“To us, interoperability means we’ve got to support whatever we put out there. Standardizing on how we’re going to make things talk to


each other—that’s probably the most important thing to us.” —Mike Freeman, Biomedical Device Integration Manager for Sentara


17 For providers who choose to virtualize EHRs to iOS United opted to develop its own iOS-based EHR app,


integrating NextGen Healthcare Information Systems, Inc. and Siemens AG EHR systems. The health interoperability piece—along with HIPAA-compliant iPad EHR security— was tricky, and the health system did it without vendor support. “We did not ask them,” for help, Rehman said,


“because we did not expect any.” His colleague and co-presenter, systems analyst


Rebecca Kennis, told SearchHealthIT.com that the thorniest health interoperability issue during the implementation process was configuring the pass-through server that takes data from practitioners’ iOS devices to the Siemens back-end Invision mainframe and storage servers.


Bridge the Mobile Health Gap


with Virtualization Of course, most health systems have neither the


in-house bandwidth nor expertise to create a custom iOS app for their EHR system. With outside custom application development costly, and security issues and HIPAA compliance intimidating, desktop virtualization is a popular method for iPad EHR implementation. Some hospital IT leaders have admittedly expressed


reservations about the performance and usability of EHR systems virtualized to iPads. But that situation is improving, said Ed Rodriguez, Director of Healthcare ISV Sales for Citrix Systems, Inc., one of the main iOS virtualization vendors. The primary interoperability issue Citrix attempts to


address, Rodriguez said, is making systems designed for Windows PCs—complete with mouse navigation and a user interface meant for large monitors—usable on small touchscreen devices. The Citrix virtualization products include software


development kit for vendors developing iOS applications as well as access scroll and zoom navigation features familiar to users of those touchscreen devices. Whenever these products are upgraded, Rodriguez said, Citrix aims to build in more and more iOS-friendly features.


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devices because of a lack of vendor support for the platform, or for internal reasons such as simpler security support, Rodriguez said Citrix promotes interoperability by building iOS native controls—such as finger-enabled pointers—into the end-user’s Receiver application. This application is the pipe through which the giant back-end healthcare applications such as EHR, radiology imaging and lab information systems that are virtualized, and where some iPad interoperability features can be added. “[At first we added] magnifying glasses to the touch


pointer, and then we started introducing ‘gestures,’ which are ways to emulate right-click mouse, left-click mouse, and double click—the ways you traditionally interact with a Windows system,” Rodriguez said. “That was kind of starting to get over the hump of usability.” The next step for Citrix is focusing development efforts


on XenApp Mobility Pack features that automatically detect which device the physician or nurse is using at the server level and enable native features in context, such as the familiar iOS touchscreen keyboard that pops up when the user touches a text box.


CONNECTION


VOLUME 2 • ISSUE 2


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