reduced lifecycle support costs. “We achieved cost savings from productivity gains due to increased uptime, as well as ROI due to less time being spent on servicing desktops,” says Allison.

Now there are more service options for patients. “Clinics don’t have to shut down on weekends for EHR software updates anymore. Hillcrest now operates Sunday clinics where family physicians at one location can see any other provider’s patient. They log into the EHR and all the relevant patient information comes up. Each of the Sunday clinics sees about 30 patients, which means that we can see an average of 1,500 more patients a year.”

Measurable dollar savings have been achieved by reduced bandwidth costs. Prior to adopting Microsoft Virtualization technology, data traffic consumed seven to eight percent of bandwidth; today it is only one percent. As a result, Hillcrest has been able to drop some expensive Gigabit Ethernet connections down to 20mb broadband connections, saving approximately 35 percent, or $50,000 per year.

The ability to run the EHR system in a cost-effective manner allows Hillcrest to continue reaping ROI benefits. There is a two-percent rebate on Medicare and Medicaid billings for

using electronic-prescribing, as well as the savings achieved by batching claims to make billing more streamlined and reduce accounts receivables.

“I’d estimate the company’s $600,000 investment in the EHR system was recouped in the first three years. We want to protect that investment. The superiority of a Microsoft and Wyse thin computing solution meant it was the only solution that made sense for our EHR application and our entire IT environment,” concludes Allison.

Keywords: Thin Client Devices; Thin Clients

Windows EmbeddedWindows Embedded is a high-performance and highly reliable platform used by innovative OEMs to deliver devices that stand out through rich user experiences and seamless connections to the world of Windows. The Windows Embedded family of products includes Windows Embedded CE, Windows Embedded Standard, Windows Embedded Enterprise, Windows Embedded POSReady, Windows Embedded Server and Windows Embedded Automotive.

For more information visit:www.microsoft.com/embedded.

For More InformationFor more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to: www.microsoft.com

For more information about Wyse products and services, visit the Web site at: www.wyse.com

For more information about Roby Solutions products and services, visit the Web site at: www.robysolutions.com

For more information about Hillcrest Baptist Medical Center products and services, visit the Web site at: www.hillcrest.net

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published July 2010

Software and Services Windows Embedded Standard

2009 Microsoft Server Product Portfolio

− Microsoft Windows Server 2008 R2

Hardware Wyse V10L Wyse R90LEW Wyse C90LE