1. Virtual Mayo: Creating a Virtualized Computing Environment Paul H. Lenko and Judd D. Shaft Division on Information Technology Mayo Clinic Arizona

2. 2© 2005 Citrix Systems, Inc.—All rights reserved. Largest private health care organization in the USLargest private health care organization in the US 3,000 physicians and scientists 3,000 physicians and scientists 35,000 allied health staff 35,000 allied health staff 1,800 residents/students 1,800 residents/students Mayo ArizonaMayo Arizona 65 Medical and Surgical Specialties 65 Medical and Surgical Specialties 332 Staff Physicians and Scientists 332 Staff Physicians and Scientists 3,330 allied Health Staff 3,330 allied Health Staff The Mayo Foundation

3. 3© 2005 Citrix Systems, Inc.—All rights reserved. Electronic Medical Record Hospital designed to be paperless and filmless Clinic outpatient practice converted to EMR in 2000 Technology integral to practice of medicine at Mayo Clinic Arizona

4. 4© 2005 Citrix Systems, Inc.—All rights reserved. MCA IT Core Values Employ technology for the value it brings to our business processes and not for the sake of technology itself Minimize complexity of systems Reduce cost of ownership Stabilize systems and ensure business continuity “Buy - not build” approach to new systems Centralized (vs. de-centralized) model for systems Enforce technology standards and selection criteria Apply rigorous methodologies

5. 5© 2005 Citrix Systems, Inc.—All rights reserved. Background 2003: Day of Reckoning –NT end of life announced –Processing/memory requirements exceeding hardware capabilities –Rapid increases in IT problem ticket volumes Failing hardware System response time issues

6. 6© 2005 Citrix Systems, Inc.—All rights reserved. The Challenge: PC Operating System (OS) at end of life Applications that are no longer supported on old OS 2400 PCs that won’t support new OS Organization wants it all upgraded in 18 months –Pent-up demand for new desktop systems –Low tolerance for long upgrade cycle –Funding considerations and timing

7. 7© 2005 Citrix Systems, Inc.—All rights reserved. Architecture Options Considered Higher Support Cost (Highly Distributed) Lower Support Cost (Highly Centralized) Greater Standardization (Lower Support Cost) Greater Individualization (Higher Support Cost) Server-Based Computing Blade PC Traditional Desktop PC User Desktop (Applications, Customizability) IT Support Model

8. 8© 2005 Citrix Systems, Inc.—All rights reserved. 3 Configurations Presented –Dell GX270 PC (current replacement standard) –HP Blade PC –Server-based computing platform Usability Lab Process –60 participants from across Mayo Clinic Arizona –Participants tried each device for 15 minutes –Able to access MS Office, IDX, Apollo, Intranet –Completed short survey on experience with each configuration Usability Lab Overview

9. 9© 2005 Citrix Systems, Inc.—All rights reserved. Usability Lab Outcomes “Overall speed for each of the devices was good, much improved from current speed on the older workstations we have in the clinical areas today.” “Difficult to notice a difference in speed.”

10. 10© 2005 Citrix Systems, Inc.—All rights reserved. All 3 technologies tested are viable in our computing environment –Perceptions of platforms differ, but all appear to have a place in the organization (not “one size fits all”) –Many differences related to setup issues that can be addressed at implementation Other replacement device considerations –Costs (acquisition, implementation, TCO) –Timeline required to implement each platform –Maturity of candidate technologies and vendors –Internal capability to support each candidate technology Where Did This Lead Us?

11. 11© 2005 Citrix Systems, Inc.—All rights reserved. What is Virtual Mayo? Components of desktop upgrade –Migration from Windows NT to Windows XP –Replacement of sub-Pentium PC hardware –Standardization on MS Office 2003 –Incorporates migration from eDirectory to Active Directory Migration to Thin PC computing Creation of a virtualized desktop Your applications, your settings, on any PC or thin client, delivered on demand

12. 12© 2005 Citrix Systems, Inc.—All rights reserved. “The Road Less Traveled” Virtual Desktop 16-bit apps Location-specific Application settings Poorly written apps: “I own the whole box” Apps written for “Fat client” “Citrix just won’t work with our apps!”

