Universal Health Services Troubleshoots End-User Experience Issues at Their Hospitals

Justin Monnig“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 & 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 of Crossings Healthcare Solutions, a subsidiary of Universal Health Services, Inc. 

Infrastructure:  Citrix XenApp, Citrix XenServer and VMware

Performance Monitoring Products: Goliath Performance Monitor for Hospitals Using Cerner, Goliath Logon Simulator for Citrix, Goliath for NetScaler

The Business Challenge

UHS, one of the ten largest healthcare management organizations in the United States, was faced with session performance-related issues when physicians and healthcare workers used XenApp delivered applications hosted by Cerner.

Due to the factors detailed below, pinpointing and resolving their issues was especially challenging:

  1. There were no real-time performance metrics accessible from the underlying Citrix XenApp delivery infrastructure components.
  2. Limitations in visibility were not isolated to just the XenApp servers. There was a significant lack of insight into Citrix ICA/HDX sessions.

These issues presented barriers to UHS solving their end-user experience challenges. The fact that Cerner was seeing everything performing correctly from an application standpoint meant that the issue was occurring somewhere between the application and the user. Without having visibility directly into sessions or ICA/HDX, it was difficult for the UHS IT team to ascertain whether the issues were symptoms of network-related problems.  They also lacked visibility into the XenApp servers, which limited the extent of their insight into the delivery infrastructure. In short, they were blind to the entire scope of where the root cause would be found.

The Solution

Goliath Technologies had been used by UHS Corporate to monitor and manage their Citrix environment for several years, so the Cerner team at UHS quickly identified Goliath Technologies as the vendor to help them overcome their challenges. They knew Goliath’s suite of technologies provides complete end to end visibility to the entire Citrix user experience from the connection through the whole delivery infrastructure.  While the data and metrics provided by Goliath’s technology alone set it apart from other tools, the major differentiator for UHS was that the Intelligent Agent could be deployed on the XenApp servers hosted at Cerner’s Kansas City datacenter. Then, the Goliath Application Availability Monitor was configured at each remote hospital location to test and confirm applications would launch. This meant for the first time, the entire Citrix workflow could be analyzed end to end. Furthermore, the data and metrics gathered could be used for proactive alerts and historical reporting.

UHS Proactive Deployment Architecture

For the purposes of this blog post, I will focus on the benefits of having the Intelligent Agents deployed in the Kansas City Data Center. For more on the Goliath Application Availability Monitor for Cerner Hospitals please see the blog post dedicated to this specific use case.

By having Goliath installed across their entire environment’s XenApp infrastructure and hospital locations, administrators were furnished 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 that could impact end-user performance.
  • Have a real-time view of the entire delivery infrastructure from a single pane of glass to pinpoint and correlate root cause.

ICA/HDX Performance

Goliath Performance Monitor 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. This is done by differentiating network latency from ICA latency, and then correlating the metrics to ICA round trip time. Also, by drilling deeper into each session, the UHS team was also able to view the activity of each session and see how each of the 50 individual HDX channels impacted user sessions.

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 data needed to resolve them quickly.

Below is the user session display used for troubleshooting session performance issues.

Cerner session display

ICA/HDX Performance

Goliath Performance Monitor 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. This is done by differentiating network latency from ICA latency, and then correlating the metrics to ICA round trip time. Also, by drilling deeper into each session, the UHS team was also able to view the activity of each session and see how each of the 50 individual HDX channels impacted user sessions.

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 data needed to resolve them quickly.

Below is the user session display used for troubleshooting session performance issues.

XenApp Server Performance & Errors

By leveraging the Goliath Intelligent Agent on the Cerner XenApp servers, the UHS team gained both real-time and historical insight into server performance and activity. This provided them with the ability to see and understand when server side issues occurred.

After gaining an understanding of what conditions impacted user experience and how each correlated to problems, the UHS team used their observations to create threshold based alerts. The alerts enabled them to become aware of server side issues before the user community was impacted (See image below on how alerts also can be displayed within the user session display showing).

In addition to being leveraged for creating alerts, the server metrics gathered by Goliath were also put to work in the form of historical reports. These reports proved to be invaluable as the information could then be used for collaborating with application owners to address root cause.

Cerner session display

XenApp Server Error Report

The final piece to having a complete solution was a single view of the entire delivery infrastructure. The goal was to have complete perspective for identifying session issues and correlating them to the network, infrastructure, or XenApp server immediately upon receiving notification. This was accomplished by leveraging the real-time performance graphs available out-of-the-box in Goliath Performance Monitor.

The UHS team configured a fully customized dashboard to view the entire delivery infrastructure end to end. Logon, statistics, ICA latency, server performance, and application load could all be viewed on one screen, empowering the support team to quickly identify and drill into the root cause of session problems as they occurred.

Below is an example of the real-time dashboard configured by UHS.

Cerner session display

The Summary

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 it also gave them the ability to proactively identify and address the issues before they impacted productivity. This was accomplished by leveraging network and ICA channel visibility, proactive alerting, historical reporting, and real-time dashboards.

Click here to get a fully supported 30-day free trial or demo of Goliath for Hospitals Using Citrix & Cerner.

Additional References

 

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