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March 25, 2020: For this episode in our COVID-19 series, we are joined by Josh Peacock and Kyle Quinby from Sirius Healthcare to talk about scaling VDI and clinical systems. We are shifting from understanding the problem set to more solution focussed content and Kyle and Josh have done some great work in addressing how to scale systems during a time of crisis. This episode is a pragmatic discussion on this process at present and in the coming weeks, as we look at connectivity in the cloud and allowing more people in health sector to work remotely. We get into the ins and outs of this transition and the steps that Sirius has taken to allow enough runway for these changes. With so many potential hurdles and potholes, it is great to see such dedicated minds applied to the current crisis! Listeners will hear about how they are creating more bandwidth, safeguarding against the dangers of VPN connectivity and leveraging the existing systems into something workable for current needs. We finish off the chat talking about the great resources that our guests and Sirius have made available and where to find them!

Key Points From This Episode:

  • The two prongs of cloud connectivity and enabling a remote workforce in the crisis.
  • Problem-solving in the VDI environment; allowing safe access to corporate networks.
  • How Sirius is ramping up for an increased customer load.
  • Coverage and software for different platforms on home computers. 
  • The multitude of challenges faced currently and allowing more bandwidth and runway for this. 
  • Clinical systems that need to allow for increased capacity at present. 
  • Leveraging existing systems and putting together the documentation for more capacity. 
  • Where to find the resources that Sirius has made available.

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health It. With our continuing series on Coronavirus Prep, uh, we've moved from understanding the health IT problems that the, uh, health systems are facing to looking at a set of solutions. My name is Bill Russell Healthcare. CI coach, creator of this week in Health. It has set podcasts.

Videos and collaboration events dedicated to developing the next generation of health leaders. Uh, before we get going, I want to give you three resources for those in health it during the crisis, uh, for CIOs. I'm currently helping my coaching clients walk through this as a sounding board and advisor through this time.

Uh, if you'd like to connect, connect with me over the next two months to experience coaching at no cost, shoot me a note at, or you can hit the website, uh, health Uh, for anyone in health it, two more resources for anyone in health, IT who finds themselves in uncharted territory and you want to crowdsource solutions.

With a team of seasoned professionals, as well as other health systems, uh, we've set up, uh, two ways to do that. We now have a Slack channel that is monitored and supported by our sponsors, who I am greatly, uh, appreciative of how they have stepped up VMware, Galen Healthcare, Sirius Healthcare, Starbridge advisors, and pro talent advisors, uh, as well as health lyrics.

I'm monitoring the channel as well. The Slack channel allows you to get your questions answered, things like, uh, can my telehealth scale? . Uh, we're having problems with VDI. What's the best telehealth solution? Uh, what's a good backup telehealth solution? Uh, which ones are you using for, uh, clinical versus, uh, business?

Um, you name it. Uh, that channel is designed for you. We launched that on, uh, Tuesday, yesterday. and, uh, we have gotten all the, uh, technical resources on it and the channel, uh, the glitches worked out. So we are good to go. Uh, if you want access to that, send a note to Slack at this week in health, and we will get you set up immediately.

You're gonna have to use your health system, uh, email address in order to do that, that's the only way we can verify that you're with a health system. We want to protect the, uh, integrity of the channel. Our sponsors are also supporting an email channel at, uh, support at this week in health And you can tell we're moving a little fast here, but it's support at this week in health

Uh, if you just wanna shoot an email over . Get it routed to an expert in your area from our group of sponsors. Uh, we will do that for you as well. Uh, I, I, again, I want to thank each of our sponsors for stepping up to provide these services to our listeners and the industry. Um, now we're going on to, uh, another, actually one of the first of a series of, uh, interviews I'm gonna be doing with, uh, technologists around what they, uh, are finding.

As they work with their clients and what solutions they're finding that are, are working. Uh, today I'm, I'm talking to two people from Sirius Healthcare. I'm talking to Josh Peacock, who is the Health Solutions, uh, architect, um, for, uh, for Sirius as well as Kyle Quimbee. I. And, uh, the two of them have been working on solutions to scale VDI and to scale the, uh, clinical settings within health systems.