13. 13© 2005 Citrix Systems, Inc.—All rights reserved. “Perceptions…” Sounds risky…PCs are “proven” We tried Citrix 4 years ago – and it failed! You know, MS Office won’t run on Citrix… I won’t be able to map my own drives or printers! Multiple users will make the servers run very, very slow IT won’t be able to support it

14. 14© 2005 Citrix Systems, Inc.—All rights reserved. Delivery Solutions Citrix Presentation Server 3.0 –Server-based computing –Local application install on server farm in the data center. (IBM Blade Servers) –Multiple users on single server. –Roaming profiles within virtual environment. (network mappings, etc.) –Presents complete desktop environment, on a server class machine Citrix Access Gateway –SSL/VPN Gateway –Seamless Access to Virtual Mayo Desktop –Resident Physician Pilot

15. 15© 2005 Citrix Systems, Inc.—All rights reserved. Hardware Platforms PCs – Dell SX280, GX270 (1600 total) –Individual user offices/cubicles –Applications licensed by end-user device –Network downtime workstations Thin Clients – HP Compaq t5710 (800) –Shared user areas –Standardized clinical desktop (add’l desktops planned) Servers – IBM BladeCenter HS20-8843 (70) –Dual Xeon 3.4Ghz, 4MB, Dual NIC –56 in production farm; 14 in test farm

16. 16© 2005 Citrix Systems, Inc.—All rights reserved. Phase 1 Clinical and Business Applications Clinical Applications CSO IDX LastWord EPIC QReads Apollo/Clinical Notes OneStaff WinPFS Midas+ Misys RPS/PERN RIMS Business Applications Microsoft Office 2003 Microsoft Visio 2003 Microsoft Project 2003 Adobe Acrobat 6.0 Internet Explorer Webmail

17. 17© 2005 Citrix Systems, Inc.—All rights reserved. Building the Clinical Desktop “Guiding Principles” –Consistent user experience between XP and Virtual Mayo environments –Lock down settings where warranted –Initial focus on a working desktop – keep end goal of virtualization in mind –Anything we roll out has to work well – rather have it “right” than “fast”

18. 18© 2005 Citrix Systems, Inc.—All rights reserved. Architecture Redundancy, redundancy, redundancy –Split server farm across two subnets –Redundant NICs –Network load balancing solutions Seconds count –Web front end –High end thin client units –Importance of “smooth roaming”

19. 19© 2005 Citrix Systems, Inc.—All rights reserved. Internal Marketing Messages Thin clients rebranded as “ThinPC” –Familiarity with PC terminology –De-emphasize differences Virtual environment benefits emphasized –Improved support model, reduced end-user downtime –Future plans for application delivery –Appeal to management – less variation among devices and desktops Within IT – Focus on new technologies and expansion of staff skills

20. 20© 2005 Citrix Systems, Inc.—All rights reserved. Implementation Pilot rollout in clinical and hospital locations –Lots of positive feedback –Limited negative feedback (mostly application issues) –Opportunity to identify and address additional issues – no substitute for “real world” experience

21. 21© 2005 Citrix Systems, Inc.—All rights reserved. Implementation Strategy –Swap PC for Thin Client in shared use areas –Pre-configuring images –Final server image rollout via Altiris –Goal of all Thin Clients deployed by December 2005

22. 22© 2005 Citrix Systems, Inc.—All rights reserved. Future Plans Citrix Presentation Server 4 –Application Isolation –IP Address Virtualization –CPU & Memory Optimization –Printing Focus on virtualizing all applications before considering fat client installation Shared virtual desktops with other Mayo Foundation sites

23. 23© 2005 Citrix Systems, Inc.—All rights reserved. Before you leave… Recommended related breakout sessions: Session surveys are available online at www.citrixiforum.com Tuesday, October 11 (please provide feedback) www.citrixiforum.com Breakout session handouts are located at the Breakers Registration Desk South