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Saving a Healthcare Citrix Build gone Sideways - 6 LESSONS

With 100+ agents working from a local Starbucks or with clients and patients in their homes, a government healthcarefalse

March 2017

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With 100+ agents working from a local Starbucks or with clients and patients in their homes, a government healthcare organization we met with a few weeks ago relies heavily on Citrix to make their EMR (Electronic Medical Record system) available anytime, anywhere.

The business model is simple.  Patient visits equals revenue.  No visits, no revenue.  Anything that improves productivity, allowing field agents to see more patients in a given day, is by definition improving revenue for the organization and that is what Citrix was brought in to facilitate.

Citrix’s ability to allow staff to work from anywhere Internet access is available, from a 4G cellular hotspot to Wi-Fi, on any device, should have been a game changer for the organization.

The problem is that Citrix has not been reliable.  In fact it has been anything but reliable, forcing staff to slow the number of patients they can see in a day because they cannot connect consistently. 

Security and compliance risk (HIPAA/HITECH) to the organization has increased dramatically as field staff have been forced to take handwritten notes to complete their visits, instead of being able to connect from the patient’s home and typing data directly into the EMR located back in the healthcare organization’s data center via Citrix XenApp.

These visit notes contain patient data and thus must be maintained and protected until transcribed into the EMR when the field agents are in the office or have better luck connecting.  The significance of the problem becomes clear when realizing that over $15,000,000 in fines have been handed out over the last few years because laptops that have been lost containing patient data.

What was originally intended to consume one resource, part time for Citrix, has actually consumed 2.5 full time employees now dedicated to Citrix out of necessity to address trouble tickets and literally babysitting the system minute-by-minute to keep Citrix alive which has robbed IT of key staff otherwise stuck in support mode instead of maintaining the systems they were hired to support and completing new projects.

IT leadership has not fared much better with constant pressure from line-of-business management and executive staff furious over the productivity drain on the business.  The productivity loss that field staff are experiencing has also morphed into some damage to the brand promise of the healthcare organization, disappointing patient families and partners.    

The frustrating part for the healthcare organization is that the problem was not with the technology they selected, Citrix XenApp and XenDesktop in this case, it was the quality of the deployment done by their trusted Citrix partner. 

The healthcare organization has all of the right pieces in place to meet their use case.  The decision and planning were good, but everything fell apart in the execution and was further complicated by the healthcare organization’s lack of intrinsic Citrix knowledge which might have been able to rescue the deployment when it started off the rails.

With a free incident we make available to everyone, the environment has been stabilized.  Field staff have been able to work and connect successfully.  The minute-by-minute babysitting of the Citrix environment by the IT department has come to an end and the noise from the line of business and executive staff has at least temporarily stopped.   

So, where did this Citrix XenApp environment go sideways?  What did the Citrix partner do wrong?

The partner followed a Citrix reference architecture script, really designed more for the unique challenges the financial services industry faces more so than healthcare, to the letter, with no real understanding of the impact the configuration decisions would have when complete.

Once the basic script work was complete, there was no optimization done to dial in Citrix performance, or SQL, Group Policies, hypervisor, etc. No tuning, no monitoring, no automation.

The end result was a Citrix environment that cost more to support annually than it cost to buy and build.  A guaranteed recipe for frustration at all levels.

Going forward this Citrix environment will be managed, with performance SLAs and guarantees around login times and overall performance.  Part of our Citrix team will become their Citrix team.

Lessons learned

  • Make sure your virtual environment (Citrix XenApp, XenDesktop, Microsoft Remote Desktop Services or VMware Horizon) is built for the way you do business. Are you a three shift, around-the-clock mobile organization or are your users more of a 9-5, in the office, crowd?  Design accordingly.
  • Reference architectures are good guides, but not something to be followed blindly. Take the time to understand why you are checking the boxes you are checking.  If Chief Engineer Google can’t give you an answer from a well worded search, get some professional help.
  • If the “professional help” can’t explain why the reference architecture is recommending this setting or that, you might want to find better professional help.
  • No matter where, how, or who builds your virtual environment, optimizations are necessary to get the most out of your published application/virtual desktop environment. We apply over 400 optimizations to every environment we build.  The reason for this is immediately understood with the very first login.  It makes the end user experience wildly better.
  • Virtual desktops can perform as good as or better than physical PCs. Don’t accept a lower level of performance just because the desktops have been virtualized.
  • The biggest cost savings from virtual desktop (VDI) environments is in support over time. If your support costs are not going down, or worse, are going up, something has gone sideways and needs to be fixed.