Securely and successfully migrating an EHR system to a VDI environment
As a support engineer I regularly visit hospitals and get to see first-hand which problems they encounter in migrating an EHR system to a VDI environment. In this blog, I want to discuss the most common challenges and how I think these challenges can best be overcome to make this migration as simple and secure as possible.
Challenges in the migration
Most English hospitals use an Electronic Health Record (EHR) system. While hospitals formerly developed their EHR systems by themselves, today it is more common for them to purchase EHR software from a supplier. The transition to an EHR supplier can relieve the burden on a hospital’s IT department, because the supplier takes care of technical support and regular system updates.
However, EHR software suppliers generally fail to deliver a system that performs adequately. As a result, the end users in the hospitals are confronted with unforeseen performance issues, whereas hospitals need to be able to depend on their EHR system being available 24/7. If an EHR system performs inadequately or is unavailable, patients cannot be treated and physicians cannot invoice their work. This not only leads to inefficiency but can also result in life-threatening situations.
I have also noticed that many IT departments combine the transition to new EHR software with the implementation of a new IT environment. This new IT environment not only involves new hardware, but also new software such as Windows 10, Citrix 7.x and Vmware 7.x to implement and manage a VDI environment. This involves a complex transition in which both hardware and software need extensive testing and optimisation before the system can go live.
I would recommend the following steps and points of attention when migrating an EHR system:
- Start by drawing up a solid test plan that includes the end user experience (EUX).
- Begin conducting performance tests on the separate components as early as possible. The feedback can be used to implement improvements before the actual migration begins.
- Start performance testing outside of Citrix or VDI. The tests should be focused on the EHR, functionality and the underlying hardware and infrastructure. Conceive use cases that involve as many of these components as possible.
Challenges during the migration
Testing is a critical aspect of the migration process. Testing is about more than only functional tests of the environment and the application; it is also important to test whether the infrastructure is robust enough to handle the intended number of sessions. All too often I have seen this not to be the case, leading to awkward tensions between management, consultancies, and IT managers.
The next step after the environment has gone live is the phase of maintenance and updates. The developers of EHR systems tend to implement new updates regularly. Many suppliers have the rule that you may only lag behind an x number of updates in order to continue receiving support. The result is a continuous stream of new updates. This not only applies to EHR systems; it is the same with Windows 10. So it is important that during the migration, not only the functional components are renewed, but the internal processes as well.
A process that many hospitals benefit from, ensuring secure installation of this continuous stream of updates, is DTAP (Development, Testing, Acceptance and Production). This process helps you keep control of your image and software management tasks. Following all of these steps results in a minimum risk of problems when the system goes live, because everything has been tested three times. Because this process not only tests functional aspects, but also performance aspects such as application start times, the time required to find a user in the EHR software, and the number of users that the system can handle simultaneously after the update, the IT manager is much more in control of the environment. This means you can offer a much better performance guarantee when the image goes live. The result is fewer support calls, better performance and – not unimportant – more time and money for other matters.
Challenges after the migration
Once the environment is live, it remains important to monitor performance and EUX. This can be done in the conventional manner (which commonly involves the monitoring of hard metrics and checking whether the server is online or offline), but performance is more than just CPU utilisation or an IOPS. Here as well it is still important to continuously measure the end user’s experience.
A brief glossary of terms
What is an EHR system?
An Electronic Health Record (EHR) system is an application/database in which a healthcare institute records all their patients’ data.
What is a server-side VDI?
A server-side VDI involves a desktop virtualisation in a datacentre. The image file of a virtual operating system runs on a server instead of a local computer. This image can be accessed and used with a thin client, PC, laptop, or tablet, just as if it were a local installation on a standard workstation. The advantage for the IT department is that a VDI environment can be managed from a central location and the end user has full remote access to the system. Examples of VDI solutions are VMware View, Citrix XenDesktop and Microsoft Virtual Desktop Infrastructure.
What is EUX?
EUX stands for End User Experience. In my opinion, it is the end users of the EHR system – typically physicians and nurses – that determine whether the performance meets the standard; and this is not only about the hardware metrics.
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