beyond monitoring | leveraging unified it performance management for patient care and satisfaction

© eG Innovations, Inc | www.eginnovations.com

Beyond Monitoring:Leveraging Unified IT Performance Management for Patient Care and

Satisfaction

Presented by:


Introduction

Today’s Moderator

Tom SullivanEditor-in-ChiefHealthcare IT News,A HiMSS Media publication


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Bala VaidhinathanCTOeG Innovations

[email protected]

Wendy HowardInfrastructure EngineerSt. Charles Health System

[email protected]

Today’s Presenters


The Keystones of Healthcare IT Today:Application and Desktop Virtualization

Citrix XenApp and XenDesktopare the leading solution

Large increases in capability and complexity over many years

VMware server virtualization drives most Citrix deployments

VMware Horizon is the leading competitor for desktop and application virtualization



Citrix healthcare deployments:

Mostly on-premises datacenters

Running all Windows applications

Running all enterprise healthcare applications



Privacy Security FlexibilityOperational

Efficiency

Improved Service

Delivery and Patient Care

Benefits of Virtualized Applications and Desktops



Risks in a Virtualized Applications and Desktops Strategy

Cost to deploy

Increased downtime and slow

performance

Reduced productivity

Lower patient

satisfaction

Delayed billing


Consistent, excellent user experience directly

impacts patient care and satisfaction

Clinical

Administration

Out-patient

In-patient

The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm


The Impact of a Traditional, Siloed Monitoring Strategy

I can’t login.

There is too

much lag on my

screen.

My application is

taking forever to

load!

Users care about “services”

The CPU usage of

the Linux servers

is ok.

The DNS servers are

responding well to

queries.

IT operations teams focus on infrastructure silos

The User / IT Management Disconnect


Different teams are responsible for the performance of separate

tiers/components, but IT service delivery involves ALL.


Impact on IT

Cross-team coordination reduces speed to resolution for problems that arise,

and impacts the ability to implement preventive fixes and smart growth.

End User

Client Admin

LAN Admin

Firewall admin

Server admin

Virtualization admin

Domainadmin

ERP Admin Sys admin ApplicationAdmin

The serveris working

OK

No othercomplaints

All lights Are green

We don’t see anything

wrong

Database Admin

This is not

working

VMs are lightly

loaded

EverythingIs OK

Not ourproblem

Looks fine Not mine

either

Talk tothe other

guys

IT Service Manager



Impact on Help Desk

Help desk support is negatively impacted by inability to route issues correctly and quickly.

End User

Client Admin

LAN Admin

Firewall admin

Server admin

Virtualization admin

Domainadmin

ERP Admin Sys admin ApplicationAdmin

The serveris working

OK

No othercomplaints

All lights Are green

We don’t see anything

wrong

Database Admin

This is not

working

EverythingIs OK

Not ourproblem

Looks fine Not mine

either

Talk tothe other

guys

Help DeskAssociate

VMs are lightly

loaded



Citrix XenApp/XenDesktop and VMware

Horizon are mature and complex platforms

Provisioning, user access, GPU resource

management, mobile, etc.

Multiple steps, multiple logins

Susceptible to conditions across the entire

infrastructure, so small issues almost

anywhere can impact the user experience

Traditionally, performance monitoring has

required many tools



Example: Suppose the database server is 50% slower than normal. . .


A problem in one tier can affect all the other tiers involved in service delivery.



Disk reads

Streaming Media AppSlow Database Queries

Excessive disk reads by the media server slow down Oracle database accesses

Virtual infrastructures are hard to manage. Traditional, siloed monitoring tools are not designed to handle these dynamic environments.

