Internet Cure-All - Thin Client Computing

A six-year-old integrator with Internet know-how proves that you can beat the big guys by providing a flexible, low-cost solution.

As consolidation in the for-profit healthcare industry attracts the attention of the largest solutions integrators and consultants, an enormous opportunity exists for those integrators willing to serve the technology needs of smaller healthcare providers. Although the motive is profit for some ofthese small providers, many more want to invest in innovative applications that let them cut costs and remain solvent in an increasingly competitive healthcare environment.

New Internet-based applications and Web-enabled extensions of legacy systems are among the solutions these providers are most interested in, particularly those providers with distributed sites.

Take, for example, Community Memorial Healthcare (CMH) of Maxysville, KS. CMH is a small, rural health organization that serves a population spread across four cities in northeast Kansas. CMH operates a 49-bed hospital, six clinics, a rural health agency, a nursing home, a home health agency, a behavioral-health unit, an endowment foundation, and a fitness center.

CMH's infrastructure served it well until a very different kind of Year 2000 problem struck. Doug Easton, CMH's CFO, explains: "The product we were using to tie our systems together got axed when one large healthcare ISV bought another. We were told all support would cease on the first day of the year 2000. Migrating is hard enough when you're a big-city hospital system with a centralized campus and a budget to match. It's even tougher when you're a rural provider on a tight budget like CMH."

In a stroke of good timing, CMH won a grant to look into how to build the perfect rural healthcare, system. After studying its options, the CMH team concluded that it needed a hub system from which all of the healthcare information in the area could be serviced.

In addition to CMH, the system would service the county health records, the school health program, and other local health institutions. A key component of the plan would be to use the Internet as a lowcost network and NCs as clients to reduce administration costs.

Continuity Sells

Finding the right integrator to build this system was more challenging than Easton expected. Most firms that reviewed CMH's situation recommended scrapping the existing system and starting from scratch or converting all of the existing data into a proprietary format.

Eventually Easton received a direct-mail piece from Creative Healthcare Systems (CHS), a six-year-old integrator and ISV in Springfield, MO. CHS specializes in building solutions for rural healthcare providers using Sun Microsystems and Informix technology. Easton gave CHS a call.

"[CHS President] Steve Everest looked for ways we could use our existing network to get the job done," says Easton. "He showed us how he had designed his MedGenix software to use the Internet to connect distant offices for a very low feewhile maintaining the appropriate security."

"He demonstrated how all of our applications could be accessed from Java-based thin clients or PCs running a Web browser. And he showed how we could use an Informix database to keep all of our data in its existing format," says Easton.

Easton admits that he was concerned about trusting his IS future to a small firm with a fairly new product. He wasn't alone. "Some of my board members preferred a larger vendor with a more traditional client/server approach," he says. "But their solutions were much more expensive and less appropriate for our situation. And we'd been burned by a large vendor the last go-around."

Why Thin Clients?

"Customers like CMH grimace when you mention new technologies, because they dread upgrading 200 to 400 PCs," says CHS's Everest. "That prospect is so painful that they gridlock and make no decision at all. Using thin- technology eliminates this problem. We install thin clients and make updates on the server. The server then sends out screens that any NC or any PC equipped with a browser can view."

To minimize costs, CMH will keep most of its PCs and use them as Java workstations. CMH will purchase 15 of Sun's new $699 JavaStations from CHS. Each unit includes a built-in HotJava browser, a just-in-time Java compiler, and Sun's MicroSPARC processor.

More JavaStations will be purchased as needed. If all goes well, CMH expects that within a year it will have purchased an additional 45 to 55 JavaStations.

"The sort of rural hospital networks that CHS targets are just right for the thin-client, Web-centric approach," says Bruce Elder, worldwide healthcare-industry manager at Sun Microsystems. "You don't need an expensive support staff or high-speed connectivity. NCs are low-cost, easy-to-administer devices that can access every application the client wants to run-be it a Windows app, a Java applet, or some back-end mainframe."

Another requirement for CNN's new system was that it had to run Windows applications on the same thin clients used to run the Java applications. "Too many of my people have gotten to know and love applications like Microsoft Word," says Easton.

Everest's solution was to install an NT box on the same Ethernet backbone as the Sun server. The NT box runs Citrix Systems' WinFrame thin-client/server software. This allows users who have thin clients to run office automation apps like Word off of NT Server.

Another mission for the NT server is to run new transcription software from Medical Systems International of Kansas City, MO. Now long-distance calls to reach the transcription service are no longer necessary.

"The new system allows you to dictate off a PC connected to the NT server over the Internet," says Easton. "That means anyone can be provided with access to a month's worth of transcription services for the price of a $15 Internet subscription."

"There's a reason why the best solution for CMH came from a freshman reseller," says Elder. "The consolidation in healthcare is keeping many of the major players busy, allowing smaller organizations such as CHS to step up and provide the new technologies that CIOs are looking for. Thus CHS was able to take the job away from some of the biggest players in the game."