Virtual Desktop Infrastructure

DECEMBER 1, 2013

VENKATESH EKAMBARAM
SHANNON HART
LENA MATTERNAS
ED MLI NEK
SCOTT ROBERTSON
Agenda
! Virtual Desktop Infrastructure (VDI)
! What is VDI?
! Benefits (HIPAA, Security and Economic)
! VDI Applicability to Pneumonia Severity Index
! Enhanced and consistent quality of care throughout
the health system
! VDI Improves CMS Compliance
! Value Based Purchasing / Meaningful Use
! Medicare Spend per Beneficiary
! Readmission Reduction
! Public Reporting
Proposal
! Implement a Virtual Desktop Infrastructure (VDI)
throughout the entire 500 bed hospital
! Upgrade network and Single Sign On (SSO)
capabilities to support
! Leverage cloud hosting service provider to meet
storage requirements in a secure environment
! Utilize existing:
! Desktops/laptops (roughly 400 workstations)
! Microsoft Professional Licenses with Software Assurance that
were previously acquired
What is VDI?
! Software technology that separates the desktop
environment from the physical client device
! Virtual machines are used to access the user’s
desktop on the remote data server
! All operating systems and applications are installed
on central server
! Requires strong network infrastructure and adequate
storage
Benefits of VDI
! Reduced administrative and support costs by centralizing
installed applications
! Most troubleshooting issues can be conducted remotely
! Enables organizations to implement “Bring Your Own
Device” programs for employees while maintaining
system security
! Decreased risk of HIPAA violation if a device is stolen or
lost as data is stored on the server and not the actual
device
! Combined with SSO and strong authentication tools, can
improve organizations security posture
VDI in the Clinical Environment
! Implementation within clinical environments
support movement of staff while treating patients
! Allows all clinical applications (EMR, PACS, etc.) to
be accessed from any location via a virtual machine
! Improved workflow efficiency
! 31% of users reported time savings of 15 minutes with SSO and
VDI
! Doctors at Seattle Children's reported saving 45 minutes a day!
! Organizations also reported a significant reduction
in the number of help desk calls
! Hospital in Seoul reduced help desk calls by 92%
• The use of the Pneumonia Severity Index (PSI) tool is a
clinical proof of concept that it will work in a hospital that
leverages VDI
• 75% of these patients are evaluated in the emergency
department (ED) setting
• 25% of evaluations are in other clinical setting
• Primary physicians office
• Outreach and remote satellite clinic settings
• Inpatient setting

VDI can improve Management of
Patients with
Community Acquired Pneumonia

Pneumonia Severity Index
Quality of Care: Inpatient vs. Outpatient Management
! Reported in the New England Journal of Medicine
! 14,199 patients in 1997
! Validated in multiple subsequent clinical trials
! Treatment location (inpatient vs. outpatient) is based upon a
determined risk class
! Clinical Characteristics
! Demographics e.g. age and gender
! Coexisting illness
! Physical Examination findings
! Laboratory and Radiology results

Risk Class Assignment
Pneumonia Severity Index.
VDI and Meaningful Use?
What is required for 2014 and beyond?
• 13 required core objectives
• 5 of 10 menu set objectives
• 16 clinical quality measures (3 of the 6 key policy domains must be used)
• Patient and Family Engagement
• Patient Safety
• Care Coordination
• Population and Public Health
• Efficient Use of Healthcare Resources
• Clinical Processes/Effectiveness
What does VDI accomplish?
In regards to Community Acquired Pneumonia:
• 1 Clinical Quality Measure within the “Efficient use of healthcare resources”
policy domains
• NQF 0147: Initial antibiotic selection for community-acquired pneumonia
(CAP) in immunocompetent patients



Economics
Payments:
! Medicaid Payment = $6,370,200
! $2,000,000 + $200 x (23000-1149) = $6,370,200
! Medicare Payment = $4,204,464
! $6,370,400 x 0.88 x 0.75 = $4,204,464
! Total Incentive Payments = $10,574,864
! $6,370,200 + $4,204,464 = $10,574,864

Money saved from better outcomes due to:
! Reduced “never events”
! Quicker turnover, reduced length of stay, and increased
volumes
! Keeping “customers” alive and satisfied


Economics of VDI and VBP
! What is Value-based purchasing (VBP)?
! a.k.a. paying for quality care
! A CMS priority
" So is effective CAP treatment!
! Achievable through application of PSI which is made accessible
because of VDI
! Increases revenue through:
! Achieving MU metrics
! Attaining incentive goals
! Reduces financial penalties associated with:
! MSPB (Medicare Spend Per Beneficiary)
! Hospital Readmission Reduction Programs
" Effect is increased costs and risks of complications from unnecessary
treatment

Economics of VDI and VBP
MSPB
! Spending per hospital patient
• A CMS measure in its FY2015 Hospital VBP Program
! Assessed at three time periods:
! during the 3 days prior to admission
! during the index admission
! during the 30 days after hospital discharge
" This is where VBP has the greatest impact!

