Whitepaper. Next-Generation Desktops: Meeting the Growing Demands in Healthcare IT HEALTHCARE

Transcription

1 Whitepaper Next-Generation Desktops: Meeting the Growing Demands in Healthcare IT HEALTHCARE

2 Introduction This whitepaper has been authored by experts at Liquidware Labs in order to provide guidance to adopters of desktop virtualization technologies. In this paper, we outline how the healthcare industry is benefitting from Liquidware Labs solutions in order to create flexible, follow-me desktops, not only providing clinicians with mobile workspaces for anytime, anywhere, any device access, but also enhancing the accuracy and security of patient data. Information in this document is subject to change without notice. No part of this publication may be reproduced in whole or in part, stored in a retrieval system, or transmitted in any form or any means electronic or mechanical, including photocopying and recording for any external use by any person or entity without the express prior written consent of Liquidware Labs. Liquidware Labs, Inc Mansell Road Suite 200 Alpharetta, Georgia U.S.A. Phone: Liquidware Labs Inc. All rights reserved. Liquidware Labs, Stratusphere, FlexApp, Flex-IO, and ProfileUnity are trademarks of Liquidware Labs. All other products are trademarks of their respective owners. 1

3 Contents Introduction... 1 Next Generation Desktops in Healthcare... 3 Growing Demands in Healthcare IT... 4 Managing Users in Healthcare Organizations... 5 Expanding Diversity of Healthcare Software Applications... 6 Exponential Growth in Patient Data... 8 Requirements for High 24/7/365 Availability and Disaster Recovery... 9 Requirements for Security... 9 Liquidware Labs Transforms Desktops in Healthcare... 9 Delivering Follow-Me Desktops and Printing Accelerating The Login Process Down to Seconds Safeguarding User-Authored Data Boosting Desktop Security Delivering High Performance and High Availability Summary

4 Next Generation Desktops in Healthcare The U.S. Healthcare sector continues to accelerate the use of advanced technologies to both improve the quality of patient care and to document to U.S. agencies that these improvements are real, quantitative, and progressive. Increasingly high tech approaches are being used to: Improve the accuracy of patient data by enabling point-of-care entry of data into HIT systems. Provide clinicians with mobile workspaces for anytime, anywhere, any device access for 24/7/365 access to HIT systems. Improve sharing of patient information across all caregiving organizations and patients themselves. Secure and protect patient-related data electronically in compliance with HIPAA privacy guidelines. Deliver high performance follow-me workspaces that can easily handle the diversity of Healthcare applications as well as data- and graphics-intensive software applications needed by clinicians. Since the launch of the Health Insurance Portability and Accountability Act (HIPAA) in 1996, Healthcare institutions have been required to use electronic means to collect, organize, store and share patient information while maintaining a high standard of security to safeguard patients privacy. HIPAA compliance mandated that Healthcare organizations adopt certified Electronic Health Records (EHR) software as a central clearinghouse to collect and share patient information securely. Since HIPAA was enacted, the U.S. Department of Health and Human Services (HHS) continues to impose increasingly precise reporting standards to maintain reimbursement eligibility. Insurance companies, likewise, require detailed documentation from health services organizations. Finally, the majority of Healthcare institutions seek to go beyond simple compliance, recognizing that precise tracking and analysis of patient information leads to the superior patient care that is their overriding mission. Some recent trends having a significant impact on Healthcare IT Systems and Service include: In 2016, the Center for Medicare and Medicaid Services (CMS) Meaningful Use Rules entered Stage 2, which expanded requirements for electronic capture of clinical data. Stage 2 criteria promotes using Healthcare IT for continuous quality improvement at the point of care and to exchange information in the most structured format possible. As of fall 2015 providers are required to use ICD-10 codes, increasing the number of diagnoses from roughly 18,000 to 140,000. ICD-10 codes utilize new taxonomies to provide greater detail and granularity when entering diagnoses and hospital procedures into IT systems. Physicians and other clinicians are seeking 24/7/365 access to their workspaces and want the flexibility to enter data not only at the point of care, but also after-hours, using their own devices outside the Healthcare setting. The Healthcare industry is increasingly under attack by cybercriminals at a higher rate than any other sector. More than 100 million healthcare records were compromised in 2015, according to a report published by IBM. Given, too, that clinicians want to use their personal devices for work, Healthcare is consistently deploying identity management and encryption practices as well as leveraging virtualization technologies to prevent hackers from gaining access to systems. 3

