Virtualized desktop can provide iPad EHR implementation shortcut

Virtualized desktops offer physicians secure access to electronic health records while they're mobile. This model is the way some facilities are implementing iPad EHR systems.

At least by one recent measure, consumers are adopting the Apple Inc. iPad faster than any other electronic device

that's not a cell phone. In health care, this adds up to more iPads in more doctors' hands. CIOs already using Citrix Systems Inc.'s virtualized desktops can harness their iPad lust to drive the implementation of electronic health records (EHRs) -- and still maintain Health Insurance Portability and Accountability Act, or HIPAA, compliance without a lot of back-end support.

Numerous EHR vendors are developing or have released iPhone or iPad clients, but those applications don't necessarily sync real-time information to an EHR system, and don't necessarily allow IT departments to manage security under hospital rules, said Todd Smith, Citrix senior system engineer. He spoke to SearchHealthIT.com at the 2010 HealthMart10 conference in Worcester, Mass. More importantly, using a virtualized Windows desktop on an iPad extends the device's computing power beyond Apple's iOS operating system.

"What we're seeing is that users require access to multiple applications simultaneously," Smith said. "So, having an Epic app [on an iPad] really limits what I can do. It still stores things locally, which means that if the device ever gets lost or you need to show you need to destroy it, you still have to protect the data. … One of the challenges with browser-based solutions is that it pulls down a lot of data to the local device's cache. We eliminate all that. So, if I lose the device, there's nothing stored locally, except there may be a URL."

Citrix is working closely with several EHR vendors, including Epic Systems Inc., McKesson Corp. and Siemens AG, to develop iPad EHR tools and offer white paper tutorials containing implementation strategies, Smith said.

Using the Citrix Receiver app instead of the native iPad client that an EHR vendor might publish offers three benefits, Smith said.

•  It allows for secure login to EHR systems via such familiar methods as identification badges, RSA keys via Wi-Fi or 3G networks, and username-password configurations.

•  It puts a virtualized desktop on the iPad, which gives practitioners a familiar interface to the EHR system.

•  It gives IT staffs a quick implementation. If they are using a Citrix virtualized desktop already, they already have done similar implementations for such other devices as iPhones, Android phones, and different operating systems on desktops or laptops.

IPad EHR implementations can be simple

Dave Gravender, CIO of Kaweah Delta Health Care District in central California, said his real-world experience confirms Citrix's claims. Enabling mobile access to patient records for doctors in his facilities via the iPad and iPhone happened almost effortlessly and at no real cost to his IT department.

The iPhone and iPad patient record delivery system works so easily because no new development or management was needed to get the doctors up and running. That's because the organization used existing Citrix clients for doctors who already were accessing the Siemens applications remotely on home laptops or desktops. All that's needed is an iPad (or iPhone) with a 3G connection and the free Citrix client app available from the iTunes Store.

"The iPad is truly a mobile desktop," Gravender said at the Fall CIO Forum of the College of Healthcare Information Management Executives, or CHIME, in Phoenix. With its virtualized desktop, Citrix "changed the whole game on remote access. It's really not about the iPad at all. It's a tremendous device and form factor, but it's all about the apps."

Gravender demonstrated how fast it is to load the Citrix client and access the EHR apps, which can access patient records and stream patients' telemetry data live. Doctors can switch between platforms easily simply by logging into another device. The Citrix session can transfer automatically -- from the iPhone to the iPad, for instance.

About 40 doctors are using the iPad. Gravender said; he's not really sure exactly how many because he's managing only the Citrix server. The costs for the original deployment were underwritten by the foundation that runs Kaweah Delta Health Care District. "Any doctor on our system could go out and get an iPad and could get into his or her records without me knowing it."

With virtualized desktop, future's bright for iPad in health care

Citrix's Smith is virtualizing Windows to his iPad. Considering it's an Apple device, that might appear counterintuitive, but that paradox is the driver he sees buoying the iPad's potential in health care. In his experience, the demand has been peer-driven: One doctor sees another using the iPad and wants his own. Then, after getting to know the iPad, he demands to integrate it into patient workflow.

It's really not about the iPad at all. It's a tremendous device and form factor, but it's all about the apps.

Dave Gravender, CIO, Kaweah Delta Health Care District

Usually, any new device at that point finds that the path to implementation becomes quite difficult. Not so with the iPad. "This is the first device where a user comes into the IT department and says, 'Can you hook this up?' and the IT department says, 'Of course we can!'" Smith said. "This is one of the first times in history where the IT department doesn't say, 'No, we can't do that.'"

How did Apple accomplish that with a consumer device that isn't necessarily built for enterprise use? On the user side, Smith points to the iPad's low cost, tactile appeal, long battery life, form factor -- specifically, how it fits into a lab coat's pocket -- and no need for a tethered keyboard or stylus.

On the IT side, the simplicity of the virtualized desktop is driving iPad acceptance where other devices fail, Smith said -- at least in his experience with Citrix XenApp users, who view the iPad as just another desktop instance, as they would any other client.

"They're already granting that access on the back end; they're just using this as a connection device," Smith said. "At that point, there is no different between [the iPad] and a thin client device."

Scot Petersen contributed to this report from Phoenix. Let us know what you think about the story; email Don Fluckinger, Features Writer.

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