Post on 14-Apr-2017
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Beyond Monitoring:Leveraging Unified IT Performance Management for Patient Care and
Satisfaction
Presented by:
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Introduction
Today’s Moderator
Tom SullivanEditor-in-ChiefHealthcare IT News,A HiMSS Media publication
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Please submit your questions at any time during the webinar using the questions panel on the on-screen client.
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A copy of this presentation is posted on Slideshare:http://www.slideshare.net/eginnovations/
Logistics
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Bala VaidhinathanCTOeG Innovations
bala@eginnovations.com
Wendy HowardInfrastructure EngineerSt. Charles Health System
wshoward@stcharleshealthcare.org
Today’s Presenters
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The Keystones of Healthcare IT Today:Application and Desktop Virtualization
Citrix XenApp and XenDesktopare the leading solution
Large increases in capability and complexity over many years
VMware server virtualization drives most Citrix deployments
VMware Horizon is the leading competitor for desktop and application virtualization
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The Keystones of Healthcare IT Today:Application and Desktop Virtualization
Citrix healthcare deployments:
Mostly on-premises datacenters
Running all Windows applications
Running all enterprise healthcare applications
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The Keystones of Healthcare IT Today:Application and Desktop Virtualization
Privacy Security FlexibilityOperational
Efficiency
Improved Service
Delivery and Patient Care
Benefits of Virtualized Applications and Desktops
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The Keystones of Healthcare IT Today:Application and Desktop Virtualization
Risks in a Virtualized Applications and Desktops Strategy
Cost to deploy
Increased downtime and slow
performance
Reduced productivity
Lower patient
satisfaction
Delayed billing
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Consistent, excellent user experience directly
impacts patient care and satisfaction
Clinical
Administration
Out-patient
In-patient
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
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The Impact of a Traditional, Siloed Monitoring Strategy
I can’t login.
There is too
much lag on my
screen.
My application is
taking forever to
load!
Users care about “services”
The CPU usage of
the Linux servers
is ok.
The DNS servers are
responding well to
queries.
IT operations teams focus on infrastructure silos
The User / IT Management Disconnect
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
Different teams are responsible for the performance of separate
tiers/components, but IT service delivery involves ALL.
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Impact on IT
Cross-team coordination reduces speed to resolution for problems that arise,
and impacts the ability to implement preventive fixes and smart growth.
End User
Client Admin
LAN Admin
Firewall admin
Server admin
Virtualization admin
Domainadmin
ERP Admin Sys admin ApplicationAdmin
The serveris working
OK
No othercomplaints
All lights Are green
We don’t see anything
wrong
Database Admin
This is not
working
VMs are lightly
loaded
EverythingIs OK
Not ourproblem
Looks fine Not mine
either
Talk tothe other
guys
IT Service Manager
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
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Impact on Help Desk
Help desk support is negatively impacted by inability to route issues correctly and quickly.
End User
Client Admin
LAN Admin
Firewall admin
Server admin
Virtualization admin
Domainadmin
ERP Admin Sys admin ApplicationAdmin
The serveris working
OK
No othercomplaints
All lights Are green
We don’t see anything
wrong
Database Admin
This is not
working
EverythingIs OK
Not ourproblem
Looks fine Not mine
either
Talk tothe other
guys
Help DeskAssociate
VMs are lightly
loaded
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
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Citrix XenApp/XenDesktop and VMware
Horizon are mature and complex platforms
Provisioning, user access, GPU resource
management, mobile, etc.
Multiple steps, multiple logins
Susceptible to conditions across the entire
infrastructure, so small issues almost
anywhere can impact the user experience
Traditionally, performance monitoring has
required many tools
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
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Example: Suppose the database server is 50% slower than normal. . .
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
A problem in one tier can affect all the other tiers involved in service delivery.
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The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
Disk reads
Streaming Media AppSlow Database Queries
Excessive disk reads by the media server slow down Oracle database accesses
Virtual infrastructures are hard to manage. Traditional, siloed monitoring tools are not designed to handle these dynamic environments.
