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For Kaweah Delta, using the iPad a natural extension of Citrix network

Crystal Bedell, Contributor

Health care professionals have been using the iPad ever since Apple Inc. unveiled the wildly popular device last spring. This case study illustrates how using the iPad is helping a central California health

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care district improve patient encounters and, in the long run, cut its hardware costs.

When the iPad came out last year, Nick Volosin, ISS director of technical services at Kaweah Delta Health District in Visalia, Calif., didn’t waste any time. He preordered three of the mobile devices and tested them on the hospital network the same day they arrived. Now, just over a year later, 76 hospital-owned and 70 physician-owned iPads are used to access medical apps over the Kaweah Delta network.

The Kaweah Delta Health District consists of five sites -- the main hospital, a dialysis center, nursing facility, rehabilitation hospital and mental health hospital. Since 1995 Kaweah Delta has been using technology from Citrix Systems Inc. to deliver hospital applications to its 6,500 users. Physicians and other medical personnel can use any Internet-connected device to access a number of applications, including Soarian and Invision from Siemens AG, McKesson Corp.'s Horizon Patient Folders, NavigatorWeb from Poseidon Group Inc. and Microsoft applications.

"With the latest versions [of Citrix], we have been able to deliver desktops and applications faster than on traditional PCs, without the bandwidth limitations," Volosin said.

The health system is following a trend that shows an explosive growth in iPad use since the device was released. Executives are struggling with developing mobile device management policies to keep pace with the growth of personal devices in the workplace. In addition, using the iPad has led to new concerns for mobile device security.

Kaweah Delta had been providing connectivity via the Apple Inc. iPhone and iPod Touch for about six months prior to the iPad release. (Previous experience supporting the iPhone, as well as the BlackBerry, has made it easier for CIOs manage how employees are using the iPad in the enterprise.) After reading reviews from beta testers using Citrix on the iPad, Volosin preordered three of the WiFi-enabled models. They arrived April 3, 2010.

Testing went well. "Right after the iTunes registration process, I was able to download and install Citrix Receiver for the iPad and connect to our hospital applications," Volosin said, referring to the Citrix product that lets IT departments create a virtual desktop infrastructure, or VDI.

It gets the physicians in the patient rooms more. If the physician is in the room charting -- versus at the documentation desk -- the patient feels that they're present.

Nick Volosin, director of technical services, Kaweah Delta Health District

"I was amazed how easy it was to navigate [on the iPad] -- then very impressed with the battery life. It lived up to the 10 hours as advertised," he added. Hours later, with testing completed, Kaweah Delta's medical director purchased and began using the iPad for rounds and patient visits, all in the same day.

Virtualization maximizes benefits of using the iPad

The iPad provides most of the functionality of a desktop, including an onscreen keyboard, but Kaweah Delta lets users reconnect to their virtual desktop from a mobile device or a desktop. A thin client is also available in each of the 500 patient rooms. This lets users see what device works best at any given time, Volosin said.

This flexibility helps improve efficiency and care quality at Kaweah Delta. For example, physicians can check on patients from anywhere -- at home, the grocery store and so on -- by viewing a patient's live telemetry chart on an iPad. Similarly, physicians can look at an X-ray from their office, open it on the iPad and then show it to the patient during a visit.

"It gets the physicians in the patient rooms more," Volosin said. "If the physician is in the room charting -- versus at the documentation desk -- the patient feels that they're present. The patient can ask questions. They don't have to push the nurse call button as much."

Finally, using the iPad has brought financial benefits as well. With computers on wheels costing $7,500 and tablet PCs costing $2,500, the iPad cost-- ranging from $499 to $829, depending on storage capacity and whether it connects via WiFi or 3G -- allows the hospital to extend its IT budget.

In future fiscal years, Volosin expects the iPad to replace most requests for other mobile devices. "We can see an opportunity for either substantial savings or additional devices to improve patient care," he said.

Addressing iPad security, management concerns

Of course, no discussion of health IT is complete without a look at how security and regulatory concerns are addressed. Kaweah Delta users remotely access applications and virtual desktops via a secure, encrypted VDI connection. "No data is stored [or cached] on the device, because it’s all running in the data center," Volosin said. In addition, his team uses the Apple iPhone Configuration Utility (for iPad and iPod Touch as well) to set up and enforce a simple PIN policy on time out.

In terms of user-owned mobile device and iPad management, Kaweah Delta doesn't do anything special. For example, physicians and other medical personnel can use the Apple tablet on the guest network, provided that Citrix Receiver for the iPad is installed. "We don't own it, so we can't enforce too many policies on it. That is the responsibility of the end user," he said.

Along with the virtual desktop implementation that Kaweah Delta uses, additional mobile device and iPad security considerations include robust help desk support processes, stringent requirements for installing software updates and the use of application certificates, which restricts access to users who have the appropriate certificates. Mobile device management and security platforms are also an option, but these can be costly and may offer only limited controls.

Crystal Bedell is a technology writer and editor. Her articles, tips and guides help IT professionals evaluate technology, secure and modernize their IT infrastructure, solve business problems, and prepare for IT certification. She can be reached at cbedell@bedellcommunications.com.


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