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engaging doctors to agree on policies for the types of test results, medications, allergies and other patient data that would be shared across the HIE. The doctors determined how the data would be collected and updated at the point of care and in the EHR. Ultimately, Doylestown believes that physician buy-in was achieved because it was the independent doctors deciding and collectively agreeing on the data collection and sharing policies – not the hospital dictating the rules. DCN’s hybrid federated HIE model, which keeps data decentralized while combining data “push” and “pull,” reinforces physician own- ership by taking the hospital out of the center. That factor is critical, because when doctors view an HIE as hospital controlled, they often shy away from it.

The hospital and community physicians examined every aspect of patient safety and prioritized the data to be shared based on those issues. The objective was to derive the highest quality of care from sharing patient information while incor- porating it as seamlessly as possible into clinician workflow. Doylestown took an incremental approach to rolling out the various data elements physicians were able to access on the HIE, so as to not overwhelm them. The HIE started with patient demographics, brought up lab results (including feeds from reference labs) and then radiology, cardiology, endos- copy and other hospital reports. That way, the hospital was able to sequence value by adding features that simultaneously improved care, patient safety and physician workflow. The selection and prioritization of reporting features – such as the integration of the HIE feed into the EHR – was a byproduct of the HIE design, which was based on the simple but critical elements of patient safety, quality and physician workflow. An HIE must demonstrate value. Early on, physicians doing e-prescribing, for example, were able to accrue a 2 percent bonus from Medicare. E-prescribing will not work without a comprehensive medications list across an enterprise, because the provider must know what medica- tions the patient is already taking and how those medications may have changed. Laboratory and radiology reports have traditionally drowned physician offices in faxing and scanning. Automat- ing functions such as prescription drug refills and telephone tasks has allowed doctors to see more patients. In Doylestown, if a patient sees any physician in the community and then shows up at an emergency department (ED) – and is registered – the system quickly queries the DCN for any clinical data. If any exists, the HIE automatically populates the hospital EHR with the patient’s lab or radiol- ogy reports or clinical summaries. The ED doctor does not have to look up anything; he simply clicks on an icon and the information automatically pops up on the ED tracker board. Being able to access this kind of real-time patient infor- mation onscreen at the point of care is testament to both the amazing workflow improvements and the quality care enhancements possible through an HIE.


VDI approach to desktop delivery, desktop instances can be rapidly deployed within secure data centers and then accessed remotely by end users from a variety of endpoints, such as thin clients, walk-up kiosks, tablets and even smartphones – in addition to the traditional physical laptop and desktop endpoints, which now serve a terminal-like function. Also, because virtual desktop environments reside within a central- ized datacenter location, access rights and security policies can be painlessly enforced over robust and secure end-user connections to protect the integrity of enterprise information. In addition, now that applications and data no longer reside on the endpoint, having replaced those with thin clients, the ability to “shortcut” the system is eliminated. Clinicians are forced to log into their own virtual desktop. With a VDI solution, IT can enforce security and compli- ance policies that secure applications and patient data. At the same time, clinician workflows can be streamlined, making their job easier. IT now has the ability to enforce new security policies with minimal impact to clinician productivity. For example, connection timeouts can be enforced that automati- cally disconnect virtual desktops from the endpoint after a period of inactivity. Disconnecting means that the clinician’s desktop remains unchanged and any work in progress does not get lost. Even when this happens, a user’s virtual desktop stays logged in. When they need their virtual desktop again, their session is preserved regardless of what endpoint (laptop, desktop or iPad) they may have been using – even if they choose to transition between devices.

This process can be simplified even further with the integration of smart-card and single sign-on authentication technologies. Now, when clinicians arrive at the start of their shift, they no longer need to log into the operating system and then manually log into each application they require. They can use their smart card to enable automatic log in to their virtual desktop and the clinical applications they may need to use. When they have finished working at that device, they can use their smart card to automatically disconnect from their virtual desktop. This allows them to leave their desktop in a “ready” state, so that when they reconnect, their desktop and applications are already running and ready for use. Processes such as this simplify clinician workflow, and, when implementing an EMR/EHR solution, help ensure accurate records of patient care are being recorded. With smart-card technologies, the authentication process becomes dramatically simplified.

Moving to a virtual desktop delivery model is a complex journey with many decisions to be made along the way that affect the success of your transformation project. It requires a clear understanding of your end users, their compute require- ments, access methods, security controls and other technical and process information to shape the correct design. But equally important, it requires end-user buy-in and support from key stakeholders, which in turn requires good program management and project planning.


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