Another Example:
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Performance sensitivity negates the effectiveness of
traditional monitoring approaches. Effective
management requires:
Visibility across the infrastructure for
troubleshooting
Reporting from across the infrastructure for
planning and design
Single pane of glass view across all tiers and
throughout each layer is the only means to
preventive management
Virtualization complexity demands dependency-
aware, automatically correlated insight for
efficiency
The Challenge: Great User Performance in a Performance-Sensitive Service Delivery Paradigm
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The Solution: Unified Performance Management for the Healthcare Enterprise
Unified Performance Management Goes Far Beyond Traditional
Monitoring:
REACH across the infrastructure
DEPTH throughout each stack
SPEED to resolution, through automated
correlation and diagnosis
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The Solution: Unified Performance Management for the Healthcare Enterprise
• Reduce downtime
• Increase application availability
• Boost user experience
Boost User Satisfaction
& Productivity
• Simplify, automate & accelerate diagnosis & troubleshooting
• Optimize staffing levels & reduce OPEX
Reduce IT Support
Cost & Complexity
• Increase hardware utilization
• Leverage investment in software
• Right-size & optimize environment
Reduce Infrastructure Cost & Avoid Cost
Overruns
• Accelerate deployments & rollout
• Reduce risk, deliver successful projects & peace of mind
Deliveron Time, on Budget,
on Target
KEY
BEN
EFIT
S
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St. Charles Health System
Largest provider of medical care in Central Oregon
Non-profit, multi-location health system focused on excellent care and high patient satisfaction
Four hospitals and 120+ medical providers
Region’s largest employer with 3800+ caregivers
“Creating America’s healthiest community, together.”
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St. Charles Health System
Our Complex Environment
Virtualization in two datacenters
Application types:
Windows 32bit/64bit applications
EMR, clinical, non-clinical
XenApp and XenDesktop 4.5/6.5/7.6
Citrix Servers
300+ servers – VM and provisioned
Running Windows 2003/2008/2012
“Creating America’s healthiest community, together.”
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St. Charles Health System
Key IT Responsibilities and Tasks Performed:
Maintenance
Troubleshooting
New projects
Reporting
Emergency upgrades
“Creating America’s healthiest community, together.”
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St. Charles Health System
Healthcare Expectations of IT at SCHS
Every IT activity needs to have a focus on patient safety
Generate positive Caregiver experiences with IT
Keep up with HIPAA and ICD changes, meaningful use
Comply with legal and government regulations for data retention
Provide interoperability between healthcare entities
Maintain HIE – Health Information Exchange
“Creating America’s healthiest community, together.”
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SCHS IT: The Challenge
Late 2014:
Aging IT infrastructure
Growth of healthcare information
requirements
“A massive technology overhaul” was
required to streamline IT services
How do we improve the user experience?
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SCHS IT: The Challenge
Late 2014:
Legacy Citrix XenApp was historically problematic
Difficult upgrade path
Login problems
System availability issues
Prior tools included EdgeSight and Powershell scripts
Siloed monitoring ineffective and not scalable
Missing the “big picture”
Overall frustrating experience for clinical users
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SCHS IT: The Challenge
Impact:
Lack of real-time visibility across the
infrastructure
Extra effort to identify root causes with
each problem: Is it Citrix? The network?
Elsewhere in the physical or virtual
infrastructure?
Multiple tools with manual correlation and
analysis across teams
Long Mean Time to Recovery (MTTR)
Service Desk “in the dark”
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SCHS IT Transformation
Primary goals for Desktop Transformation
Project (DTP):
– Create Citrix XenApp/XenDesktop 7.6 site
– Move from physical desktops to virtual
desktops (VDI) via XenDesktop (Windows 7)
– Supply XenDesktop on Thin Clients to clinical
areas
– Adopt Citrix Provisioning Services and
Microsoft App-V for images and application
virtualization
– Many sub-projects:
• Single sign-on, follow-me desktops, AppSense,
active-active disaster recovery site availability
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SCHS IT Transformation
Select a proven healthcare IT service integration provider
Denali Advanced Integration
Richard Hussain, Solutions Architect from Denali, to advise and manage transition
Assessed goals and challenges of Citrix XenApp performance monitoring
Responsible for success of design, architecture and rollout
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SCHS IT Transformation – We need help!
SCHS Enterprise Client Architect asked Denali to
search for a monitoring solution
Requirements
Unified, real-time monitoring across the entire IT
infrastructure, including in-depth Citrix insight
Support all existing technologies at St. Charles
Support future technologies being architected for DTP
Single-source solution for total visibility
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The Solution: Unified-Citrix Performance Management
Watched demo of eG Enterprise and gained interest
After leadership buy-in, we decided to implement
Worked directly with one support person
Received on-site training
Customized our configuration
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Four 60” monitors centrally displaying system
status at all times in the IT department
“Monitoring At a Glance” by anybody who walks
by.