5 Patients increasingly are expecting access to their personal healthcare information through electronic means, including healthcare portals. Healthcare providers are seeking other software applications, including SAAS offerings and mobile apps to supplement or replace functionality in EHR systems. Growing Demands in Healthcare IT These trends place tremendous pressure on Healthcare IT staff to create IT infrastructures capable of meeting the following demands: Respond to HIPAA compliance regulations for patient information privacy as well as Meaningful Use mandates for quality improvements and information exchange. Meet the productivity needs of a highly diverse and increasingly mobile workforce which needs high-performance workspaces that can support sophisticated software applications, high definition graphics and multimedia. Deliver anytime, anywhere, any device follow me workspaces to enable point-of-care interface with patient data as well as easy access to peripherals, such as printers and scanners, proximate to the clinician s physical location. Ensure that HIT systems and the workspace environment are designed to support 24/7/365 high availability as well as data backup, replication and disaster recovery. Ensure the security of their entire environment to prevent data and systems from being hacked and exposed to malware. In order to meet this demand for a next-generation, flexible workspace environment, Healthcare IT staff are increasingly turning to desktop virtualization technologies including user profile and environment management, application layering and user experience monitoring and diagnostics solutions. 4

6 Managing Users in Healthcare Organizations Healthcare organizations employ a wide variety of professionals from physicians and nurses to a vast number of clinical specialists, researchers, administrators and support staff. They use a variety of devices, applications, peripherals and other resources to do their work. Illustration 1. And today, they are increasingly mobile. As Healthcare workers move through their environments and login to a fresh workspace or device, users must be recognized by role to access the resources they need. If they are logging in from personal devices, controls must be put in place to limit access to HIT systems. As security must be strictly be maintained, it is critical that data entered be stored to a centralized share where it can be backed up and protected. Managing secure user access to IT System resources by user roles is nearly impossible in Healthcare settings without the deployment of a user environment management (UEM) solution such as Liquidware Labs ProfileUnity. UEM software enables the user personality to be abstracted from the operating system and applications to be centrally managed and subsequently to be deployed to any device on-demand, enabling dynamic personalization of provisioned desktops and easier migration of users to newer technologies such as virtual desktops. UEM solutions enable the follow me workspace that can be deployed to a variety of devices anywhere, anytime as the user logs in. 5

7 Expanding Diversity of Healthcare Software Applications Another major challenge in Healthcare is the sheer size, expanding scope and diversity of software applications used by staff. There are five major categories of software systems deployed in Healthcare, including Electronic Health Records (EHR) systems, Practice Management, Office Productivity, SAAS and Mobile Apps. Ideally these systems will be integrated and provide a seamless user experience to staff. Illustration 2. Electronic Health Records (EHR) Software Systems The linchpin in most Healthcare organizations in the EHR system mandated by HIPAA compliance which handles the majority of patient interaction functions, including: Patient demographic and care-management data on patient visits Clinical-decision support Reports required for financial management, quality assurance, chronic disease management, and public-health data collection Consents, authorizations and directives Interfaces and interoperability required to exchange health information with other providers, laboratories, pharmacies, patients, and government disease registries E-prescribing Alerts and reminders Medication reconciliation 6

8 Practice Management Software Medical practice management software (PMS) is a category of Healthcare software that deals with the dayto-day operations of a medical practice. This software allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports. PMS is often connected to electronic medical records (EHR) systems. While some information in a PMS and an EHR overlaps for example, patient and provider data in general the EHR system is used for the assisting the practice with clinical matters, while the PMS is used for administrative and financial matters. Office Productivity Software This is the standard office software most often Microsoft Office and Outlook that includes , word processing, presentation, spreadsheet software, etc., that most organizations deploy. SAAS Third party Software as a Service (SAAS) either complements or takes over functional modules in EHR systems. Some examples of these applications include ZocDoc, Castlight, Surescripts, and referralmd. Mobile Apps Mobile applications are increasingly being used by clinicians for daily operations. Some types include: Apps that free providers from offices or workstations. These include EHR remote-access apps such as EPIC system Haiku, Allscripts' Remote app and MedPlus' Quest Care360 Mobile Apps that provide access to lab results and medical imaging. Some examples of this type of application include Mobile MIM, Normal Lab Values, and Pocket Lab Values. Apps that offer practice management. Examples of these apps include Hospital Rounds and E/M Code Check. In traditional desktop provisioning, desktop images are designed with the OS and applications required by each end user group. However, with so many applications (with so many interdependencies) needing to be delivered to such a variety of users, this practice can quickly lead to desktop sprawl in Healthcare organizations. Therefore, IT staff is looking for better ways to manage and deliver applications. A solution such as Liquidware Labs FlexApp solves the issue of desktop image sprawl, allowing IT administrators to set up only a few master images and deliver all other applications to users on demand as needed. When utilized with ProfileUnity, applications are delivered to users based on their roles and policies. Centralizing the majority of applications allows IT administrator to more easily inventory, patch and update versions, ensuring security and that all users are on the same, supported versions. 7