And they have written some, some really good material and I'm looking forward to sharing that with you. Alright, we're joined, uh, today with Josh Peacock, the Health Solution architect for uh, Sirius and Kyle Solutions.

The conversation from really understanding the problem set. So we've talked to a lot of CIOs and they're saying things like, you know, scale my BDI environment, how do I ramp up? Uh, people working from all over the place. Uh, telehealth, obviously people are ramping that up and whatnot. And what I wanted to do was talk to people who are solving some of these problems to get really pragmatic and into the, uh, into the weeds.

And you two, they locked the two of you in a room and said, figure these things out. I love the fact that they, they gave me access to the two of you. Uh, what are the, what are the kind of things, Josh, we'll start with you. So what are the kind of things that you're working on, uh, in the lab right now for your clients?

Uh, well, some of it we really took what we learned, even what we talked about in the last podcast I was on with you around cloud connectivity and using the cloud as a, a way to use Dr.

Expand and certain components, the environment up into the a timeframe. And the other one, Kyle, with.

Awesome. Uh, all right, so let's break this down. We'll start with, um, we'll start with VDI. So we just sent a whole bunch of people home. Actually. We sent most of the workers home that we possibly could. I'm hearing people say, um, you know, scaling this stuff up. In order of magnitude, uh, which is just up until this point unheard of.

We would've never done a project this quickly. Um, so, you know, Kyle, what are some of the, what are some of the considerations as people are ramping up this VDI environment, sending people home, uh, getting them situated? What are, what are the kind of problems that you guys are, are looking at and trying to solve?

Sure. Uh, so a couple, um, number one is, uh, while we are looking at capacity security is a huge concern, right? Um, going home on the, uh, family PC that my kids have, uh, downloaded, who knows what to, and how to make sure that I can, you know, use that to get into an environment and. Um, we've been looking, you know, to leverage a lot of, uh, the existing, uh, VDI solutions and vendors that, that we know and love.

Um, we see a lot of customers trying to leverage VPN, which honestly can be a little bit risky, right? Uh, to just connect that, that home PC up to the corporate network. So we're really looking at, um, these VI solutions, uh, that can be allow those kind of endpoint, those unsecured endpoints to, uh, to get in securely.

Um, and the same time, you know. It's really gotta be easy for the end users. Um, it cannot be a lot of steps because at this point we just don't have the time to give everybody the white glove treatment, right? We gotta be able to give people in, um, really fast. For example, I just got off with a. Um, right before this, uh, this talk, um, that normally had a high watermark about four 50 users and yesterday had 4,500 users on their system.

Wow. Um, so that kind of ramping, just, you've gotta be, um, you gotta be able to scale it really, really quickly, and it's gotta be dead simple to, to get in place. Yeah, so, oh my gosh, you, you just, I have like a thousand questions now, so we'll try to make this a shorter podcast, but, uh, you know, my first question is, so you're connecting up AVPN, which would be the first thing that somebody would think, oh, well, we'll just connect up the v pn.

The problem is you have no idea where it's like, you have no idea where that computer's been, so you just can't connect it up. So you. Uh, an abstraction layer and this abstraction layer is delivering that VDI workstation down. Are you simplifying the, the application mix, um, of what you're actually delivering down?

Or are you trying to deliver a, a core desktop that has been sort of pre-thought out, uh, prior to this? Well, I mean, this is something Josh and I have been working with, and I think right now we're, we're looking at the minimum amount of applications to get the job done right. The less applications we have in the mix, the, the easier the challenges.

So a lot of what we've been focusing on is kind of the core EMR, uh, apps that are needed. To work effectively. So at the end of the day, we're just trying to support the folks that are on the front lines trying to take care of this. So the problem with VDI I is the challenge with VDI is, um, you know, you go from these workstations running all the applications, which is really simple when you think about it.

