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SUNY Buffalo School of Dental Medicine

Thin Client Solution Gives Dental Students Real-Time, Patient-Side Access to Vital Clinical Systems
The School of Dental Medicine chose a Sun thin-client solution, provided by Oracle/Sun partner Delta Square, with smart-card technology to give students real-time access to electronic health records and clinical systems while working with patients.

Products and Services
 • Sun Ray 2FS Virtual Display Client
 • Sun Ray Software
 • VMware ESX
 • Windows XP
 • Solaris 10 Operating System

Story Details
At the University at Buffalo School of Dental Medicine, first- and second-year students receive most of their training in the classroom. Third- and fourth-year student dentists, under faculty supervision, begin seeing patients in a clinical setting at the school’s healthcare facility. Housed on three floors, the clinic has about 100 dental “operatories” on each floor. “Unlike some dental schools, we’re fortunate to be able to assign each student an individual dental operatory — essentially, an office for seeing patients. It’s as close as we can get to simulating a private practice,” says Gunther Kohn, Chief Information Officer at the School of Dental Medicine.

There were no computers in the operatories. Students and faculty used shared thin clients on each floor to access the electronic health record (EHR) system and to use the school’s own clinical information system (CIS) for tasks like recording patient progress, viewing x-rays, and scheduling appointments. “Not having access to these systems in the operatory made it difficult for students to access up-to-date patient information or record new information,” says Kohn. “Some things just can’t be done without having information available on the spot.” For example, during a root canal treatment, dentists take x-rays and record measurements throughout the procedure, so they need to be able to view x-rays in real time.

To give students real-time access to information in the operatories, the School of Dental Medicine wanted to add a point-of-care component to its CIS software, but physical space and support issues were major constraints. The operatories are small and counter space is limited, so whatever solution the school chose needed to have a small footprint and be easy for the school’s limited number of technicians to support. “Also, the clinic is considered a covered entity under the HIPAA regulations, so the solution needed to meet our privacy and security requirements,” says Kohn.

The school considered three options: PCs, blade computers, and thin clients. “We laid out all of the options on a matrix and started scoring them based on our criteria,” says Kohn. PCs, with onboard operating systems and applications, were too expensive to purchase and support. “We figured we would need to add between 3 and 15 full-time support technicians, depending on the complexity of the PC configuration,” says Kohn. “That just wasn’t an option for us; it was too cost-prohibitive.” The heat and noise output of PCs and their relatively large footprint were also limiting factors. The school briefly considered the idea of having students use their own laptop computers but quickly rejected that option because of lack of control of the systems and security concerns. And, after running a trial with blade computers, the school realized that hardware and licensing costs were too high to make that a viable option.

“Based on our general criteria, the thin-client solution scored the highest, so we met with several vendors to understand all the options and demo some hardware,” says Kohn. In January 2009, the school worked with Delta Square [www.deltasquare.com], a Sun Microsystems principal partner “To better understand the dental schools challenges, we had several discovery sessions with the customer's management and engineering teams and used that to design a demo system that could provide simple centralized management, and address caregiver mobility as well as security and HIPAA concerns,” says Vincent Catanzaro, Sr. Systems Architect at Delta Square. The demo equipment used several Sun Ray 2FS Virtual Display Clients and a Sun Fire T2000 server running the Solaris 10 Operating System and Sun Ray Software. The Sun Ray 2FS Virtual Display Client can drive two monitors, has an integrated smart-card reader, and includes a fiber optic port for enhanced network security. The Sun Ray Software acts as “connection broker,” providing authentication and encryption between the Sun Ray clients and the school’s VMware servers, which host the Windows desktops that students use to access the EHR and CIS systems.

“After evaluating several thin-client vendors, it became clear that the Sun solution offered certain advantages, such as hot-desk mobility,” says Kohn. This feature lets users move from one Sun Ray client to another and resume their desktop sessions. “Sometimes students need to consult a specialist on a different floor, so they pull their smart card out, walk upstairs, put their card into a Sun Ray client there, and everything’s exactly as they left it — they can continue working just as before. This is a huge advantage for both students and faculty.”
The School of Dental Medicine worked with the University at Buffalo security office to integrate the Sun smart-card features into the dental students’ school ID cards. Faculty members have a magnetic stripe on their ID cards that make two-factor authentication possible. “When a student needs a faculty member to approve, for example, the diagnostic quality of an x-ray, he or she can swipe the card right there in the operatory, without logging in, logging out, or even touching the keyboard,” says Kohn.

Smart cards also help the school meet HIPAA requirements. “When a smart card is removed from the Sun Ray client, the screen goes blank — there’s nothing left behind for anyone to see,” says Kohn. “We don’t really have a problem enforcing privacy rules because students and faculty have a vested interest in always having their smart cards with them and the hot-desking capability of the system makes it very easy to use.”
With the assistance of Delta Square engineers, the school began a pilot program in March 2009 and decided to purchase the Sun Ray client solution even before the pilot was completed. The solution was deployed in early August 2009, just in time for the beginning of the 2009-2010 school year. Kohn says the Sun Ray clients also have the ability to display streaming video, which the school plans to use for patient educational videos in the future.

“The Sun Ray clients made sense, were cost effective, met our security requirements, and were easy to manage and support,” says Kohn. In addition, they don’t put out the heat and noise of a PC, and they consume less than 10% of the power of an average PC. Because there is no resident operating system or applications, support technicians never have to perform onsite diagnostics or repair; they can just swap out the Sun Ray client. Delta Square and Sun continue to provide ongoing support and assistance.