9 Exponential Growth in Patient Data The requirements imposed by U.S. Healthcare agencies have created new challenges in management and consumption of health-related data. To say that Healthcare relies on big data is a gross understatement. The shift to ICD-10 codes (140,000 codes) reflects the growing requirement that healthcare providers be substantially more granular and precise in describing patients conditions and treatments. Much of patient information is not standard or uniform in nature. It comes in a variety of formats, including text, numeric, paper/pdf, digital, pictures, videos, multimedia, etc., and comes from a variety of sources. Illustration 3. To ensure capturing comprehensive, highly accurate data, more and more information is input by clinicians at the point of care rather than later. To do this, physicians, nurses and other specialists must have access to powerful workspaces through a variety of end-point devices at the location where they are delivering services. Finally, it is critical to ensure that no patient data can ever be stored to local devices, but be routinely saved to a central repository to ensure that it can be backed up, recovered if needed and replicated. Features within Liquidware Labs ProfileUnity support the delivery of follow-me workspaces that allow clinicians to interact with data at the point of care. This solution can also ensure that user-authored data is migrated from local devices and saved to centralized storage, ensuring that it is never lost. 8

10 Requirements for High 24/7/365 Availability and Disaster Recovery Patient care never ceases. Hospital IT Systems must be available every day of the year, 24 hours a day. In addition, clinicians also require that they be able to access test results, scans and other patient data around the clock both for continuity of care and to keep up with the demands of communications, paperwork and other support tasks. It is critical that HIT staff not only are able to architect high performance complex systems, but also prevent unplanned downtime to keep them running 24/7/365. It is also critical that disaster-recovery strategies be put in place so that all patient data and systems can be restored asap in the event of an unforeseeable event. A solution like Liquidware Labs Stratusphere UX provides unparalleled visibility into users, workspaces, devices and the systems that power desktops in Healthcare organizations. Healthcare IT administrators can proactively monitor desktop environments to gain data about user experience and trends, as well as potential issues in order to prevent major outages before they occur. Requirements for Security Healthcare IT systems must meet the highest standards of security of all industries as they are mandated to utilize electronic means for collecting and storing patient data and keep this information private. Having massive amounts of data in electronic formats makes Healthcare institutions a greater target for cyber criminals. In a recent report compiled by IBM, Healthcare moved into the top spot of the rankings as the most-attacked industry in 2015, replacing financial services. Five of the eight largest healthcare security breaches since the beginning of 2010 took place during the first six months of 2015, and over 100 million healthcare records were compromised in the same year. Therefore, it is imperative that Healthcare organizations impose the kind of security best-practices that are enabled by Liquidware Labs solutions, including user and application rights management, application white- and black-listing, and centralizing data and applications for better maintenance and monitoring. Liquidware Labs Transforms Desktops in Healthcare Founded in 2009, Liquidware Labs is an industry leader and pioneer in desktop virtualization solutions for next-generation physical and virtual desktops, including VMware Horizon View, Citrix XenDesktop and XenApp and Microsoft Windows. The company's innovative and award-winning products include Stratusphere FIT and Stratusphere UX for desktop monitoring and visibility; ProfileUnity, which supports desktop portability; and FlexApp, which supports the design of sophisticated application delivery strategies. 9

11 Delivering Follow-Me Desktops and Printing Healthcare organizations today require follow-me workspaces for staff in order to free them from deskbound restrictions. ProfileUnity is a sophisticated User Environment Management (UEM) solution that decouples user profiles and user-authored data from the Windows OS, stores them independently in central storage in order to be utilized upon login, regardless of platform, location, or end point device. Triggers and context-aware filters can fine tune automated mapping of printers and other peripherals so users have seamless access to work resources even as they move from location to location. Illustration 4. 10