Everybody go, goes home and works on their own workstation, but essentially what you're doing is running the workstation in the data center, as all of our listeners would understand. How are you ramping up the equipment? Because most, most organizations weren't scaled up for 45. Ations prior to this, they were scaled to whatever their, their run rate was, which was, you know, plus or minus 20%.

So they were probably scaled to 600 workstations. Now all of a sudden they're at, you know, 4,500. Um, how did they burst that up? How did they ramp that up so quickly In the, in the data center? Yeah, so we're airdropping servers, um, as, no, we can't do that. So, uh, you know, some hospitals or some, you know, locations have additional capacity in their dr.

Um, some, in some cases they're required to by, by standards, and in some cases they're able to flex, right? Where let's take advantage of our DR capacity. Um, and in some cases that's enough to meet the demand. In some cases it's not, or they don't have that capacity in Dr. So at this point, a lot of hospitals are asking all of their workers to come in, right?

They're, they're just absolutely swamped. Um, so that's where the cloud comes in. Public cloud, um, both Azure and AWS, um, we're able to sort of take advantage of, that's the whole thing about public cloud, right, is to be able to flex, uh, and expand your capacity on demand. So this is almost like textbook, uh, how cloud suits the problem.

So in a lot of cases what we're doing is we're, we're hooking up, um, via VPN tunnel or existing connectivity options if they already have a presence in public cloud and connecting, um, virtual networks where we can spin these desktops up in the cloud and be able to traverse back to on-prem securely. And again, you know, securely, we wanna make sure we're not just opening things up or exposing, um, you know, records.

We're trying to do this as, as securely as possible. You know, one of the things I like is, uh, you guys sent me over some documents prior to this and, um, and Josh eventually I'm gonna ask you for, you know, where people can find these documents. So you're gonna wanna have the URL, uh, handy, but I, I'm looking at these documents and you made it so simple that ACIO can understand them.

And it's almost like a runbook or a, a recipe book for this is how you do it, this is how you're gonna scale out this in. Uh, you know, and that's the kind of stuff we need in a crisis. You don't need, uh, you know, these, you know, just really challenging, difficult things to scale up. Um, alright. Hey, so is there anything else, Kyle, is there anything I forgot to ask you?

'cause again, I'm ACIO I'm not as technical as you that I, that you guys are focused in on that I should be, uh, that I should have asked that I, I'm missing. I don't think so. I think, you know, you nailed it as ease of use, um, security. Um, and making sure that we're focused on the, the base apps that are needed to, to get the job done.

What's, and that's the way to get it done as quickly as humanly possible. So I'm sitting here on my Mac, you're gonna be able to run things on my Mac in this environment. Yeah. Mac, windows, Linux, there's pretty much, uh, endpoints or, or software for, for any number of, of endpoint devices because when you send that many people home, you really don't have control over, you know, what's, what's gonna be, uh, be used.

Uh, Josh, let's talk about scaling up these core applications. Um, obviously the most pressing one is the EHR and, uh, I imagine a whole bunch of use cases just. Uh, materialized overnight that people had not anticipated, uh, potentially no users grew potentially the, uh, the workload on those systems grew. Um, is, is that what you're finding?

Is that what you're hearing, uh, from your clients? Uh, what, what kind of challenges are they facing? Uh, definitely an exploration to make sure that they understand what their options are. Uh, one of the things we've seen is actually because of people staying home canceling s and.

Consumption of some of our clients', uh, environments. What we're also expecting is, you know, some of these really hard hit areas have to ramp up and increase bed counts. And maybe, you know, we're hearing that they're gonna be looking to bring back retired, uh, clinicians and other people from private practice and such.

We do expect that there might be an increase. And so what we were trying to do is just provide some options so that if they get into a whatever. The opportunity to opportunity expand internally and they, they need that extra capacity that we can provide something from a, you know, delivery of the EHR uh, core application.

