Monday Nov 06, 2006

Are PCs Killing Health Care?

There is no debating the benefits of technology to the field of health care.  From medical imaging to cancer research, information technology plays a huge role in the betterment and saving of lives.

Sometimes however, things that are meant to help turn out to hurt.  It wasn't that long ago in the scheme of things that doctors used to recommend smoking.  IT people (frequently) get it wrong too, and the Windows based PC is a prime example of this in health care, at least where they are directly involved in patient care.

Larger hospitals have hundreds if not thousands of Windows based PCs on site, many in patient care roles.  These PCs require a lot of care and feeding and this care and feeding leads to higher infrastructure costs and can affect patient care.

Viruses and Malware:  It's a constant battle to keep these PCs updated.  The larger the install base, the more sophisticated your management solution must become.  A simple push mechanism does not work in patient care scenarios.  You can't interrupt a doctor updating a chart, or nurse requesting medication.  What's even more important is ongoing test and QA that must occur to ensure that patient care is not interrupted by a product patch.

Parts availability:  The PCs that are bought in hospitals are not your typical $300 clone.  They buy the more expensive business line of these PCs since the manufacturers guarantee the availability of replacement parts.  Unfortunately due to PCs being commodities, the parts in these models often change from month to month which gets back to the need for the testing and QA of updates to these machines. You can’t afford to have PCs down because you pushed out the wrong graphics card update.  Compare this with the Sun Ray model that the only part to replace is the unit itself.  The first Sun Ray sold in 1999 is still 100% functional with the latest Sun Ray Server Software.  Keep a few in the storage closet next to the boxes of rubber gloves.  The rubber gloves will get replaced before the Sun Rays do.

Power/Cooling:  Most PCs used in the hospital setting never get a chance to go into hibernate or sleep mode.  What's more is that these features are more often than not intentionally disabled in patient care scenarios.  Seconds can make the difference in patient care and while waiting for your PC to "wake" is surely faster than waiting for it to boot, it still takes precious seconds, which turn into minutes and hours over the course of a month.  This takes the Doctors and Nurses away from direct interaction with their patients, which is never a good thing.  Take the Dell GX620, a popular model often seen in hospitals.  Dell's own tests show this PC will use between 70 and 125 watts to run excluding monitor.  In patient care scenarios the power use is probably on the higher end due to 24/7 nature of hospitals.  Even if we take the lower end, compare this to a Sun Ray 2 which averages 4 watts with a max of 30 watts and we throw in a conservative 20 watts per user for the back end server costs you are still using far less than a PC.  Let's triple the noted average of the Sun Ray and call it 12 watts (let's say everyone is using a couple USB storage devices each), add in the server for a total 32 watts per desktop.  The Sun Ray will save you at least 50% of your power costs over the unrealistic "low" end of the spectrum of the PCs power use.

PCs are "on" in patient care scenarios 24 hours a day, 7 days a week, 365 days a year.  That equals over 8,765 hours.  In New York ($0.13 KWH), this PC will cost you roughly $80 per year.  In Hawaii ($0.18 KWH), it will cost you over $110 per year.  The Sun Ray (including server and tripling the average consumption) would cost you $36 in New York and $50 in Hawaii.  Even for a smaller hospital with 200 PCs, these are real savings.

Uptime:  While Sun Rays rarely break, bad things do happen to good devices.  Administrative costs to diagnose/repair/replace a PC can run into the hundreds of dollars per visit.  Anyone who can put staples in a stapler can replace a Sun Ray, and more importantly since the device is stateless as soon as the device is plugged in, it is available right where the failed unit left off.

Refresh Cycles:  Most health care organizations state that they are on four year refresh cycle on your PCs, except the reality is that it's never really a four year cycle.  A PC rarely lasts four years in this environment due the constant use and increasing demands of the software stack.  Three years is more like it, however it's not a batch replacement every three years.  Health care industry folks I talk to tell me PC replacements happen monthly, if not weekly.  In some of the larger hospitals I've visited, it's a daily occurrence.  Sun Ray customers refresh servers, not desktops. 

Privacy and Security Regulations:  The HIPAA act of 1996 forever changed the face of technology in health care environments.  Most organizations are still struggling with implementing all of the requirements today.  Simple things like not leaving patient data on the screen is procedural nightmare for not only the health care providers (You didn't log off?  Be prepared to visit the human resources department) but also those who manage the computer systems.  The hot desking feature of Sun Ray makes thing like HIPAA easier to implement.  More over, a stolen Sun Ray does not endanger patient information.  Even in Terminal Server environment, care must be taken to ensure that patient information cannot be stored on the device whether it is something as innocent in jotting down notes on the local computers notepad, or something more malicious like screen captures of sensitive data being saved off as bitmaps.  You can't save any data off to a Sun Ray.

Mobility:  Hospitals are large, fast moving places.  IT staff do their best to keep the amount of time it takes to log on to a minimum.  However as noted above, changes happen and logon times vary from PC to PC.  Hospital staff members find themselves logging in and out of multiple different PC's many times a day.  Again the benefit of Sun Ray hot desking is that the user logs in once and her session follows her everywhere.  Nothing else comes close to this, not even smooth roaming from Citrix.  As one hospital exec said regarding Citrix smooth roaming "it's close, but it's just not hot desking."  There's a lot of FUD coming from our competition when it comes to comparing their thin client mobility to Sun Ray hot desking.  As Jimmy Buffett sang, "Don't try to describe the ocean if you never seen it".

Location of Devices: For many reasons it’s impractical to put PCs every where that you might want one. Noise, heat, security are the top reasons you don’t see PCs in most hospital rooms. Rather they are stuck in the nooks and crannies, behinds desks, and in lounges. This means that doctors must take notes, recall advice, etc when entering patient data. If you had a device that was totally silent, used power like a night light, and didn’t jeopardize patient data wouldn’t it make more sense to have these devices in the room? Think of the time saved and mistakes prevented if a doctor or nurse could update the patient records in real time.

Now you may hear others telling you that these benefits apply to all thin clients.  Not quite.  You can read some of my other thoughts on this, but here are a few more.

Firmware/OS Image management:  Sure others have it too, and it may also include a license for a management tool.  Be sure to watch for limitation on number of desktops you can manage with the "free" version.  Yes, you just read a limitation of five desktops if you followed that link and read the fine print.

Compare the size of the updates as well.  Is sending a 114 MB (or larger) image out to a desktop the same as sending a 300 KB update?  Bigger is not better in the thin client world.  Oh, and make sure you grab the right image too...

Viruses and Malware:  Is that embedded OS really safe from viruses?  Or did you just trade your current headache for one in a smaller package.

Device Replacement: What exactly must happen with other thin clients when they are replaced.  Do I have to configure it locally to talk to a server farm?  Out of the box, do I have to wait for a push of a different image?  Or is opening the cardboard box the hardest part of the replacement process as it is with Sun Ray.

Bottom line is that Sun Rays can help health care organizations by putting their focus back on the patient instead managing PCs and worrying about HIPAA compliance.


My name is Craig Bender aka ThinGuy. I'm a Principal Software Developer for Oracle's Virtual Desktop Engineering group.

I architect and evangelize the use of Oracle's Desktop technology including Sun Ray, Secure Global Desktop, and Oracle VDI.


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