12 Accelerating The Login Process Down to Seconds Healthcare not only needs flexible follow-me desktops, but its workers require near instantaneous access to them. If login times expand to unacceptable durations, the root cause of problems must be corrected immediately. Liquidware Labs Stratusphere UX provides a specialized login breakdown analysis that provides vital and granular visibility into the events that run during the machine boot and the login process. Once the analysis confirms no abnormal bottlenecks exist, Liquidware Labs ProfileUnity can be used to optimize the login process. ProfileUnity solves common problems that cause the profile bloat, including eliminating cached files or deleted items, or ignoring cached files application settings folders. ProfileUnity allows you to store PST and local OST files outside of the user profile. Once the profile size is reduced through automation and best practices, ProfileUnity further compresses the transfer and network storage of the optimized user profile in a ratio that is up to 50:1. Microsoft GPOs, which perform lookups for each policy, are a major login bottleneck. ProfileUnity can execute polices based on Microsoft AD criteria and by more than 300 context-aware filters combinations. The solution performs only a single master lookup when authenticating policies against Microsoft AD and is significantly faster. ProfileUnity almost always runs Microsoft AD templates/gpos faster than Windows itself due to very efficient AD lookups. ProfileUnity includes a robust ADMX import capability to replace AD policies, thus significantly speeding up logins for the majority of users. ProfileUnity s Portability feature module can set portions of the profile to load silently after login. This feature can be used with ProfileUnity s exclusive ProfileDisk technology to easily handle large profiles such as those housing Microsoft Office 365 Offline Cached mode data. ProfileDisk delivers the entire profile as a layer from an attached user VHD or VMDK, thus avoiding typical profile redirection problems. In fact, the profile layer is so transparent that the OS does not realize that it is not on the local drive. Together, these technologies deliver user profile performance that is the fastest in the industry. ProfileUnity can easily integrate with providers such as Imprivata for secure single-sign on authentication thus reducing repeat logins. Clinicians need only actually login the first time; subsequently their profiles and all group policies will follow them from station to station. Safeguarding User-Authored Data It is critical for Healthcare organizations to ensure all patient data is saved to central storage and does not remain on local devices, for both compliance and recovery reasons. Microsoft s best data storage practices requires that user-authored data be directed to networked file shares. ProfileUnity includes an innovative built-in feature to automate migrations of user-authored data automatically in the background. Built-in throttling lets administrators select a data transfer speed that will not impact network performance, so data can be trickled up to the new location over time. Once migration is complete, users can access data from the redirected folder location and subsequently save to that location seamlessly. The data can be backed up and replicated through standard processes. 11

13 Boosting Desktop Security Liquidware Labs solutions used together helps Healthcare organizations meet Dept. of Homeland Security US-CERT recommendations to protect their computer networks from malware and ransomware attacks as follows: ProfileUnity supports centralized backup of user-authored data, thereby enabling a sophisticated data backup and recovery plan for all critical information through standard backup and replication solutions. ProfileUnity supports integration with Imprivata. ProfileUnity enables a follow-me persona that can automatically detect the location and context upon user login either as normal or through a solution such as Imprivata OneSign. The user s profile, policies, access to data and location-aware printing are then instantly configured. Additionally, desktop/workstation features can be locked down to ensure the desktop and environment remains secure and compliance regulations are kept intact. According the US-CERT, application whitelisting and blacklisting is one of the best means for preventing malware or ransomware from compromising IT systems. Stratusphere UX can be used to perform an application inventory to be the basis of an application whitelist. Once the base whitelist is established, ProfileUnity features to manage whitelisting and blacklisting allow only the specified applications to run. ProfileUnity also can restrict users ability (permissions) to install and run unwanted software applications, and can apply the principle of Least Privilege to all systems and services which can additionally stop malware from running or limit its capability to spread through a network. FlexApp supports centralized storage and management of applications, thus greatly simplifying maintenance and helping administrators ensure that OSs and all software are up-to-date with the latest patches. Vulnerable applications and operating systems are the target of most attacks. Ensuring these are patched with the latest updates greatly reduces the number of exploitable entry points available to an attacker. Regular use of Stratusphere UX to monitor the desktop environment will also help administrators quickly spot abnormal processes or non-standard applications. Simplifying Desktop Image and Application Management Healthcare organizations have an onerous task of tracking and maintaining all the applications used by their diverse staff. Many are looking for alternatives to managing hundreds of desktop images. Liquidware Labs Stratusphere UX can be used to perform an application inventory as a first step to designing an application-delivery strategy that matches applications with the most efficient delivery approach as follows: Deploy the application within the base image Virtualize the application through isolation Virtualize the application through streaming or publishing Deliver the application through an application layering solution such as Liquidware Labs FlexApp 12

