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 Welcome to this Week in Health it. With our continuing series on Coronavirus Prep, we've moved from understanding the health IT problem set to really starting to look at solutions. My name is Bill Russell Healthcare, CIO, coach, creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders before resources for.

I'm currently helping my coaching clients, uh, by being a sounding board and advisor. Through this time, if you want to connect with me over the next couple of months to experience what coaching is like at no cost, shoot me a note. bill@healtherics.com for anyone in health it who finds themselves in uncharted territory.

We want to crowdsource solutions with you and, uh, we've put together a team of seasoned professionals and we have set up two ways you can do that. We now have a Slack channel that is monitored. By, uh, and supported by our sponsors. And I'm really excited that our sponsors have stepped up here, VMware, Galen Healthcare, serious Healthcare, Starbridge Advisors, pro Talent Advisors, and me Health.

Erics, uh, slack channel allows you to ask any questions that you wanna answer around telehealth, around VDI, you know, whatever, whatever questions you have, we have a, uh. A great team that's sitting there who can, uh, who can, uh, respond to that. If you want access to that, uh, and you're with a health system, you need a health system.

Email address, slack.

Aren't used to Slack and you're, but you still want to participate in some way. Our sponsors are also supporting an email channel support at this weekend, health it.com. If you just wanna shoot an email over, it'll get routed to an expert in the area of the question that you're asking. And one of the, uh, one of the.

People from our sponsors will get back to you, uh, and begin a conversation around that. And I really wanna thank our sponsors for stepping up to provide these services to our listeners and the industry now onto our guest. And I'm really excited, uh, to have John Sheta with acon. John was in the trenches with me when I was the CIO and uh, one of those guys that whenever I have a question.

This is the person who I pick up the phone and call because, uh, 'cause we were in the trenches together. We, we stood up. How many, how many, oh, by the way, welcome to the show. I'm just. Thanks, bill. Thanks for having me on. How, how many BDI workstations did we set up over that timeframe? I mean, there was a, there was a lot about 20,000.

Yeah, it was, it was, it was insane. The, and, and we did that over a period of time. We were consolidating the EHR, we were, uh, doing app rationalization and we, we stood up, uh, the Citrix environment. It was, uh. As well as badge in, badge out. We had a whole bunch of really fun stuff that we, uh, that we stood up.

All right, so we're gonna talk Citrix. Are you ready to talk Citrix? Uh, every day of the, every day of the week, every day of the week, every day of your life. Um, yeah, you, uh, you, you really do follow Citrix, uh, pretty well. And, uh, stay up to, stay up to, is Citrix doing anything special during this time for, uh, for healthcare to sort of, to cope with this and, and to adjust with it?

So interesting times. Yes. They, uh, for the last two weeks they've been pushing, um. Uh, a directive to go to Citrix Cloud if you were a previous CI Citrix customer and, or even if you weren't. What they're doing is they're offering special terms, um, for a short term, and they're offering the ability to move, uh, your workloads to Citrix cloud with using, um, if you don't have app and desktop workloads already.

Or in the cloud somewhere, they're looking at pushing them to their technology called remote pc. I mean, is that, is that, is that gonna be a heavy lift for, well, actually I'm getting into the technical, so they're offering some special deals around that. What do, what do the special deals look like? So the, their deep discounts that surround, uh, a certain timeframe, and it could be

It's completely negotiable. And what they're doing is they're offering, essentially they're offering help to customers that need help getting their workforce remote. So a lot of places were caught short with having the capacity to bring like 80 or 90% of their workload to be able to work remote from home.

So what they're doing is they're kind of stepping in and saying, Hey, this is a special, uh, situation. During this situation, we will help you get set up in Citrix cloud. Even if the customer was already on prem, they're offering this in Citrix cloud to be able to get your company set up and get your people working remote.

Wow. And so, so what's the, what's the lift here? So we had clinical workstations. Nothing really would change with that, except for some clinicians are going home, so we have to. Uh, that those images and those applications that we virtualized and move them out into this cloud environment, is it, is that a heavy lift?

It depends on the customer. Some of the customers have mature cloud environments, and so it's an easy shift over to Azure or Google or AWS. And those workloads are being spun up on demand, wherever needed. And then the thing about it is, is a lot of the clinicians that aren't working from home still go into, you know, the hospital, the clinic, um, what they're looking at is helping, like HR and accounting and all those other workloads that they haven't accounted for, the hospital organization hasn't accounted for with being able to enable them to work from home.