So are, so if you came into my environment, I'm, uh, let's just take the, I, I assume Epic shop, I'm ramped up and all of a sudden my, uh, my utilization started to peak or, or, or go over. Is that the kind of thing we're talking about at this point? Yeah, we, we'd obviously like to have a little bit of ramp time to help you alongside that as you're seeing.

But, um, you know, some of the things that even ahead of time that you could be looking into to, to request, um, for example, ISPs, if you don't already have express routes or direct Connects or whatever to your preferred cloud vendors that are close. Um, asking your ISPs if there's a way that they can quickly turn up and.

Steps to help us start preparing for it. And then, you know, the team can come in and help address, uh, building out that environment in the cloud to scale up into and burst into. So again, if I'm an epic shop, most of my stuff is on-prem. I mean, I know there's, there's a bunch of hosted, but there's a lot of, on-prem, Kyle talked about utilizing, uh, DR.

Capabilities. Is that what you guys are, you're sort of tapping into that stuff in this. Oh, sorry. So part of what we would also see too, so our, our team like Kyle, is super busy helping organizations inside and outside of the healthcare industry right now. But, um, so the healthcare team has really been taking it to focus on kind of addressing the situation initially to see what we can help out with.

Uh, one of those would be, you know, if there's an organization, they're already active, active, they likely have 200% of capability between sites. If they're active, passive for Citrix in their, uh, environment, we can, you know, maybe help them spin up if there's not too much latency between, so there's a lot of things that we can help address before we even have to get to cloud.

Um, but the cloud does offer up as a, you know, an option at the end if we can't utilize stuff they have on the ground. And maybe even that's. Kyle and I been talking about how do we segment users so that maybe more business focused users have the more degraded performance environment. If you're too far away or a lot of latency, they can use that 'cause they can, they can handle that extra, um, de degradation in performance and then focus the clinical teams to have the stuff that's OnPrem.

Most valuable performance. So we're talking about the EHR. What other systems are you guys looking at? Uh, you know, what other, uh, clinical systems are you looking at that, uh, may see increased capacity as we sort of step into this? Uh, yeah, so we've been looking at a lot of, um, mostly the, the business side apps have been potentially like VDI options and some of that's new exploration for organizations 'cause they haven't had, um, true VDI I in the past.

Um, but most of it has been focused currently on EHRs just because that is what we have. Uh, it's the easiest and known most known quantity. We expand up into the cloud at this point in time. You know what's crazy? It's, I, I remember, so we were doing VDI and we stood up our first, uh, and we chose a small location.

We stood it up. And, uh, and we, we learned a lot of things, you know, virtualizing those applications, packaging them up, that, that whole thing, I think took about a three and a half, four months to really get that, that desktop solid. And then we started to work on scaling it. And I would say it took us some good six months or so to scale it effectively.

Uh, we, you know, we, we, a lot of things about latency, a lot of things about, uh, bandwidth and latency essentially. But, um, as we were sort of progressing, uh, we're doing that very rapidly. Now. Are there, are there, you know. How long does it take from the point that a client calls you and says, look, we need, we need to scale up our EHR, we need to scale up our VDI and we'll keep those two separate.

Um, how long does it take to that for them to get from where they're at to where they're going? Assuming, you know, they probably have some equipment they can scale to. They probably have some Dr. They can scale to. Um, but they, they, they may even need to go to a, a third tier, which is, you know, off offsite and those kind of things.

Um, so let's just start the question there, which is, how, how long does this usually take? Well, I, I'm gonna add one point quick too, is, is that we've been focused in on leveraging technology that they already have in place. 'cause we don't wanna put any extra load on the help desk or the teams that are trying to support this stuff too.

So we're, we're leveraging. Technology they already have in place, uh, as much as possible in the conversations, um, as far as deployment and, and those pieces. I'll actually let Kyle, uh, speak to those. Yeah, so this is, I mean, basically what we put together in the documentation that, that you were taking a look at is all about speed.

