St. Joseph’s hopes to avoid Sick Kids-style scandal with thin clients

While hospitals and clinics are making the move to electronic patient records, some patients have a concern – and a valid one – about the privacy of their personal health information.

In January, a researcher’s laptop was stolen out of his car that exposed the personal health information of 2,900 current and former patients at Toronto’s Hospital for Sick Children. As a result, Ontario Privacy Commissioner Ann Cavoukian is calling on custodians to take steps to protect patient information, such as encrypting data.

For St. Joseph’s Community Health Centre in St. John, N.B. – part of the Atlantic Health Sciences Centre – thin-client technology has not only boosted security, it’s substantially improved workflow.

St. Joseph’s, which serves 9,000 patients with seven GPs and four nurse practitioners, is using 32 Sun Ray 2 Ultra-Thin clients throughout its facility. Java-enabled smart cards provide authorized staff with access to patient data, such as X-rays, from several locations.

“We went electronic with our patient record system about two years ago and we endeavoured to go paperless,” said Dr. Keith Wilson, a physician at St. Joseph’s. Initially, the health centre went with tablet PCs. “They’re very portable, but they’re a little bit heavy and carrying them around from room to room every day can be a bit of a problem.” There were also issues with the wireless connection dropping out.

So St. Joseph’s ran a small pilot last fall with 10 Sun Ray clients. “Very quickly we realized the benefit of the hot desk support where you can go room to room with a smart card and resume where you left off,” said Wilson. The benefits were noticeable, and soon staff members were fighting over who would get to do the trial next.

“From a security perspective, we leave the room, we take the card with us and we don’t have to worry about it,” he said. If someone walked away with a Sun Ray, it wouldn’t make any difference in terms of compromising patient privacy.

Sun Ray clients use smart cards that contain Java Card technology, so users are authenticated with a server-based infrastructure that protects the desktop environment. The clients don’t have an operating system, nor do they have applications running on them. “You really can’t compromise them because there’s nothing to compromise,” said Edward Moffatt, solution architect for Sun’s Canadian desktop practice. “When you pull your card out, whatever you were looking at is gone.”

In February, the Sun Ray environment at St. Joseph’s became fully operational. Aside from security, thin-client technology has had other benefits. “Keeping caught up on paperwork has got to be the most painful portion of medicine – I’ve never been able to keep on top of things because there’s so much paperwork,” said Wilson. “Since we’ve implemented this, I’ve totally caught up – I no longer have to work weekends doing paperwork. I never realized how important it was to have those precious seconds.”

St. Joseph’s has Sun Ray clients in all patient exam rooms, so GPs can sit with patients and show them X-rays or draw graphs on the screen. “It allows us to focus on other things like chronic disease management,” said Wilson, adding that patients are now more engaged with their own health information.

“Organizations are justifying Sun Ray both from an IT perspective as well as an end-user perspective, being able to control the environment, being able to protect the environment, and that’s manifested in terms of greater administrative efficiency,” said Jon Erickson, senior consultant with Forrester Research, who conducted research into the economic impact of deploying Sun Ray clients. “We saw one customer reduce administrative costs by roughly 40 per cent.”

If something goes wrong in an insecure environment, restoring the data could be extremely costly. “Having a reliable, secure environment tends to drive a lot of the benefits,” said Erickson. With it comes to security, thin-client technology allows IT departments to perform more value-added tasks rather than just put out fires.

But whenever an organization is considering a migration to server-based computing, there’s a concern about adoption – because without user acceptance, the benefits of thin clients quickly disappear. Ways to mitigate that risk, said Erickson, include effective training, doing a slow adoption over time to generate interest rather than a big bang, and making sure the infrastructure is able to support the move to server-based computing.

“That’s why you’re getting organizations looking at a five-year perspective,” he said. “You want to do deployment right and start with a pilot and expand out over time.”

Sun’s Moffatt admits there’s a healthy scepticism around this technology – if it’s something that power users could take advantage of. You have to understand the user’s workload, he said, and where it makes sense, such as military, education and health-care applications. Where thin clients don’t play well is in the multimedia space, where pixels move quickly across a screen. But the OEM community is growing, he said, with three companies making Sun Ray-based laptops and Mitel producing a VoIP handset with built-in Sun Ray client.

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Vawn Himmelsbach
Vawn Himmelsbach
Is a Toronto-based journalist and regular contributor to IT World Canada's publications.

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