Thin Client
ARE THIN CLIENT APPLIANCES VIABLE SOLUTIONS FOR MILITARY AND VA HEALTH CARE FACILITIES?
To reduce cost, increase efficiency and tighten security, veterans and military medical facilities are deploying or actively studying thin client and PC blade replacements for their desktops. “We started to look at thin clients seven years ago, when supporting all the PC desktops was difficult to do,” said Dennis Howard, CIO of the Veteran’s Integrated Services Network (VISN 23), which today covers Minnesota, the Dakotas, Nebraska and Iowa. “We had 3,500 PCs at the time—all loaded, configured and purchased differently. Everything was unique, including the servers.”
As VISN 23 was expanding its number of desktop devices, Howard decided to add thin clients instead of PCs to the growing network. Today, VISN 23 includes 11,500 desktops, of which 6,500 are thin clients and 5,000 are PCs.
A thin client is basically a PC replacement that does not contain a hard drive, a fan, CD drive or other moving parts. Instead, the applications and data reside on a CPU that is running elsewhere. Several thin clients can be hooked to one remotely located PC instead of assigning one user to one underutilized PC. “Thin clients are good any place where you have a lot of people doing similar things, running the same set of applications but spread out over a large campus,” noted Dave Bachman, federal program manager with Wyse Technology, Inc.
When applications and data are managed centrally rather than locally, information technology managers can make better use of IT support staff. Instead of traveling around a campus to upgrade software or make repairs at 1,000 different desktop locations, much of the work can be done once from the central server.
Removing the variables of local PCs also can increase desktop security and serve to comply with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA regulations require patient privacy by preventing the unauthorized disclosure of patient information through the use of administrative procedures and physical security for data.
Since thin clients are diskless machines that store data on the remote server and not locally, users can only access the data and applications to which administrators have granted them access. Thus, the privacy of medical records is protected. In addition, thin clients do not require software patches and do not have the virus vulnerabilities of the Windows 2000 and Windows XP Professional operating systems. Because operating system updates are applied to the server and not to the client, the thin clients are not affected by viruses.
After installing thousands of thin clients, Howard began in 2000 to collect help desk statistics. He has since gathered enough data to determine that 80 percent of the trouble tickets and work orders were for PCs, while only 20 percent were for thin clients. “We don’t have to send IT staff out to repair rogue software or PC components like memory because there isn’t any. It’s all on the central processor,” said Howard.
The statistics also found quicker time to resolution for thin clients compared with PCs, resulting in more time for providing medical care. User productivity also improved, since thin client architecture inherently provides session mobility, in that users can start work at one thin client workstation in one area of a facility, pause their work, move to a different thin client location and pick up easily where they left off.
This could be especially beneficial in clinics and wards where staff must move from room to room, according to Howard.
“Uptime is important when you’ve got people’s health on the line. If one device doesn’t work, staff can just walk over to another thin client and go on with their job because their data is not tied to any one particular device. The desktop experience is based on who you are rather than which device you use,” Bachman said.
“We have many deployments where users swipe smart cards into the thin client. They could be at one end of the hospital and as long as they have their smart card with them, they can use whatever thin client is nearby. They don’t have to walk to the other end of the hospital to find their PC in order to do their work,” he noted.
Bachman pointed out that thin clients are compatible with a hospital environment, owing to their silent operation and lack of a fan, reducing the threat of the spread of airborne bacteria that comes from the dust accumulated on a PC fan. This has become more important as desktops have moved into patient rooms. In addition, Wyse Technology thin clients can be as small as a VHS videotape, taking up less space than a desktop PC.
Howard’s statistics also showed accelerated application rollout with thin clients, given the standardization that can be achieved from centralizing software management. “When we do a software upgrade, in two days I can upgrade 6,500 customers. All I have to do is load the software in the server. And I can activate 6,500 users in a new application within a few hours,” he said.
VISN 23 uses Wyse Technology thin clients linked to Windows 2000 servers with Citrix Metaframe Secure Access Manager software sitting atop Microsoft Terminal Services, which balances and manages server workload. Wyse Device Manager manages the thin clients, enabling a centralized manager to turn them on and off, determine which version and model they are and update them—all remotely.
Thin clients also require less power than PCs at the VA hospitals and clinics covered by VISN 23. Various studies there have shown a savings ranging from $27 to $60 per year per device. With a deployment of approximately 20,000 Wyse thin clients, the VA estimates that it saves $540,000-$1.2 million per year in power costs.
It can also take less time to deploy thin clients than PCs according to the Tri-Service Infrastructure Management Program Office (TIMPO), which conducted a thin client technology assessment in October 2005.