14 FlexApp Application Layering is proving to be boon to Healthcare organizations. This solution "redirects application installations onto virtual disks that look "native" to Windows OSs when attached to the endpoint. FlexApp solves the problem of maintaining desktop images for every user group. Administrators need only create a limited number of master images. Other applications used by specific groups or individuals can be layered on top of the master image on demand. FlexApp has demonstrated support for EHR software such as Cerner, McKesson, MEDITECH and EPIC, etc., and can be set to automatically deliver these applications for time of day, location or any other compliance attribute based on the user s context. Because the majority of applications can be stored centrally, application upgrades, patches and other maintenance can be regular and comprehensive, greatly enhancing desktop security. Administrators can maintain existing SLA s with zero user disruption. Delivering High Performance and High Availability Healthcare IT infrastructures and desktop environments must be always available to staff and patients. However, as these systems become larger, more complex and more virtualized, it becomes extremely difficult to spot potential issues before they turn into major problems and bring systems offline. Liquidware Labs Stratusphere solutions are unique, purpose-built to provide desktop user-experience assessment, monitoring and diagnostics. When used for assessments, Stratusphere FIT can ensure that desktop images and desktop environment infrastructure are properly designed. As a monitoring and diagnostics solution, Stratusphere UX tracks the performance of production desktops through the user experience view. However, irregularities can pop up at the user-experience level as in slow or unresponsive logins or applications, lost data or files, or other random glitches. The root cause of these problems can be any number of things, including poor configurations, too little capacity, rogue or misbehaving applications, poor desktop design or inappropriate user behavior, all of which would not be detected through systems monitoring. With Stratusphere UX, HIT staff can proactively monitor ALL desktops in the environment, regardless of platform, and provide support to Help Desk staff to triage trouble tickets and more effectively identify, route and elevate looming issues before they become systemwide nightmares. Stratusphere UX supports diagnostics by: Providing detailed analysis of a single user, single machine or single application view that is suitable for entry-level desktop administrators Executing a cursory diagnostic analysis (Health Check) to help quickly route trouble calls to appropriate IT teams Leveraging the Stratusphere UX API a point and click GUI API builder to assist any level administrator or consultant to extract information from Stratusphere UX and repurpose it in other more commonly used formats or systems monitoring solutions. 13

15 Summary Current trends place tremendous pressure on Healthcare IT staff to create IT infrastructures capable of meeting the demands of compliance agencies and at the same time support the productivity needs of a highly diverse workforce as well as handle enormous amounts of patient data. In order to support point-ofcare models, they must deliver anytime, anywhere, any device access of workspaces, with speedy logins and easy access to peripherals, such as printers and scanners, which are proximate or required for the tasks at hand. They must deliver a wide spectrum of software applications to a highly diverse staff of clinicians and others. They must make sure that workspaces can support the applications required and deliver high performance as well as high availability. Finally, they must maintain extremely high standards of security to safeguard sensitive, private patient information. In order to deal with all of the requirements imposed through compliance regulations as well as the demands of Healthcare staff, HIT systems professionals are increasingly leveraging desktop virtualization technologies in order to create the kind of architectures that can meet these requirements. Healthcare devices (desktops, mobile and kiosks) are the points of entry for patient data as well as the conduits to access this data. Healthcare organizations recognize they need to move from static deskbound architectures to a flexible, responsive and secure desktop environment to meet staff productivity needs. A pioneer and innovator in desktop virtualization solutions for next-generation physical and virtual desktops, Liquidware Labs solutions meet the need of Healthcare organizations to transform their desktop environments to meet escalating compliance, productivity and security needs. Using Liquidware Labs Essentials, including ProfileUnity UEM, FlexApp application layering and Stratusphere UX monitoring and diagnostics solutions, allows Healthcare IT staff to gain a number of benefits, including: Deliver follow-me mobile desktops to enable clinicians to perform work at the point of care with greater accuracy Accelerate logins to workspaces to mere seconds with integration with solutions such as Imprivata Boost desktop security with user and applications rights management, application whitelisting and blacklisting features, as well as monitoring and simplified management to keep OSs and applications current. Simplifying application management to reduce administrative workloads in provisioning and maintaining applications. Centralizing applications to ensure comprehensive and timely maintenance thus boosting security. Monitor all desktops in the environment to prevent unplanned downtime. For more information about Liquidware Labs solutions, visit 14