Economics of VDI and VBP
Readmission Reduction Programs
! “an admission to a hospital within 30 days of a
discharge from the same or another hospital”
! Strict criteria
! readmitted for any reason!
! Rate is 20%
! represents low care quality
! Failing to lower it results in a penalty of 2%!
! Over 2,200 hospitals will be paying this!!
Economics of VDI and VBP
Public Reporting
! Medicare.gov
! Hospital Compare
! Available to the Public
! Influences a Health
Consumer’s Choice
" Readmission Rates
" Timely & Effective care
" Use of Medical Imaging
" Patient Survey Results
Appropriate Antibiotic in
Pneumonia Patients
Anticipated ROI
Planned Expenditures
Cost of purchasing VDI solution $2,800,000
Cost to upgrade infrastructure $2,500,000
Initial implementation cost $1,500,000
Cost of cloud hosting storage and services $1,500,000 annually
Ongoing maintenance and support costs $1,000,000 annually
Cost to train IT staff and end-users $60,350
Cost Avoidance
Anticipated cost avoidance in increased workstation
lifecycle, from 5 to 10 years (realized in Year 6)
$200,000
Reduced help desk support requirements & user
downtime (realized beginning in Year 2)
$500,000
Clinical time savings (only partially realized in Year 1;
fully realized beginning in Year 2)
$4,065,600 annually
Anticipated ROI
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Year 1 Year 2 Year 3 Year 4 Year 5
Expenses
Return
Anticipate ROI will be realized in Year 5, consistent with other organizations who
have completed similar IT efforts. Additional ROI may be achievable through MU
incentive payments; likely in Year 3.
Why VDI?
! Other methodologies could produce similar results
! Staff education
! Implement the PSI in the current legacy IT system
! Rationale to adopt VDI
! Centralized applications reduced administrative and support costs
" Reduced Help Desk calls (92%)
! Remote trouble shooting
! Further support HIPAA compliance via central data storage
! Improved workflow efficiencies: Time saved 45 minutes per day
! Security Optimization with mobile devices
! Augment Physician and Staff Engagement and Satisfaction
" “Bring your own device” initiative
! Return on Investment
What’s the Bottom Line?
! ENHANCED HEALTH CONSUMER CHOICE
! Improved public perception via review of Hospital Compare Data
! IMPROVED QUALITY of CARE
! Recognition of safer, more effective, and more appropriate care
! REVENUE OPTIMIZATION (CMS)
! VBP (Meaningful Use, MSPB, Readmission reduction)
! VDI
! Increased staff productivity through improved workflow
! Improved HIPAA compliance
! Enhanced Security efforts
! Decreased IT management and support costs
! Positive ROI
References: VDI and ROI
! Business Desktops and Workstations. (n.d) from Dell Web Site:
http://www.dell.com/us/business/p/desktops-n-workstations.aspx?
ref=tile2

! Desktop Virtualization. (2013, September 21). Retrieved October 2013,
from Wikipedia: http://en.wikipedia.org/wiki/Desktop_virtualization

! Harbaugh, L. (2013, March 22). The Pros anc Cons of Using Virtual
Desktop Infrastructure. PCWorld. Retrieved October 2013, from
http://www.pcworld.com/article/252314/the_pros_and_cons_of_
using_virtual_desktop_infrastructure.html

! Hospital Frees Up 45 Minutes Daily for Clinicians. (2013). from Cisco Web
Site:
http://www.cisco.com/en/US/solutions/collateral/ns340/ns517/ns224/
case_study_c36_675367.pdf
References: VDI and ROI
! In A 500 Bed Hospital There Are 200 Nurses And 150 Other Staff. If The
Hospital Extends By A New Wing For 100 Beds, Then What Additional
Staff Is Needed?. (n.d) from Blurtit Web Site:
http://education.blurtit.com/694796/in-a-500-bed-hospital-there-
are-200-nurses-and-150-other-staff-if-the-hospital-extends-by