Yeah, that would, I, I'm thinking about this. We, we did, we did the clinical setting pretty extensively. The other setting, uh, we were, uh, you know, we didn't have all the applications set up 'cause there was never a need for all those applications to really be set up. Um, yeah, I mean is that a heavy lift? I would assume actually, actually with the remote pc, because typically if you are in a revenue operations center, somebody that's collecting money.

The, all the application stack is on their PC at work. So with the Citrix technology of remote pc, we just put the VDA, the virtual delivery agent on that pc, and then they have the exact same capa uh, ability to go to the landing page where they'd get any Citrix application and run their desktop remotely.

Oh, so such, it's easy. This is gonna show how old I am. So this is sort of like the old Timbuk two, uh, application we used to have where you were, you're essentially looking, you're working from your desktop. Yep. And it's all delivered through the Citrix Iica channel. You have the ability to span it across multiple desktops.

You have the ability to plug in peripherals that you might need at, uh, at the office, and you've taken them home. So like the old PC anywhere days. Yeah. Yeah. PC a, yeah. Where they Timbuktu PC anywhere. Yeah. That's, that's pretty interesting. Uh, so is, is this more lightweight though? I mean, you, you talked about the, the Iica protocol and those kind of things.

I, I assume that Citrix has a way to do that without just sucking up bandwidth. Yeah, so it's, it follows the same protocol stack as any virtual desktop. You deliver the, the desktop stream through the ICO channel, and it's really tiny. A hundred twenty eight, two hundred fifty six K, depending on what that employee's role is.

Uh, really small. Wow. Um, it's interesting. So, so, um, as a lot of this, a lot of the scaling up has been around the business applications, which, uh, you know, so there's a lot of different ways they could do that if they had a. So, so give me the different ways they could do that. VDA, which is the virtual desktop architecture, is that what you just said?

Virtual virtual delivery agent. Yeah. Citrix is great. Citrix is great for acronyms, by the way. Yeah. , uh, virtual delivery agent. So that's, that's one way. What's, what's other ways that people are doing it? So depending again on how mature the environment is. A lot, a lot of customers were lucky and they had, uh, existing capacity in their app and desktop workload environment.

So on-prem servers, you know, the traditional way server storage network. And we just turned up capacity there, giving them the ability to do application specific applications for users that are not in the clinical environment. So hr, um, accounting, uh. Basically any application that way, and then they deliver it through their existing, uh, on-prem workload.

But a lot of customers already had, uh, their foot in the door with Azure or AWS, mostly some Google, and we ended up just taking their template of their current delivery and then making it available in that cloud workload. Citrix actually has a cool feature with AWS called scale. Where you can bring up DR environments up and down as needed.

So you're not paying for the cloud delivery workload if you're not needing it. It's not sitting there online consuming, you know, processing and dollars. So, uh, it's interesting because I want to talk futures here a little bit. Um, you know, does this accelerate a move to the cloud in the. Because all of a sudden people had to scale all this stuff up and we had, you know, extenuating circumstances, you know, before, I mean, you were there when we were trying to move to the cloud and we had all sorts of pushback.

Televis I think are gonna take hold as a result of this. I think we're gonna see change behaviors. Um, will remote work take a hold as a re I'm not asking you that question 'cause we can't really predict that. Will remote work take hold? Right. But I've just virtualized for let's tenfold what it was yesterday and it's now out in the cloud and it's working.

IT organizations have gotten the experience of moving it out there, the tools that are available. And quite frankly today, in today's day and age, how easy it is. Do, do you think that some health IT organizations are gonna sit back and go, wow, I I really thought this was gonna be harder than this. Yeah, I think they're going to, if, if they hadn't already, if they had a small cloud presence, they're going to realize how

Easy and scalable. And movable. And resilient that it is, and they'll probably never pull back from it now. So what are, what are some of the mistakes that you think people are gonna make as they try to scale this up? Because I'm sure somebody's listening to this going, it wasn't easy, ours broke. So what are some mistakes that people might make?

So mistakes is turning up too fast. Um, obviously in a situation where, let's use AWS for example, uh, there is a lot of painstaking effort that goes into image continuity. So if you're not starting from square one and trying to create a brand new vanilla image. You want to use your existing image, you have to make sure that that converts over correctly and that you have a mature enough cloud environment to be able to scale that on, on a, like a moment's notice, a flip of a switch.

So taking your current image and making sure that it works in Amazon. Is the hard part of all this. Um, issues with connectivity to be able to get authentication. A lot of you, a lot of hospital systems use Okta now so that they, you need to make sure that communication flow and transit is all there working before you even start turning this on.

Um. We've had a bunch of customers, even small ones, that have just decided to put up a thousand, um, desktops in the cloud just to get people available. Yeah. I'm sorry, I'm just laughing.

