Based at the Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust is one the UK's largest hospital trusts. It serves a local population of over 650,000 and, including junior doctors on rotation and agency staff, employs more than 6,000 staff. The hospital handles 132,000 emergency patients, conducts 44,000 day-surgery procedures and delivers 6,000 babies every year. As Head of IT Operations Phil Kenney says, "It is a very dynamic environment within which to deploy any system."
Making effective clinical decisions requires having all relevant information for each patient to hand as quickly as possible. However, clinical staff at Portsmouth relied on outdated Windows XP based-desktops. Not only was it extremely slow to log on to the system and access data, but their profile data was frequently corrupted. PC terminals were often locked unintentionally by users who had been called to other areas and, due to the limited number of desktops available in clinical areas, this frequently delayed access to information. Certain applications were only available on particular PCs, adding to the difficulty. IT Operations Manager Jonathan Murden was also aware that the ageing system had very high running costs. Most PCs ran the Windows XP operating system, required for various legacy applications, but this was coming to the end of its supported life and the Trust needed to plan for a replacement. Jonathan explains, "Clinical staff want very quick access to everything, wherever they are. Their user experience was key to any new system we developed."
Deployment of a new solution would be subject to some constraints: it had to be deployed quickly with a small team, and deployment could not disrupt clinical work or adversely impact essential legacy systems.
Jonathan approached a number of software providers to form an ecosystem that would develop a solution to meet clinicians' demands. Together, they defined iDesktop, a hosted shared desktop solution built on Citrix® XenApp® and Citrix XenServer®. The system uses Citrix NetScaler® for secure remote access and load balancing across the network. It supports delivery of a Windows 2008 R2 Hosted Shared desktop to around 2,000 thin-client terminals. Legacy applications are delivered using XenApp 5 and Microsoft Application Virtualisation (App-V) 4.6. iDesktop is a persistent, hosted shared desktop that is available to authorised users from any terminal within the hospital. With Tap-and-Go access, clinicians can instantly access their desktop by tapping their security card on a terminal's RFiD reader. In this way, a doctor can instantly retrieve his or her working session from another ward and terminals are never locked out by absent users; a new user can simply tap over another on any available device. iDesktop also features proximity printing and single sign-on so that users can be instantly effective wherever they are needed.
Jonathan and his team selected the Accident & Emergency department and Acute Medical Unit as their pilot test beds. These departments have a very high throughput of cases and are visible across the rest of the hospital. Jonathan and Project Manager John Franklin knew that a pilot here would have a potentially large benefit. In addition, a successful pilot would be a powerful proof point to answer resistance from other departments in the future.
Clinicians in Emergency Medicine estimate that iDesktop can save them up to two hours a day from their 12-hour shifts. Dr. Mike Bacon of the Acute Medical Unit confirms, "This is the first IT system that has actually made my life easier. Before iDesktop, it could easily take five to 10 minutes per case simply to access medical records. We would typically see 20 to 25 cases each shift."
Clinicians now have access to all relevant information in one place: radiology, blood results and any previous correspondence. There are no more locked PCs and all relevant applications are available from all terminals – no more waiting for the only PC in the department running a particular package.
iDesktop is not limited to the hospital site. Clinicians can now access their desktop session easily and securely from anywhere, at any time, on any device (provided Citrix Receiver is installed). Laptops, PCs, Macs, iPad and Android tablets and smartphones can all be used. iDesktop is also accessible via the Public Services Network, allowing clinicians to work from other hospitals, schools, libraries and so on.
The project team has been able to reduce environmental costs with energy-efficient thin-client terminals. These simpler terminals are also three times cheaper than PCs and have a significantly longer life.
IT support is more effective, too. "Our service desk is more proactive now; finding problems in advance and noticing trends," says Jonathan. "We can focus on key areas rather than fire-fighting the end-user experience."
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