! Jha, D. (2010, April 3). 900-bed hospital needs 500 PCs. From The Times
of India Web Site:
http://articles.timesofindia.indiatimes.com/2010-04-03/delhi/
28147066_1_hindu-rao-hospital-mcd-hospitals-swami-dayanand-hospital

! Operating System Virtualization. (n.d) from Microsfot Web Site:
http://www.microsoft.com/en-us/windows/enterprise/products-and-
technologies/virtualization/operating-system/default.aspx

! Panko, R., & Panko, J. (2013). Business Data Networks & Security. Upper
Saddle River, NJ: Prentice Hall.
References: VDI and ROI
! Salary Wizard - Physician - Hospitalist . (n.d) from Salary.com Web Site:
http://www1.salary.com/Physician-Hospitalist-Salary.html

! Salary Wizard - Staff Nurse R.N.. (n.d) from Salary.com Web Site:
http://www1.salary.com/Staff-Nurse-RN-salary.html

! Strauss, E. The Pay Rate for a Hospital Help Desk Technician. (n.d) from The
Houston Chronicle Web Site:
http://work.chron.com/pay-rate-hospital-desk-technician-5744.html

! Subramanian, K. (2012, February 22). How To Assess the Cost of Implementing
VDI. from Virtualization Review Web Site:
http://virtualizationreview.com/Blogs/Desktop-Reality/2012/02/How-To-Assess-
the-Cost-of-Implementing-VDI.aspx

! VMWare. (2013). Desktop Managment. Retrieved October 2013, from VMWare:
http://www.vmware.com/desktop-management.html?src=WWW_BestMatch_US
! Yoo, S, et. all (2012). Economic analysis of cloud-based desktop virtualization
implementation at a hospital. BMC Medical Informatics and Decision Making,
12:119. from http://www.biomedcentral.com/1472-6947/12/119
References - PSI
! Fine, M., Auble, T., Yealy DM, Hanusa BH, Weissfeld LA, Singer DE,
(1997) A prediction rule to identify low-risk patients with community-
acquired pneumonia. New England Journal of Medicine .;336:243–
250.
! Mandell, L., Wunderink, R., Anzueto, A., Bartlett, J., Campbell, G., et.
al. (2007) Infectious Diseases Society of America/American Thoracic
Society Consensus Guidelines on the Management of Community-
Acquired Pneumonia in Adults Clinical Infectious Diseases.44:S27–72.
! Yealy, D., Auble, T., Stone, R. Lave, J., Meehan, T., et al. (2004) The
emergency epartment community-acquired pneumonia trial:
Methodology of a quality Improvement intervention. Annals of
Emergency Medicine Jun;43(6):770-82.

References – Meaningful Use

Centers for Medicare & Medicaid (2012). Clinical quality measures finalized for
eligible hospitals and critical access hospitals beginning with FY 2014.
Retrieved November 2013, from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/
2014_CQM_EH_FinalRule.pdf

National Quality Forum (2010). NQF #0043 Pneumonia vaccination status for
older adults. Retrieved November 2013, from https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDQQFjAB&url=h
ttp%3A%2F%2Fwww.qualityforum.org%2FWorkArea%2Flinkit.aspx
%3FLinkIdentifier%3Did%26ItemID%3D68272&ei=C7t2Up7tN-
zdsATnvYCIBA&usg=AFQjCNEJqYI5yHYfRRBRwSaM9ht7Hlj7gw&sig2=5ZTY
MnmqewEl2nxKjy6TRg&bvm=bv.55819444,d.cWc

References VBP
! Centers for Medicare & Medicaid Services. (n.d.). Medicare
Spending Per Beneficiary (MSPB) Measure Overview. Retrieved
from
http://www.qualitynet.org/dcs/ContentServer?
pagename=QnetPublic/Page/QnetTier3&cid=1228772053996
! Centers for Medicare & Medicaid Services. (n.d.). Spending per
Hospital Patient with Medicare. Retrieved from Medicare website
http://www.medicare.gov/hospitalcompare/data/spending-per-
hospital-patient.html?AspxAutoDetectCookieSupport=1
! American College of Emergency Physicians. (n.d.). Medicare's
Hospital Readmission Reduction Program FAQ. Retrieved from
http://www.acep.org/Legislation-and-Advocacy/Practice-
Management-Issues/Physician-Payment-Reform/Medicare-s-
Hospital-Readmission-Reduction-Program-FAQ/