Getting the desktop right. We took a long time to get that desktop right. And we had a, we had a test and dev environment. We, you know, we, we implemented best practices to move the stuff along, but once we got that right, we thought, oh, we're good. We're gonna scale. And then we, we started scaling and realized, oh gosh, we got, we got latency, we got bandwidth because we were doing it from, you know, Texas to Vegas and other things.

And so we learned a whole bunch of stuff. People just had to do that over the course of two weeks. But we essentially took, you know, nine months of really, it's amazing long, when everybody's focused on it, how fast that stuff comes together. Yeah. So that's, that's what we've seen in the last two weeks, is if you have every team IT team in your, in your corporation looking at it, it all gets done really fast.

I'm not saying it's perfect, but it, it is doable and it's, and it, uh, it has come together point. Uh, focus is an amazing, uh, uh, catalyst within health. It, because a lot of, a lot of that time was, you know, all right, let's go talk to the security team, make sure they're okay. Let's go talk to the legal team, make sure the contracts are right.

And I've heard people saying, oh, we got a contract done in an afternoon. We, you know, we had our security team vet it within a couple hours. I was like. You know, those and people just don't appreciate it in health. It, those two things I just said are usually about two and a half, three months. Yep, exactly.

It's, it's unbelievable. Uh, well, and the other thing is, I'm thinking of the challenge we had taking that much time, but we had the luxury of time. Mm-Hmm. and, uh, and you guys pushing back on that, my timelines were too.

But you know, I, I'm just picturing people going to a thousand and this, this thing breaking. I mean, it has to, I mean, when it breaks though, it breaks for everybody if you do it wrong. Right? Well, the nice thing about Citrix cloud is you have the, they call 'em resource zones and you can turn them on and off as needed.

So that. If you want to spin up AWS and try it out, you add it to your delivery groups. You know, not trying to get technical, but you add resource and the resource is available, and if it's broken, you just turn it off so that you can figure out what's, what the problem is with it. And, uh, that's can kind of been the trial and error.

Um, every transition, every night for the last two weeks of. Is it available? Um, you know, what routes are taking, you know, how come it's so much slower? Do we have domain controllers in the cloud that can authenticate us quickly? How do we get communication open to our multifactor, whatever it is, whether it's Azure AD or Okta or something else?

Um, that, that's the things that happen. After hours, we get that set up and we turn it on and figure out what's broken. Get a couple. Hundred users or try to get a few hundred users in there to try to test it. And once we see that communication stream, the transit that's broken, we end up fixing it on the spot or stopping the the, the change.

Yeah. So how much of this is, is common across different VDI environments? Uh, it's, it's almost the same, just the, the dependencies names change. You, you don't wanna get in trouble with anyone for saying it's almost the same, but they really have, well, started to converge. I mean, if you look at Citrix VDI and you look at VMware's, VDI and you look at, yeah, I mean, they, they, I mean, they're, they're mature stacks now.

Yep. And they're all available in the cloud, so that all you really need to do is have your image ready. And sign a contract and they start, uh, you, you have the ability to get in and start building. Is there anything people need to this, this the age question, which is licensing, right? You get tired of me talking about licensing.

Mm-Hmm. But the, um, are people gonna be surprised? 'cause after this, you know, after they get to a certain point in this, then we're gonna go back to normal. People are gonna start to see licensing. Is there anything that should be, uh, considering? Um, well, I mean, not, not now you wanna get through the crisis, but Yeah.

As they're looking at it, so for the crisis period, Citrix is offering like, you know, like we said, the discounts and for a different period, like when you. When you sign up with Citrix cloud, it's usually for a three year or a five year term. They're offering like 12 month, 13 month. Uh, I haven't seen any shorter than that right now, but they're offering that small term and then that term is not, uh, renewable.

So when, you know, a year from now, and hopefully this is all blown over, you have to renegotiate your deal with them. So. Licensing is a big factor, but they're definitely coming up with some creative ideas to get people on board. So yeah, get, get 'em on board, get 'em used to the technology. Um, yeah, but also offering a service to healthcare by helping them ramp up, which otherwise they wouldn't normally have been able to do.

Uh, are people doing this with emotionally on-Prem or are you finding a lot of it? It's a lot of it. It's a, so. Before, like if, if this last two weeks wouldn't have happened, I would've said the majority of the Citrix uh, customers across the United States are still on-Prem. But now because of this crisis, everybody's turning towards the cloud because the expertise doesn't need to be there to start up your cloud.

