Rapid growth at the SANA-Klinikum Remscheid validates the timely introduction of a thin client architecture. Since its integration into the 'SANAVerbund ' medical association at the beginning of 2001, Sana-Klinikum Remscheid has been pursuing ambitious goals. The vision of a 'hospital of the future' was developed to meet new challenges in healthcare and provide top quality medical services, while achieving financial success. The technical basis for this transformation is an organization-wide thin client architecture initiated in the year 2000.
The core function of the hospital is to provide stationary medical services and care to the population of Remscheid as well as emergency services to the region. In addition to the main facility Burger Strasse, a day clinic for child and adolescent psychiatry in Wuppertal is included. A particular challenge for the hospital's central computer system is providing support to two other medical facilities in the Cologne-Düsseldorf- Wuppertal triangle: Child andAdolescent Psychiatry Solingen and Sana-Klinik Hürth near Cologne. In 1999, the hospital beganlooking for an alternative to the PC-based workstations in surgery.
Michael Willmann, IT Manager Sana-Klinikum Remscheid GmbH, recollects:
“At that time, any administrative task threatened to interfere with surgical activities. It was quite complicated for service employees to enter and exit while ensuring that the rooms remained sterile. To eliminate the potential for organizational conflict and medical risk, we decided to introduce thin clients with remote administration capability.”
Since the initial practical experiences with thin clients in the Remscheid operating theatres werepositive, the hospital's IT management elected to restructure the network environment extensively in 2001. The PC-supported client/server structure was replaced by 19 central terminal servers with Citrix Metaframe XP where applications are centrally stored. 15 of the 19 Compaq servers are used to administer desktop log-on, two to house proprietary patient administration, and three for system administration, access control and Internet access.
Approximately 325 thin clients manufactured by IGEL Technology of Germany are in use. The lower maintenance, lower consumption terminals are installed in all areas of the organization. Except for a few fat clients that are still used for special purposes, the old, mostly DOS-based PCs have already.
Backbone for administrative reform
The hospital's newly established infrastructure serves as a basis for necessary renovation projects. For example, the client pool increased gradually and now provides access to KIS, the new central patient administration system, for about 1000 users. Furthermore, radiology was digitalized in January of 2005. “Today, our employees no longer carry xrays across the hall”, reported Michael Willmann, IT Manager of Sana-Klinikum Remscheid GmbH. “All images and videos are stored electronically, which is an important step toward digital hospital operations.” For this type of work, which requires powerful computing and graphics capabilities, highperformance clients, model IGEL-564 Premium, are used. Integrated graphics offer more color depth and resolution than the lower priced IGEL CE and Compact series, which are used for administrative tasks, for example.
Willmann considers the 140% increase in user penetration 'a giant leap forward'. As a result of extensive user administration on the server side and multisession capable clients on the user side, it is possible for several employees to share a monitor. In addition, operational procedures within the organization are less dependent upon location.
'The separation of work and workplace offers an enormous time gain for us as an interdisciplinary hospital. For example, if a physician has to leave the screen on short notice because he is called to emergency surgery, the session remains open on the server and can later seamlessly resume on any client within the system without a cumbersome logon process. Unlike PC workstations, all previously opened applications and up-to-date data are available immediately.' Due to a separate log-on server, the process takes only about ten seconds.
Flexible connection
A particularly noteworthy feature of the new infrastructure in Remscheid and environment is the varietyin communication methods. 'The superior connectivity of the thin clients allowed us extraordinary flexibility in the integration of our satellite facilities', said Willmann. 'For example, 20 to 30 terminals in child and adolescent psychiatry in Wuppertal communicate with the terminal servers through a 128 kBit/s dial-in connection, while 30 clients in the Hürth hospital, about 42 km away, are connected by a 2 MBit/s fixed DSL line.
10 clients installed in Solingen share the necessary screen and control data with the computer center through a WLAN access point and a 3 MBit/s DSL line which is operated as a VPN. From a technical standpoint, this configuration required no significant effort. 'It was easy to upgrade the IGEL-464 Winestra thin clients installed in Solingen with a PCI WLAN card and they were immediately available for use.' The low data volume of the ICA-compatible clients reduced the load on the 9 kilometer 32 MBit/s radio link between the two primary facilities in Remscheid. Another 2 MBit/s dedicated line connects the external computer center of the municipal utilities in Heiligenhaus near Düsseldorf where 20 more IGEL thin clients were installed to take advantage of the benefits of the new architecture. Willman has not experienced any acceptance problems with the new thin clients: 'Word quickly got around that they make work easier, and the brand name of the terminals did the rest. The positive perception was helpful in reducing potential concerns, especially for employees with less advanced technical skills. User interfaces can be individually designed and programs can be provided user-specifically, and therefore, there is no need for time-consuming training or wading through incomprehensible menu mazes.
Supporting rapid growth
In retrospect, Willmann is glad to have opted in favor of a thin client architecture at an early stage. 'Our system has grown consistently since 2001. Including the two external computer centers, the two locations we initially had to manage grew into six, the number of clients increased from 15 to 230. With another architecture, it would certainly have been more difficult to expand. Although the initial investment of about ' 200,000 is equivalent to a comparable client/server system, we realized enormous savings in terms of administration and maintenance. For example, the costs of the help desk dropped by 21 percent. We are confident that the trend will continue.
