Can't Virtualize Allscripts EHR in VDI? Layer It!

Posted by Jordan Murphy on Nov 5, 2014

Allscripts is the electronic health record (EHR) software for many small and mid-sized medical practices. As more care providers move to Virtual Desktop Infrastructure (VDI), they need a way to deliver Allscripts EHR to their new virtual desktops. Howerver, as most everyone now knows, and as Gartner covered recently in "The Secret Bottleneck of VDI," application delivery is one of the major reasons for stalled VDI projects and IT headaches. So, it's no surprise that many healthcare IT teams find they can't virtualize Allscripts for VDI application delivery.

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Why Don't Traditional App Delivery Methods Work with Allscripts EHR?

The four traditional methods of delivering Allscripts in VDI all have their issues:

  • Building Allscripts into your Windows gold image is super-inefficient.
      EMR apps change often to keep pace with compliance requirements.  You don't want to be cracking open your Windows image every time you need to apply the latest Allscripts update. Bundling apps with Windows also results in image sprawl, as many images are created to meet the different application requirements of different departments and users. Since EHR is a core app that's used by almost everyone, you'll be applying the same Allscripts patches over and over and over...
  • Virtualizing Allscripts is hard and prevents interoperability. 
    Trying to virtualize Allscripts with traditional application virtualization tools such as ThinApp or App-V requires a lot of IT staff time (think days) and expertise. These solutions also use a techique called isolation to protect apps from conflicting with each other. That means no interoperability with PACS, Adobe PDF, and the other applications that Allscripts needs to communicate with. Read more about the challenges of virtualizing EMR apps in VDI.
  • Streaming Allscripts is redundant.
    You could stream Allscripts using a terminal services approach. But then you'll be maintaining two separate server-based computing environments: one to host Allscripts and one to host your virtual desktops.
  • Using PC management tools to deliver Allscripts is resource-intensive
    Managing your virtual desktops with the same tools you used on your PCs isn't a good idea. Agent-based PC configuration tools were designed for physical desktops with local CPU and disk. Having those agents install Allscripts over and over again on every VM will bring your shared server and storage infrastruture to its knees.

What's the Better Way to Deliver Allscripts in VDI? Application layering!

Application layering is the new way that many healthcare organizations are successfully delivering Allscripts EHR software to virtual desktops:

  • Layering Allscripts offers package-once, patch-once efficiency.
    Instead of building Allscripts into your Windows image, abstract it as its own application layer. The Allscripts layer can be assigned to any number of desktops separate from your Windows image. Patch the layer once centrally, and every virtual desktop will be automatically updated with the new layer.
  • Layering Allscripts is easy and enables full interoperability!
    Packaging applications, even complex ones like Allscripts, is simple with layering. It takes the same time as installing Allscripts on a physical PC. And unlike when you virtualize Allscripts, layering Allscripts is the same as doing a local install - it's not isolated. So Allscripts will have no problems cross-communicating with your other key clinical apps.
  • Layering Allscripts is resource-lite.
    Your Allscripts layer is saved as a virtual disk (VMDK on vSphere, VHD on Hyper-V) that can be attached to and shared by many VMs.  This resource-efficient method - designed for desktops in the cloud, not physical PCs - uses file system and registry virtualization technology to merge the Allscripts layer with all other assigned layers.

Read more in-depth about how layering is the better way to deliver EMR apps in VDI.

Customer Proof Points

Sunrise Health Region

sunrise_health_stackSunrise Health Region is one of the largest desktop virtualization projects in Canada with hundreds of applications, 3,000 desktops, countless use cases, and access from multiple devices - mobile and fixed.

For Sunrise Health, patching and updating Allscripts EMR as well as hundreds of other clinical applications were diverting resources that could be better used on projects that advance the quality of health care. Clinicians were not making consistent use of electronic systems due to terminal server performance issues and the inability for desktops to remember where they last left off. Falling back to paper records was reducing the effectiveness and consistency of diagnostics and prescriptions. Non-clinicians accessing information on behalf of care providers was creating privacy and security concerns, making it harder to comply with Canada's Health Information Protection Act (HIPA).  VDI was the solution.

Unidesk layering technology has made the move to VDI easy and efficient for Sunrise Health.  Unidesk is used for desktop provisioning, image management, and the delivery of Allscripts and more than 100 other critical apps. The organization currently has 620 virtual desktops deployed, with more desktops being implemented as PCs reach end-of-life. Half are persistent desktops for clinicians and administrative staff, while the other half are non-persistent for common areas and nursing stations.

USF Health

USF_Health_StackUSF Health is located in Tampa, Florida. It is a unique institution that deals with education and research, but also has active practicing doctors.  This creates a broad set of use cases, including USF students and professors, practicing physicians in the clinic, operating rooms, and procedure rooms. USF Health has an IT team of 140 people, but only two of these people are dedicated to virtualization.

For USF Health, there were multiple factors driving a switch to VDI.  Clinicians wanted greater desktop and application availability so they could spend more time on patient care. VDI is delivering with "anytime, anywhere" access through
zero clients, mobile devices, and PCs.

Increasing the use of Allscripts to standardize order entry and achieve meaningful use objectives was another key driver for VDI. Virtual desktops were the way to get care providers to use the EHR system more consistently.

Currently, USF Health has ~800 virtual desktops deployed and managed with Unidesk. The two-person VDI IT team has successfully layered 113 applications, including Allscripts.

North Bend Medical Center

NBMC_StackNorth Bend Medical Center, a health cooperative on the Oregon Coast, is setting an example for how to solve complex virtualization challenges across multiple care facilities. Their centralized IT department supports over 400 users, each with unique accessibility and security needs.  Unidesk desktop layering technology has enabled NBMC's lean IT staff to implement VDI and deploy Allscripts with uncommon simplicity and speed.

Says Joshua Rabe, Systems Architect at NBMC, "We had layered Allscripts with Unidesk and delivered it to the 150 users who have already been moved to VDI. Then we had to deploy a new update. On the 'go live' day which was a Saturday, we had someone click a check box to apply the new version of our Allscripts layer to the 150 virtual desktops.  It was done in 30 minutes. Then the poor guys who had to update all of our remaining physical desktops had to spend the rest of the weekend manually installing the Allscripts update on each PC. As you can see, Unidesk gives us a lot more time to work on other things or more importantly, enjoy a beer or two on the weekend."

How are you delivering Allscripts EHR in your virtual desktop environment? Traditional PC software distribution tools? Application streaming? Application virtualization? Or application layering? Let us know!

Topics: Citrix XenDesktop, VMware Horizon View, Healthcare, Nimble Storage, Allscripts, Imprivata, Microsoft Hyper-V

Posted by Jordan Murphy on Nov 5, 2014

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