The cloud is already pre-configured. You really need to come to the table with AURL and an entry point into your network and you could be up and running. Granted that the image is the biggest thing, that's the problem. But with this remote PC solution, you could be up and running in probably two to three days.

Yeah. And that's, that's your whole Yeah. Yeah. That's your whole organization. Yeah. And that's what we really needed in this, in this situation. Well, uh, you know, my famous last question, what, what am I not asking that I should be asking about?

Well, I mean, you wanna keep it all healthcare, but a lot of the customers that we've been turning up have phone systems that don't transition to home workers. Um, that's gonna be another big point for, you know, maintaining this. The ability for users to be product, uh, productive at home is to look at the whole stack of the what they need.

Besides the virtual desktop, it's communications. Um, we've seen a lot of customers that have, uh, VoIP related communications. They transition super easy, almost, almost like a blink of an eye with other customers that have antiquated phone systems and communication devices. They are all stuck. People can work from home off of VDI and remote pc, but they also don't have the ability to just pick up their phone and, you know, dial extension 10 and get their boss or whoever else they need to communicate with.

So a lot of this, the new technology like Zoom and RingCentral and other, um, companies that integrate the whole communication stack together, like phone meetings, uh. Instant Messenger are ahead of the game right now. You know, it's interesting you bring up phones, . Um, I can't think of anything that I left undone more than the phone system at at St.

Joe's. I mean, we had, we had a couple phone systems. We were buying parts on eBay. Just to keep 'em running and, yeah. And I, I don't say that with pride. I say that sort of as a, you know, every year we'd come to the, the budget cycle and you have to make choices. And it was like, you know, the thing's running and, and to, to tear a phone system out of a health system.

I don't, I don't think people realize, especially if it's been there for 20 years. Yeah. There's so much logic built into it and there's so much. The person who set it up retired 15 years ago. And, uh, you know, and, and no one, no one works on some of this stuff. And, and, and there's all sorts of routes in there.

So you think, oh, this is easy. We'll just pull this out and drop in, uh, you know, a voiceover IP solution in a way we go. Uh, but then you also have to think about the region. You have to think about disaster recovery. You have to think about all those things. And every time I got a quote from a certain vendor on this.

The, the numbers were so high that I'm like, it, the, the situation almost took care of itself. Um, yeah. I'm, I'm waiting for that cloud vendor who comes in and goes, yeah, we'll completely replace your on-prem. It looks like this. Voy VoIP and away you go. Um, but the vendor I'm talking about, which will remain nameless, people can figure out who it is.

I mean, they were trying to make money on the phones. They were making money on the software. Oh yeah. On everything. It was, it was, it was, it was so hard for me to make that decision to pull all that stuff out. It's interesting 'cause a bunch of our customers that were smaller, like small clinics, there has been a few VoIP companies that have come to the table and said, the first two months are free.

We'll port all your numbers, we'll handle all the communication traffic. We'll pre-order numbers so that we . You up and running right away that we don't have to wait for the, the term to port, but not on the scale of like St. Joe's. We're talking a couple hundred, maybe 500. Yeah. It's interesting. I should, I should probably have somebody on who, who deals with those larger phone systems and just have a conversation.

I think that would be interesting. John, thanks for taking the time and it looks like you haven't shaved, so it looks like you've been holed up there for a while. Yes. Um, sheltering at home. Sheltering at home with no, and probably doing just as much work as you normally would do, because you, you do, you could do it all from your keyboard anyway.

Yeah. I think we're averaging about 14 hours a day for the last two weeks. Yeah. And all the decisions get made during the day and then all the changes happen after 6:00 PM so, yeah. Absolutely. And I appreciate it. Acon, uh, how can they, uh, reach you if they wanted to get ahold of you? Oh websites, www.com.

Um, we do all sorts of VDI solutions, not just Citrix and, uh. Happy to help. Yeah, you do, you do VMware as well. And that's one of our sponsors. So I probably should have mentioned that in the beginning. I mentioned it at the end. Hopefully I won't get in trouble. Uh, no, our, our vendors are great. They know that we're just highlighting, um, you know, certain things to, uh, to help the industry.

So they're, they're very appreciative. John, thanks for your time. I really appreciate it. Thanks, bill. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders.

This show is a production of this week in Health It. For more great content. You can check out our website this week, health.com, or the YouTube channel. Uh, if you wanna support the show, best way to do that, share it with the peer. However you do that, send 'em an email, send 'em a whatever, dmm. Whatever you do, that's what you should do.

We'll be back again with more shows as this progresses. Uh, we'll try to drop one a day, uh, until we flatten the curve. Uh, thanks for listening. That's all for now.