All right? Because we don't have time to, to waste here. So it is leveraging existing systems. So just to use Citrix as an example. We're treating like Azure or AWS as another resource location. So most of the work is taking the image that they already have that's been vetted. So you talked about, you know, taking several months to, to get an image really solid, um, to where you liked it and you could roll it out to your users.

We're not trying to reinvent the wheel there. Uh, in a lot of cases we can take the image that they already have on prem. Prep it for Azure AWS. Um, there's a pro, very documented process on how to get that ready and then we can put it out there and essentially spin up just like a stamp, stamp out, you know, a whole bunch more hosts and a whole bunch more resources using that image.

So in, in a, in that sense, it's already pre-vetted. It's already pre-baked. Um, we're just extending what they already had and eventually cloud bursting, right? Taking what they have and just giving them a lot more room because they can't get additional servers, uh, you know, shipped in. So we're, we're giving them the compute cycles, we're giving 'em the memory cycles, we're giving 'em the disk and we're, we're taking their image and just running it up there and just making sure we can backhaul that traffic, uh, over the network link.

So it's actually, uh, it's actually something where it's very short runway to go from, oh my gosh, I need help to, okay, we've got our resources up and running. Uh, we've got additional users, we've got additional capacity in the system. Yeah, I love, I love that it's, it's, this is the scene from Apollo, uh, Apollo 13, isn't it?

They, they locked you in a room. They dumped all this stuff down and said, okay, we're not gonna spin up new this. We're not gonna spin up new this with the equipment that's on site. As quickly as possible, how do we go from 450 users to 4,500 users? And that's the, that's the challenge. Josh. Where, where do they go to find these, these resources?

Uh, yeah, we'll be posting, um, so Sirius has a site that we're, um, supporting across industry, but we'll have an area that's specific to healthcare, um, around c Ovid 19. So we'll have that, uh, out and available. We'll get a link to you, bill, uh, to post along with it. All right. And I will, uh, and, and I will download those and put them up on the, uh, on the, this week Health this week in health it, uh, website.

We'll put it under the Covid 19 resources. You guys can, uh, get those things and then if they want to contact you guys, they can, uh, they can do that as well. Uh, what's the best way to get in touch with you guys? Or is there, is, is there a, a better way to get in touch with you than just going direct? I would assume there is.

Uh, you know, we'll take, I'll take a direct call. Anybody on the healthcare team. Also, I know your Slack channel that's opening up. We'll have that, uh, a couple of us staffed on that to help out answering questions too. Yeah, I appreciate that. So you guys are, you guys are manning the Slack channel as well, and, uh, so if you guys want access, uh, to these guys to uh, hit, hit them with a couple of questions and get some support, that's, uh, that's another way to do.

Guys, thanks. Thanks for taking the time. I know you're busy and I appreciate the work that you are, uh, that you're doing for the industry right now. And I look forward. Are you, are you in the process of thinking through another white paper that you're gonna be writing? We do have a few, oh, other ones that are in, uh, in flight being written up about different aspects.

Um, a lot of it about how we support, um, you know, different access methods as maybe we expand some of the, uh, um, testing and remote clinic capabilities as well too. Yeah, and, and I, I, I don't wanna give people the wrong impression, white paper. It was, uh, the thing I loved about it was it wasn't the normal white paper jargon.

It was really, uh, right to the point, uh, step by step, here's how you get from point A to point B. And, uh, I really appreciate you guys taking the time. Thanks. That's all for this week. Special thanks to our sponsors, VMware Starbridge advisors, Galen Healthcare health lyrics and pro talent advisors for choosing to invest.

In developing the next generation of health leaders, this show is a production of this week in Health. It. For more great content, you can check out our website this week,, or the YouTube channel. Uh, if you wanna support the show, best way to do that, share it with the peer, however you do that.

Send 'em an email, send 'em a whatever, dmm. Whatever you do, that's what you should do. We'll be back again with more shows as this progresses. Uh, we'll try to drop one a day. Uh, until we flatten the curve. Uh, thanks for listening. That's all for now.

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