In Bremen's Central Hospital Sankt-Jürgen-Straße, Linux based Igel thin clients are replacing the old infrastructure, which mainly consisted of PCs. The task sheet included data protection as well as fiber optics networking and integrating chip card readers.

Bremen's Central Hospital Sankt-Jürgen-Straße is the city's largest hospital and offers comprehensive medical, nursing and psychosocial care in all medical areas. Around 400 doctors and 1400 nursing staff care for around 42,500 inpatients and 60,000 outpatients. The hospital with its 1166 beds has a spacious and decentralized layout and covers about 240,000m2. Because of the large number of clinics and institutes a complex IT infrastructure is required.

At the center of the fiber optics network there is a Windows 2000 server farm with six application servers which give the individual clients access to SAP R/3, Office and various specialized applications via Citrix Metaframe. In addition, there are two mirrored SAN caches, two SAP servers, domain and exchange servers and various Unix servers, for example in the laboratory unit. Since the switch from Windows for Workgroups and NT to a central server structure with Citrix Metaframe in 1999 the individual desktop computers have consistently been replaced
with thin clients.

The hospital's central nerve is an FDDI backbone with a throughput of 100 Mbps. From the 8 fiber 62.5µm optical cable ring, DAS (dual attachment station) leads branch off to eleven clinics and administration units as well as to the server farm with eleven servers, to the router providing Internet access as well as VPN connection to all other Bremen hospitals and to the telephone system's ISDN router. Within the individual unit networks, the desktop clients are connected to hubs and switches via 10 Mbps fiber optic cables, and are hooked up to the backbone through a router. Apart from the six Windows 2000 servers with three or four processors each and gigabytes of RAM which comprise the Citrix Metaframe application server, two large Sun machines (E 450 and E 5500) serving as SAP/R3 servers dominate the IT landscape of the Bremen hospital. More than 1500 users in documentation and patient data administration departments use various SAP components like IS-H and IS-H*MED. These components are supplemented by additional software, for example for the international ICD-10 diagnosis encoding system. The laboratory and radiology units also use Unix applications – these run on DEC servers.

Target Slim Workspaces
The aim at Sankt-Jürgen-Straße hospital was to no longer use any PC clients, because with 3500 users the high maintenance requirements involved can hardly be handled by an IT team of ten. An additional problem is created by the fact that, because the hospital is spread out over such a large area, administrators sometimes have to walk 15 minutes to reach an individual computer. Apart from easier administration, data protection is also an important argument for using thin clients, as sensitive data can't be copied on computers without floppy disk drives.

About two years ago the Bremen hospital started the transition to thin clients with the implementation of its first 150 Siemens Scovery units. One requirement for the ward units was an integrated reader for patients' insurance chip cards. However, the solution presented at the time didn't meet the approval of decision makers: It was too complicated, much too slow and very expensive. It involved a "bent to fit" access control solution via chip card (product name Transon) and required a Transon server. As the server software lacks cluster capability it
only offers limited server availability.

In addition, the signatures stored in the Citrix client's flash memory required regular updating. When presenting Bremen company C. Melchers Netcom (The company has in the meantime be renamed Igel Technology GmbH – ed.) with the task it emerged that their Igel Thin Clients are available with integrated fiber optics card, and that the  insurance card problem could also be solved in a satisfactory way: Only a month later Melchers presented a device which offers a keyboard with integrated chip card reader. This showed the superiority of the Igel Flash Linux operating system, which the company's Augsburg developing team can adapt to individual requirements. The "Fit for Hospital" box explains how Melchers integrated the Cherry keyboard G80-1501 HAD with chip card reader. Positive side effect: Compared to the Siemens devices, the Igel solution reads 4 to 5 times faster. Igel Flash Linux is based on the Linux kernel 2.4.17. Highly compressed, the operating system resides in the thin client's flash memory and boots from there. Apart from the standard protocols ICA 6.2 and RDP, it also offers Ericom's PowerTerm emulation suite, which can accommodate a whole range of legacy host systems. This way, the Igel system can, for example, be used as a desktop for IBM and Siemens terminal applications. For web based applications there is a choice of different browsers including Netscape Communicator, Konqueror, Mozilla and Opera with Java Virtual Machine. This operating system offers particularly versatile hardware driver integration, in our example 3Com's 3C900B fiber optics card and the special Cherry keyboard.

Relief for the IT Department
The Igel solution clearly came out on top, and in January 2002 the first 100 Igel 532 Premiums with card readers were installed. At present, 440 devices are used in administration, on the wards, in the laboratory and some in the operating theater area. A total of 766 work spaces have so far been equipped with thin clients. The proportion of fat clients is down to between 10 and 15 percent. In addition to the obvious administrative advantage of using the thin clients' included administration software and the security aspects, a further positive aspect is the availability of network printers. One of the disadvantages of a fiber optics network is the high connection cost. A single network connector costs around 600 Euros. Therefore, the fact that the thin clients can also act as print servers saves the hospital a lot of money. Direct printing is possible both from Windows NT and SAP and from Linux and Unix. Berkeley Spool is used for DEC Unix in the laboratory area. Not all areas of the Central Hospital Sankt-Jürgen-Straße have been equipped with Igel thin clients, and the replacement of further PCs is on the IT team's agenda. New applications can also be implemented using thin clients. Successful implementations include a bar code solution in the operating theaters and the integration of a test kit. At present, the viability of blood analysis devices on the wards is being researched. To avoid mixed installations and allow for common administration of all thin clients, the 200 Siemens Scovery clients still in use are in the process of being upgraded. With a specially adapted kernel image in their Compact Flash ROM, these clients can accomodate Igel Flash Linux. This way, the special chip card keyboard solution will also work with the older devices.

Conclusion
Looking at the experience with the system at Bremen Central Hospital Sankt-Jürgen-Straße, hospitals should consider replacing as many of their PCs with thin clients as possible. At least for standard applications a server based computing solution is inevitable if network administration is to be streamlined and unnecessary delays are to be avoided by using secure, robust work space clients.