Another Example:


Performance sensitivity negates the effectiveness of

traditional monitoring approaches. Effective

management requires:

Visibility across the infrastructure for

troubleshooting

Reporting from across the infrastructure for

planning and design

Single pane of glass view across all tiers and

throughout each layer is the only means to

preventive management

Virtualization complexity demands dependency-

aware, automatically correlated insight for

efficiency



The Solution: Unified Performance Management for the Healthcare Enterprise

Unified Performance Management Goes Far Beyond Traditional

Monitoring:

REACH across the infrastructure

DEPTH throughout each stack

SPEED to resolution, through automated

correlation and diagnosis


The Solution: Unified Performance Management for the Healthcare Enterprise

• Reduce downtime

• Increase application availability

• Boost user experience

Boost User Satisfaction

& Productivity

• Simplify, automate & accelerate diagnosis & troubleshooting

• Optimize staffing levels & reduce OPEX

Reduce IT Support

Cost & Complexity

• Increase hardware utilization

• Leverage investment in software

• Right-size & optimize environment

Reduce Infrastructure Cost & Avoid Cost

Overruns

• Accelerate deployments & rollout

• Reduce risk, deliver successful projects & peace of mind

Deliveron Time, on Budget,

on Target

KEY

BEN

EFIT

S


St. Charles Health System

Largest provider of medical care in Central Oregon

Non-profit, multi-location health system focused on excellent care and high patient satisfaction

Four hospitals and 120+ medical providers

Region’s largest employer with 3800+ caregivers

“Creating America’s healthiest community, together.”



Our Complex Environment

Virtualization in two datacenters

Application types:

Windows 32bit/64bit applications

EMR, clinical, non-clinical

XenApp and XenDesktop 4.5/6.5/7.6

Citrix Servers

300+ servers – VM and provisioned

Running Windows 2003/2008/2012




Key IT Responsibilities and Tasks Performed:

Maintenance

Troubleshooting

New projects

Reporting

Emergency upgrades




Healthcare Expectations of IT at SCHS

Every IT activity needs to have a focus on patient safety

Generate positive Caregiver experiences with IT

Keep up with HIPAA and ICD changes, meaningful use

Comply with legal and government regulations for data retention

Provide interoperability between healthcare entities

Maintain HIE – Health Information Exchange



SCHS IT: The Challenge

Late 2014:

Aging IT infrastructure

Growth of healthcare information

requirements

“A massive technology overhaul” was

required to streamline IT services

How do we improve the user experience?



Late 2014:

Legacy Citrix XenApp was historically problematic

Difficult upgrade path

Login problems

System availability issues

Prior tools included EdgeSight and Powershell scripts

Siloed monitoring ineffective and not scalable

Missing the “big picture”

Overall frustrating experience for clinical users



Impact:

Lack of real-time visibility across the

infrastructure

Extra effort to identify root causes with

each problem: Is it Citrix? The network?

Elsewhere in the physical or virtual

infrastructure?

Multiple tools with manual correlation and

analysis across teams

Long Mean Time to Recovery (MTTR)

Service Desk “in the dark”


SCHS IT Transformation

Primary goals for Desktop Transformation

Project (DTP):

– Create Citrix XenApp/XenDesktop 7.6 site

– Move from physical desktops to virtual

desktops (VDI) via XenDesktop (Windows 7)

– Supply XenDesktop on Thin Clients to clinical

areas

– Adopt Citrix Provisioning Services and

Microsoft App-V for images and application

virtualization

– Many sub-projects:

• Single sign-on, follow-me desktops, AppSense,

active-active disaster recovery site availability


SCHS IT Transformation

Select a proven healthcare IT service integration provider

Denali Advanced Integration

Richard Hussain, Solutions Architect from Denali, to advise and manage transition

Assessed goals and challenges of Citrix XenApp performance monitoring

Responsible for success of design, architecture and rollout


SCHS IT Transformation – We need help!

SCHS Enterprise Client Architect asked Denali to

search for a monitoring solution

Requirements

Unified, real-time monitoring across the entire IT

infrastructure, including in-depth Citrix insight

Support all existing technologies at St. Charles

Support future technologies being architected for DTP

Single-source solution for total visibility


The Solution: Unified-Citrix Performance Management

Watched demo of eG Enterprise and gained interest

After leadership buy-in, we decided to implement

Worked directly with one support person

Received on-site training

Customized our configuration


Four 60” monitors centrally displaying system

status at all times in the IT department

“Monitoring At a Glance” by anybody who walks

by.

