Universal Health Services, Inc. Case Study:
Proactively Ensure Cerner Millennium & Citrix Availability for End Users

“My experience with Goliath Technologies goes back several years from my time at UHS. They have the only solution of this kind that combines the ability to preemptively alert us if clinicians will have difficulty when attempting to access Citrix and Cerner. This provides us with an early warning system that is better than real time and is one of the reasons we selected Goliath as a partner.”
-Justin Monnig | General Manager, Crossings Healthcare

Summary of the Problem

Universal Health Services, Inc. (UHS), one of the ten largest healthcare management organizations in the United States, was faced with physicians and healthcare workers experiencing access and usability issues when using Citrix-delivered applications hosted by Cerner. Due to the factors detailed below, pinpointing and resolving end user issues was especially challenging:

  1. There was no way to proactively anticipate if end users would have an issue with access or performance before they arrived at the hospital and attempted to use the application.
  2. There was no end-to-end visibility from the end user located at the hospital to the Citrix delivery infrastructure in the Cerner data center. For example, no real-time performance metrics were accessible from the underlying Citrix XenApp delivery infrastructure components that impact end user experience.

UHS Proactive Deployment Architecture

The Solution

The first issue to be solved was really the most challenging – to preemptively identify physician and healthcare worker access and usability issues before they happened. Goliath developed the Goliath Application Availability Monitor which was deployed at over 30 acute care facilities across the United States. The technology, or the Goliath User deployed at the hospital, automatically logs on to Cerner Millennium continually 24/7/365 to confirm that applications are available.

Because the Goliath User takes the same sequence of steps that the actual end user takes, it tests the entire Citrix delivery infrastructure and can detect if any IT delivery element is faulty. Then, if there is an issue, it sends an alert in real time to the IT administrator so they can fix the issues before end users are impacted.

Upon logging into the Cerner application delivery environment, Goliath Application Availability Monitor launches five Cerner applications (PowerChart, Firstnet, SurgiNet, SAAnesthesia, and Pharmacy Med Manager). Launching these applications not only validates the availability of the programs, but it also exercises the entire logon initiation process which ensures that all components are available and operating efficiently end to end. On a daily basis UHS IT performs over 15,000 Cerner application logon tests. These tests enable UHS to pinpoint and isolate availability issues before users are impacted, regardless of location.

Pictured Below: The Goliath User validating the launches of Cerner applications with launch time metrics and stage-by-stage breakdowns of success and failure.

The second issue to be solved was to obtain visibility end to end – from the end user into the Cerner data center where most of the end user experience and Citrix metrics needed for troubleshooting reside. Goliath intelligent agents were installed in the Cerner data center on the UHS Citrix servers. This, coupled with deploying to the IT infrastructure at hospital locations, furnished administrators with the actionable intelligence they needed to accomplish the following:

  • Identify users who may be experiencing poor performance by analyzing ICA latency, ICA/HDX channel performance, network latency, round trip time (RTT), and connection speed/performance.
  • Identify server and application performance bottlenecks impacting end user performance.
  • Have a real-time view of the entire delivery infrastructure from a single pane of glass to pinpoint and isolate root cause.

Goliath Performance Monitor for hospitals using Cerner allowed administrators to view user sessions in real time and historically. The session view provided critical information for identifying if session performance issues were network related or session related. These capabilities proved to be invaluable as many of the session performance issues were related to network problems on the UHS side. This data pinpointed the exact cause and provided UHS with the guidance needed to resolve them quickly.

The Results

Goliath Performance Monitor for hospitals with Cerner gave UHS insight into the delivery infrastructure that was needed to not only resolve end user session challenges, but also identify and address the issues before they impacted physicians and healthcare workers.



The team members collaborated to bring together this blog post by calling on their past Customer Experiences and Expert Knowledge of Citrix Troubleshooting. Beyond writing technical documents this team supports Goliath Customers and provides product feature/function guidance to development.

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