This is a guest blog post by Lisa Pratt, Enterprise Architect, University of Vermont Medical Center.

COVID-19 has sent waves of change throughout the medical industry. Around the world, in various areas of medicine and technology, organizations have had to adapt quickly to keep up with this new normal. At the University of Vermont Health Network (UVMHN), we needed to support our clinicians using telehealth, both onsite in our hospitals and clinics, as well as remotely, to provide care while also ensuring secure access to sensitive data from any device.

Even before all of these changes from the COVID-19 pandemic, our IT organization had one goal — standardize. We wanted to standardize our virtualization environment on a single platform to simplify the deployment of a consolidated electronic health record across the entire UVMHN network. We needed a single platform that could deliver our Epic electronic heath records through both app and desktop virtualization, and Citrix was the clear solution to do just that. One consolidated Citrix Virtual Apps and Desktops environment is now being used today to deliver Epic to four hospitals in the network, with additional work under way to continue that rollout to the rest.

Thanks to this consolidation work with Citrix at the end of 2019, when many organizations had to quickly figure out how to support work from home earlier this year, we already had the tools in place to do it quickly. We used our existing Citrix Gateway, protected with multi-factor authentication, to provide safe and secure access to our growing remote workforce. Because we didn’t need to worry about setting up the environment or putting data security measures in place, we had the capacity to focus our efforts on supporting some of our other COVID-19 initiatives, including telehealth. In this post, I’ll provide a closer look at how our work with Citrix helped enable this smoother transition to remote healthcare. You can learn more, too, the recent webinar we participated in with Gloucestershire Health NHS.

Getting Telehealth Ready During COVID-19

Our biggest challenge with COVID-19 was supporting the use of telehealth to continue to provide care to patients in a way that was safe for the patients and the clinicians. We went from approximately 100 telehealth visits per week before the pandemic to approximately 7,000 per week during the height of the pandemic. Some of those visits were taking place in private home offices due to COVID-19 restrictions in place for our state. When COVID-19 hit, we had not yet implemented Zoom as our telehealth video conferencing solution in our virtual environment, and we learned quickly of the shortcomings and challenges associated with doing so.

While optimization technologies for Zoom in a Citrix Virtual Apps and Desktop environment already existed, we had not yet tested and implemented those solutions. Performance of video and audio in this environment suffered greatly as a result, forcing us to look for alternate ways to connect providers and patients via telehealth. For this, we turned to iPads.

We found that iPads managed with Citrix Endpoint Management in the cloud, combined with Apple Business Manager, gave us the ability to handle the increased need for telehealth. Using this solution, we were able to quickly deploy fully managed devices, locked down to the use of just a few required apps, that could be securely shared and used by anyone in the organization. Just to get us started, in one short afternoon with just a small handful of staff we were able to unbox, enroll, clean, and re-box about 100 iPads to have ready for deployment to provide care during COVID-19. It was exciting to be able to do that and have fully managed iPads with Zoom that we could deploy in a variety of ways, even beyond telehealth.

Providing Socially Distant Care and Connection

As the virus started to spread more rapidly, the needs of healthcare were constantly changing. Skilled nursing facilities in the area quickly went on lockdown to protect some of our most vulnerable population. iPads were deployed to these facilities to allow our clinicians to provide care to this vulnerable population safely and remotely. Telehealth via Zoom was used by clinicians to continue to provide care to all patients in the community as in-person visits were not possible, but care needs continued.

Within our own hospital, iPads were placed on stands and set up with the ability to auto-answer Zoom calls in the patient rooms of our COVID-19 patients. Nurses were able to connect with these isolated patients through these devices by calling through Zoom on the iPad, allowing for more face-to-face interactions between the patient and the clinical staff. This provided staff with the ability to connect more with patients who were feeling isolated, alone, and scared, all while saving on critical PPE that was already in short supply. These same devices were also used connect patients with their families at a time where in-person visits were prohibited. Our Palliative Care Team was able to use the devices to connect families with their loved ones through their palliative end of life care as well. These iPads became critical to our staff and patients throughout the pandemic.

Utilizing Citrix Cloud Endpoint Management

During this pandemic, we took advantage of the Citrix Endpoint Management in the cloud and used it heavily to extend our existing use of shared devices to telehealth. However, before the pandemic began, we also used Citrix Endpoint Management, integrated with Microsoft Intune, to manage and deliver Office 365 apps, internal apps, and Citrix Virtual Apps and Desktops in one secure container. This gives our end users the ability to securely access our environment on their own dedicated devices, which are often also used for personal activities. Keeping organizational data and apps in their own container, separate from the personal apps, allows for easier, yet secure, access from supported mobile devices.

Citrix Endpoint Management is the first step for our organization’s transition to Citrix Cloud. We are now currently strategizing about what other parts of our Citrix infrastructure could be transitioned to the Citrix Cloud. Our primary focus is to ensure that whatever we do, we do safely. Our Epic electronic healthcare records certainly needs to be readily available at all times, and the data needs to be kept safe. We want to take advantage of being in the cloud and the full weight of the workspace environment that’s there. However, we must create an infrastructure that allows us to continue to access our most critical systems at all times, even if the cloud is unavailable. With everything consolidated and streamlined through Citrix, we can make these important decisions and grow in the ways we can provide care.

Looking To the Future of Telehealth

As patients have started to slowly transition back to on-site visits, our demand for telehealth has decreased some from what it was at the height of the pandemic. However, it’s clear that virtual and socially distant medical care is here to stay. Our telehealth rollout, which was only in its beginning phases at the time the pandemic hit, was rolled out across our hospitals very quickly during the pandemic. We were able to find workarounds to navigate through the shortcomings identified in our environment and now it is time to fix those things to only make it better.

Looking toward the future, we want to integrate our telehealth environment directly with our electronic health record. This will provide both the patient and the provider a way to seamlessly join the telehealth meeting directly from the electronic health record from any device, anywhere. Offloading the processing of the video and audio of Zoom meetings to the local endpoint leveraging Citrix HDX Optimization and the Zoom VDI plugin is the key to this integration. Without this technology, performance of the video meetings is heavily impacted, resulting in a poor experience for both the patient and the provider.

Our biggest challenge to accomplishing this is the limitations of our thin client devices used to connect to Citrix Virtual Desktops. We currently have no way of deploying the Zoom VDI plugin to these devices now and would likely have to replace many of them to accomplish this in the future. We have now partnered with IGEL as a solution to allow us to leverage our already existing hardware, making hardware replacements unnecessary. We’re currently in the midst of a project to roll out the IGEL operating system with the Zoom VDI plugin to all of our existing thin client devices, which will allow us to roll out our full telehealth solution to our providers.

Leveraging Citrix solutions we have been able to create an environment to support a remote workforce in ways we never imagined that is also used to connect patients, providers, and families in a safe and secure way.

Learn more in this webinar with Gloucestershire Health NHS and UVMHN on how the whole world of healthcare has had to adapt to new models of service, and what they think the future of healthcare looks like.