Consistently ranked one of the top pediatric facilities in the United States, Children’s Hospital of Los Angeles (CHLA) provides care to more than 100,000 children each year through its 300-plus-bed hospital and its 14 outpatient centers in the greater Los Angeles area. The more than 100-year-old institution is also one of the country’s top teaching facilities, serving as training ground for aspiring pediatricians from University of Southern California’s Keck School of Medicine.
Although CHLA started small—admitting just 14 patients in its first year—the hospital has grown with the populace, and its urban campus now occupies more than 10 acres in the heart of Los Angeles. In 2011, CHLA implemented a Citrix-based desktop and application virtualization environment to support the new 460,000-square-foot Marion and John E. Anderson Pavilion for inpatient care. The implementation of Citrix XenApp, Citrix XenDesktop and single sign-on provided clinicians with quick, easy access to their desktops and applications on any device, without having to wait for lengthy boot, login, and logoff processes. However, the time savings provided by this virtualized environment began to erode as the load increased on the system with the addition of 41 ambulatory clinics, resulting in nearly 400 additional remote users over the course of two years. Without adequate capacity to support the additional workers or a fully redundant architecture to support failover and maintenance processes, the environment slowed to a crawl and maintenance became a nightmare. After suffering a system outage near the end of 2013, CHLA turned to Redondo Beach–based IT consultancy T2 Technology Group for help.
Upon evaluating CHLA’s environment, T2 realized that a simple upgrade would not resolve the issues the hospital was facing. While planning was underway to build out a new platform, T2 recommended and implemented fixes to stabilize the current environment. To solve CHLA’s long-term challenges, T2 worked closely with Citrix Professional Services to design a more robust, fully redundant architecture with upgrades to the hospital’s IT infrastructure and the implementation of Citrix XenDesktop 7.5 and Citrix XenApp 6.5. “T2’s VDI [virtual desktop infrastructure] expertise and agile project management methodology were invaluable throughout each phase of the project,” says Greg Bush, Director of Technology for CHLA. “They not only helped us stabilize our existing environment, but their attention to detail as they managed the design and implementation of the new environment resulted in a solid new platform and a seamless migration process.”
After extensive testing of multiple solutions on the part of T2, CHLA selected Cisco UCS blade chassis, high-speed Pure Store flash arrays and a high-availability pair of Citrix NetScaler App Delivery Controller load balancers to support the new environment. The focus of the new design was redundancy, performance and scalability.
“Redundancy is of the utmost importance,” says Bush. “If the environment is unavailable, people can’t access the EMR [electronic medical records] system. When that happens, patient care suffers. That is why we built two standalone server farms with redundant NetScaler controllers and global load balancing. If either of the environments or data centers encounter a problem, the other can continue functioning with zero downtime.”
In addition to improving performance through improved design and high-speed infrastructure, T2 worked with CHLA to improve performance by delivering applications through Citrix XenApp rather than embedding them in the desktop image. This allows CHLA to make better use of its infrastructure and improve response times by 60 percent. CHLA relies on Citrix to deliver everything from medical billing applications to email and other key hospital services. “The goal,” says Bush, “was to virtualize as many applications as possible and move them over to XenApp to leverage its inherent performance benefits.”
Today, Bush and his team rest a great deal easier knowing that the problems associated with maintaining the old environment—and the outages brought on by those problems—are a thing of the past, thanks to redundant, high-speed infrastructure and improved load balancing. “Due to limitations in the design, capacity and capabilities of our previous environment, maintenance and outages were a painful process,” says Bush. “With a fully redundant architecture, the addition of NetScaler load balancing and enough capacity to support up to 2,000 users in both server farms, we know that at least one farm will always be up and running with plenty of capacity to handle our current and future load.”
For CHLA, the new capabilities offered by Citrix products, combined with the benefits of T2’s architectural improvements and new high-speed infrastructure, have translated to huge improvements in login and roaming times. “Login times have gone from more than two minutes to as little as 35 seconds, and roaming times have been reduced from 45 seconds to as low as 10 seconds,” says Bush. “This is crucial to supporting our clinicians as they focus on delivering high-quality patient care. When you can reduce wait times by a minute and a half at the beginning of the day and by 30 seconds every time a clinician moves to a new workstation, you are facilitating huge time savings.”
CHLA is also discovering that NetScaler App Delivery Controller provides benefits beyond redundancy. By deploying the Insight Center feature within NetScaler, the hospital has been able to analyze latency issues to gain an in-depth picture of performance. The results have been illuminating. “Our users used to say VDI is slow,” says Bush. “But slow is such a subjective term. Without the right data, it was difficult to pinpoint and diagnose the issue, and we used to run into a lot of finger pointing. NetScaler Insight Center eliminates that, allowing us to identify and resolve issues much more quickly.”
As CHLA continues to grow, Bush is confident that its Citrix-enabled virtual infrastructure will be able to scale accordingly. “Thanks to our new Citrix environment, we can make applications and desktops available whenever and wherever they’re needed,” he says. “Our clinicians benefit, which means our patients benefit—which is what it’s all about at CHLA.”
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