Central view ensures immediate insight into any

issue that can impact the user experience, even

before they notice a problem

Currently monitoring 281 various components

Core Citrix infrastructure is most critical



Key Workflows and Functions

Automated diagnosis and dependency display, across all tiers: Red, yellow, green status

indicators save time and improve service

User-experience dashboards, drill-downs and infrastructure-wide topology view for instant

visibility into issues’ root causes

Proactive email alerts to indicate potential issues across the infrastructure and allow

preventive fixes

Infrastructure-wide historical analysis for targeted reporting to management and exec –

trend analysis

Customizable thresholds to ensure we meet the highest level of standards



Benefits for SCHS IT – both proactive and reactive monitoring

Proactive:

Alerts for potential issues with Provisioning Servers

Identify and fix problems as they occur, across all tiers, before caregivers experience

slowness/downtime

Reactive:

Unified monitoring yielded a 50% improvement in caregivers’ login times soon after

deployment.

Detailed executive reporting and historical analysis are used for sharing performance

improvements.

Patient satisfaction is high when clinical systems/applications are performing well.



Future Impact for SCHS

Infrastructure-wide historical data

creates opportunity for new IT

initiatives.

Future plans for expanding

Unified coverage using SCOM

connectors

Future plans to provide more real-

time status on health systems to

Service Desk



Overview: Unified-Citrix Performance Management from eG Innovations


A Real-World Example

08:00User to the helpdesk – “my application access is very slow. I am not able to work properly.”

8:00AM

Helpdesk

We will get on it

right away!


A Real-World Example

08:00 Helpdesk receives a call that application access is slow

09:00Helpdesk has received many calls that application access is slow. The Citrix admin is called to look at the issue.

11:00The Citrix admin has reviewed Director/EdgeSight metrics, has killed the offending process. But user complaints persist.

12:00The Citrix admin decides to reboot the server but the problem persists even after the reboot.

13:00The problem does not appear to be specific to Citrix. The Citrix admin calls for a conference call with the other administrators …


What Follows … Citrix Director / EdgeSight

VMware VCOPS - Virtual

Task Manager - Windows

Event Viewer - Windows

EMC Ionix - Storage Cisco UCS Manager - Hardware

CiscoWorks - Network


eG Enterprise – How does it help?

Network Web on

XenServer

Active DirectorySQL

ZDC on

VMware ESX

License Server

Profile Server

Enterprise

Apps

vCenterOracle

Client

SAN

Switch

Complete visibility – every layer, every tier!

“My

application is

slow!”

XenApp on

VMware ESX


Automated Diagnosis

User Experience Management

Right-Sizing & Capacity Planning

Pre-emptive Alerting

TotalPerformance

Visibility

End UserExperience

Storage

Connection Brokers

Profile Servers

Network

Applications

Virtualization

Infrastructure& App Performance

ServicePerformance

Online Banking

Accounting

Trading

Patient records

. . .

eG Enterprise

Overview: Unified-Citrix Performance Management from eG Innovations


Real-World Example - Revisited

06:30The helpdesk receives an automatic alert saying that access to Ctirix is slowing down. No user has been impacted yet.

6:30AM

Helpdesk

This looks odd. Let’s get to the bottom of this before users start calling …


Triage Problems Quickly

The application that is responsible for the slow down – a samba backup

job

6:35AM

Helpdesk

Yup, the backup job is taking up resources

…


Focus on the Root-Cause, Not EffectsWithout root-cause diagnosis, you have no idea where the problem lies

With root-cause diagnosis, you have a clear idea of what to do to resolve the problem.

All the problems

appear to be equally

important.

The root-cause

of the problem

The effects of

the problem


The Result

06:30 The helpdesk seels an alert of a slowdown with Citrix access.

06:35The helpdesk reviews the service topology and determines that there is an issue on the VMware server. Contacts the VM administrator.

06:45The VMware administrator realizes that the backup job is impacting the user experience. Reschedules the backup job for later in the evening.

Citrix Performance Management Made

Rap

id a

nd

au

tom

ated

d

iagn

osi

s


Why eG Innovations?

• Total visibility into the Citrix platform and all external

network/ process bottlenecks impacting performance for

caregivers: network, applications, storage, and databases.

• Accelerated discovery and diagnosis of performance

issues in virtualized applications.

• Single, scalable solution for all performance monitoring

needs, across all physical and virtual tiers.


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Q&A


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