Central view ensures immediate insight into any
issue that can impact the user experience, even
before they notice a problem
Currently monitoring 281 various components
Core Citrix infrastructure is most critical
The Solution: Unified-Citrix Performance Management
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Key Workflows and Functions
Automated diagnosis and dependency display, across all tiers: Red, yellow, green status
indicators save time and improve service
User-experience dashboards, drill-downs and infrastructure-wide topology view for instant
visibility into issues’ root causes
Proactive email alerts to indicate potential issues across the infrastructure and allow
preventive fixes
Infrastructure-wide historical analysis for targeted reporting to management and exec –
trend analysis
Customizable thresholds to ensure we meet the highest level of standards
The Solution: Unified-Citrix Performance Management
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Benefits for SCHS IT – both proactive and reactive monitoring
Proactive:
Alerts for potential issues with Provisioning Servers
Identify and fix problems as they occur, across all tiers, before caregivers experience
slowness/downtime
Reactive:
Unified monitoring yielded a 50% improvement in caregivers’ login times soon after
deployment.
Detailed executive reporting and historical analysis are used for sharing performance
improvements.
Patient satisfaction is high when clinical systems/applications are performing well.
The Solution: Unified-Citrix Performance Management
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Future Impact for SCHS
Infrastructure-wide historical data
creates opportunity for new IT
initiatives.
Future plans for expanding
Unified coverage using SCOM
connectors
Future plans to provide more real-
time status on health systems to
Service Desk
The Solution: Unified-Citrix Performance Management
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Overview: Unified-Citrix Performance Management from eG Innovations
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A Real-World Example
08:00User to the helpdesk – “my application access is very slow. I am not able to work properly.”
8:00AM
Helpdesk
We will get on it
right away!
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A Real-World Example
08:00 Helpdesk receives a call that application access is slow
09:00Helpdesk has received many calls that application access is slow. The Citrix admin is called to look at the issue.
11:00The Citrix admin has reviewed Director/EdgeSight metrics, has killed the offending process. But user complaints persist.
12:00The Citrix admin decides to reboot the server but the problem persists even after the reboot.
13:00The problem does not appear to be specific to Citrix. The Citrix admin calls for a conference call with the other administrators …
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What Follows … Citrix Director / EdgeSight
VMware VCOPS - Virtual
Task Manager - Windows
Event Viewer - Windows
EMC Ionix - Storage Cisco UCS Manager - Hardware
CiscoWorks - Network
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eG Enterprise – How does it help?
Network Web on
XenServer
Active DirectorySQL
ZDC on
VMware ESX
License Server
Profile Server
Enterprise
Apps
vCenterOracle
Client
SAN
Switch
Complete visibility – every layer, every tier!
“My
application is
slow!”
XenApp on
VMware ESX
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Automated Diagnosis
User Experience Management
Right-Sizing & Capacity Planning
Pre-emptive Alerting
TotalPerformance
Visibility
End UserExperience
Storage
Connection Brokers
Profile Servers
Network
Applications
Virtualization
Infrastructure& App Performance
ServicePerformance
Online Banking
Accounting
Trading
Patient records
. . .
eG Enterprise
Overview: Unified-Citrix Performance Management from eG Innovations
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Real-World Example - Revisited
06:30The helpdesk receives an automatic alert saying that access to Ctirix is slowing down. No user has been impacted yet.
6:30AM
Helpdesk
This looks odd. Let’s get to the bottom of this before users start calling …
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Triage Problems Quickly
The application that is responsible for the slow down – a samba backup
job
6:35AM
Helpdesk
Yup, the backup job is taking up resources
…
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Focus on the Root-Cause, Not EffectsWithout root-cause diagnosis, you have no idea where the problem lies
With root-cause diagnosis, you have a clear idea of what to do to resolve the problem.
All the problems
appear to be equally
important.
The root-cause
of the problem
The effects of
the problem
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The Result
06:30 The helpdesk seels an alert of a slowdown with Citrix access.
06:35The helpdesk reviews the service topology and determines that there is an issue on the VMware server. Contacts the VM administrator.
06:45The VMware administrator realizes that the backup job is impacting the user experience. Reschedules the backup job for later in the evening.
Citrix Performance Management Made
Rap
id a
nd
au
tom
ated
d
iagn
osi
s
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Why eG Innovations?
• Total visibility into the Citrix platform and all external
network/ process bottlenecks impacting performance for
caregivers: network, applications, storage, and databases.
• Accelerated discovery and diagnosis of performance
issues in virtualized applications.
• Single, scalable solution for all performance monitoring
needs, across all physical and virtual tiers.
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Q&A
Beyond Monitoring:Leveraging Unified IT Performance Management for Patient Care and
Satisfaction
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Thank You!
Beyond Monitoring:Leveraging Unified IT Performance Management for Patient Care and
Satisfaction