“The return on investment (ROI) portion of the study showed 3.5 hours average time to deploy a PC, including data migration, versus two hours to deploy a thin client. There was an ROI of 1.5 hours per PC resource with thin clients,” said Phillip LaJoie, CTO of TIMPO, the information technology arm of Joint Military Information Systems (JMIS), which is the central management house for the services.
The TIMPO study also found cost savings in PC blade technology, which typically utilizes a 19-inch rack to load about 112 barebones CPU boards, called PC or CPU blades. User ports on the desktop devices provide dedicated or shared connections from the thin clients to the PC blades.
“In a one-to-one comparison of a blade PC with a regular PC desktop, the blade PC was 12 percent higher in cost. But when you multiply by four to six thin client users per blade PC, then the price point for the blade PC is significantly less than a standard PC, including the cost of the thin clients,” LaJoie said. The degree of savings depends on how many thin clients are deployed per blade PC. Obviously six users per blade PC would yield a higher savings than three users.
JMIS has not yet deployed thin client or PC blade computing but is studying it now as a way to stretch the budget for desktop computing. TIMPO is testing a thin-client setup using ClearCube Technology’s PC blades as servers, Citrix thin-client remote-access management software and Motion Computing tablet computers. “Right now we are testing the technology for non-production appliances, but we are looking to move to production appliances within the next few months,” LaJoie said.
PC blade computing was born from the need for IT to regain control of the desktop and end-user computing infrastructure. However, when introducing technology, there is a concurrent need for extra IT staff-training in software management. Although ClearCube provides its own software-management suite, the company’s PC blades can be managed by Citrix software or by any other thin-client-management software on the market, according to Ken Knotts, a ClearCube senior technologist.
“We make the motherboard using all industry standard parts, such as Intel Ethernet cards, Intel processors and Nvidia graphics cards said Knotts. “And we use XP Pro as the base operating system.”
ClearCube has an agreement with Motion Computing to run PC blade technology with Motion’s wireless slate tablet computers. The tablets, which look like the monitor half of a laptop, are built on the Windows XPe (embedded) operating system and utilize biometric identification systems such as fingerprint readers and a pen input. They take the place of the clipboard used by roaming medical professionals.
According to the Medical Records Institute’s (MRI) annual survey of electronic health and record of trends and usage between 2003 and 2005, tablet PCs were the fastest growing mobile/wireless technology in the health industry.
“Instead of installing fixed desktops in patient and exam rooms, most hospitals have been assigning a mobile device to clinicians for use during their shift. This approach provides better access to data, streamlined workflow and mobility, improved asset accountability and security and—given typical clinician staff ratios by setting and patient acuity—is substantially less expensive than purchasing and maintaining a PC for each room,” said Joel French, Motion Computing vice president of health and life sciences.
“Thin clients can be an enabler to mobile or wireless computing because the information is in the server, not in the mobile computing device,” LaJoie pointed out. However, one of LaJoie’s concerns is the problem with theft of desktop PCs or wireless mobile devices, such as a tablet computer. Because there can be some patient data on a tablet computer, TIMPO has looked at Cranite’s security solution for encryption on the tablet. That way, if the tablet were stolen, it would not compromise the privacy of the patient.
Whether they are the Wyse Technology slender thin client monitors or Motion Computing’s slate tablet PCs, thin clients are network-dependent. ClearCube’s I/Ports are based on Neoware’s host access software, which connects to the PC blade over a TCP/IP network. This means I/Ports can be used anywhere in the world and connect back to the PC blade. “In high usage scenarios, you can have some latency, but a lot of hospitals are running dedicated networks to limit latency,” Knotts said.
Another IT concern is the risk of declining morale when users have their PCs taken away from them and replaced with thin clients. “A thin client is manageable, secure and centralized, but they don’t give you the performance, scalability and end user experience that some people have come to expect after interacting with PCs for so long,” Knotts said.
“The end user’s first response is: ‘You’re going to take my PC away from me?’ They cross their arms and stare sternly, until they start to use the architecture and realize that nothing has changed. Their data and applications are just located in a different place,” he said.
In addition, most people are comfortable by now with the fact that they don’t have privacy on their work computers. “Every time they log in, they have to agree to monitoring. By clicking OK, you accept and consent to that monitoring,” LaJoie pointed out.
Meanwhile the thin client is not exactly putting the PC out to pasture. “A clinician has a need for video streaming, so I would never support a solution that didn’t have it for remote surgery or consult across the wire. There are always going to be instances where a standard PC is necessary. It depends on the individual use case,” LaJoie said.
For years, there have been wasted resources on the PC that IT departments can now reclaim by moving to thin client and PC blade technology. Some users can still compare the relatively enhanced PC experience to the old mainframe, dumb terminal days. “We’ve really gone full circle. It used to be dumb terminals that reached back to a mainframe. Now it’s dumb terminals on steroids, reaching back to a computing resource, whether it’s a blade PC or a server PC,” LaJoie said. ♦