March 26, 2020

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March 25, 2020: Today on the show, we welcome John Shelsta of AvoCon Solutions. AvoCon is an Information Technology Service Provider specializing in Enterprise computing environments utilizing Microsoft, Citrix, and VMWare technologies. Headquartered in Phoenix, AZ they have been servicing the southwest region of the United States since 2000. With so many health IT organizations being pushed into the uncharted terrain of full-scale remote work, there are many challenges they are currently facing and are still to face in the future. In this episode, we discuss the process of migration to the cloud for health organizations and what this transition looks under the unique circumstances we find ourselves in today. John highlights the top mistakes he sees many organizations making, as well as the incredible tools and resources available to help them mitigate these. We also take a look specifically at Citrix Cloud and its new Remote PC technology, other solutions for telecommunications migration, and the key role that group focus will play in these challenging times. Take a listen!

Key Points from This Episode:

  • Learn more about the Citrix Cloud and the shift toward Remote PC over this time.
  • Setting up HR and accounting staff to work remotely via a virtual delivery agent (VDA).
  • How the Citrix Remote PC technology works and their other methods for remote work.
  • How Corona Virus is accelerating the move to the cloud and forcing behaviors to change.
  • Will remote work and tele-visits take hold beyond the Corona Virus epidemic?
  • The top common mistakes organizations make when first migrating to the cloud.
  • The power of group focus and using it as a catalyst for speed and efficiency within health IT.
  • How companies may need to approach licensing when the Corona Virus pandemic is over.
  • The integral role telecommunications play in health IT and the difficulty with transitioning.

Coronavirus Series: Scaling Citrix Rapidly

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Coronavirus Series: Scaling Citrix Rapidly with John Shelsta

Episode 209: Transcript – March 25, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:07.5] BR: Welcome to This Week in Health IT with our continuing series on Corona Virus prep, we’ve moved from understanding the health IT problem set to really starting to look at solutions. My name is Bill Russel, healthcare CIO coach, creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

Before we get going, I want to give you three resources for health IT during this crisis, the first is for CIO’s. I’m currently helping my coaching clients by being a sounding board and advisor through this time. If you want to connect with me over the next couple of months to experience what coaching is like at no cost, shoot me a note, [email protected] For anyone in health IT who find themselves in uncharted territory, we want to crowdsource solutions with you and we’ve put together a team of seasoned professionals and we have setup two ways that you can do that.

We now have a Slack channel that is monitored by and supported by our sponsors and I’m really excited that our sponsors have stepped up here, StarBridge Advisers, Galen Healthcare, Health Lyrics, Pro-Talent Advisers, and me, Health Lyrics. Our Slack channel allows you to ask any questions you want answered around telehealth, around BDI, you know, whatever questions you have, we have a great team that’s sitting there who can respond to that.

If you want access to that and you’re with the health system, you need a health system email address, send a note to [email protected] and we’ll get you setup immediately. Now, some of you aren’t used to Slack and you, but you still want to participate in some way, our sponsors are also supporting an email channel, [email protected] If you just want to shoot an email over, it will get routed to an expert in the area of the question that you’re asking and one of the people from our sponsors will get back to you and be in a conversation around that.

I really want to thank our sponsors for stepping-up to provide these services to our listeners and the industry.


[0:01:55.6] BR: Now, on to our guest and I’m really excited to have John Shelsta with AvoCon. John was in the trenches with me when I was the CIO and he’s one of those guys that whenever I have a Citrix question, this is the person who I pick up the phone and call because we were in the trenches together, we stood up – how many – by the way, welcome to the show. I’m just jumping into it, sorry.


[0:02:20.2] JS: Thanks Bill, thanks for having me on.


[0:02:22.6] BR: How many BDI workstations did we set up over that timeframe? There was a lot.


[0:02:27.1] JS: 20,000.


[0:02:27.8] BR: Yeah, it was insane and we did that over a period of time, we were consolidating in the HER, we were doing app rationalization and we stood up the Citrix environment, it was – as well as badge in, badge out, we had a whole bunch of really fun stuff that we stood up. All right. We’re going to talk Citrix, are you ready to talk Citrix?


[0:02:51.9] JS: Every day of the week.


[0:02:54.1] BR: Every day of the week. Every day of your life. Yeah, you really do follow Citrix pretty well and stay up to – is Citrix doing anything special during this time for healthcare to sort of cope with this and to adjust with it?


[0:03:13.3] JS: Interesting times. Yes, the last two weeks they’ve been pushing a directive to go to Citrix cloud, if you are a previous Citrix customer or even if you weren’t, what they’re doing is they’re offering special terms for a short term. They’re offering the ability to move your workloads to Citrix cloud with using, if you don’t have app and desktop workloads already, or in the cloud somewhere, they’re looking at pushing them to their technology called Remote PC.


[0:03:51.5] BR: Is that going to be a heavy lift for – well actually, I’m getting into the second one. They’re offering some special deals around that, what do the special deals look like?


[0:04:00.1] JS: They’re deep discounts that surround a certain timeframe and it could be completely negotiable and what they’re doing is essentially they’re offering help to customers that need help getting their workforce remote. A lot of places were caught short with having the capacity to bring like 80 or 90% of their workload to be able to work remote from home. 


So, what they’re doing is they’re kind of stepping in and saying, “Hey, this is a special situation. During this situation, we will help you get setup in Citrix Cloud.” Even if the customer was already on Cloud, they’re offering this in Citrix Cloud, to be able to get your company setup and get your people working remotely.


[0:04:51.2] BR: Wow. What’s the lift here? We had clinical workstations, nothing really would change with that except for some clinicians are going home. So, we have to take that workload,  that those images and those applications that we virtualize and move them out into this cloud environment, is that a heavy lift?


[0:05:13.1] JS: It depends on the customer, some of the customers have mature cloud environments, and so it’s an easy shift over to Azure or Google or AWS and those workloads are being spun-up on demand wherever needed.


The thing about it is, there’s a lot of the clinicians that aren’t working from home, still going to the hospital, the clinic. What they’re looking at is helping like HR and accounting and all those other workloads that they haven’t accounted for, the hospital organization hasn’t accounted for, with being able to enable them to work from home.


[0:05:50.6] BR: Yeah, I’m thinking about this, we did the clinical setting pretty extensively. The other setting, we were, you know, we didn’t have all the applications setup because there was never a need for all those applications to really be set up. Yeah. I mean, is that a heavy lift? I would assume.


[0:06:12.2] JS: Actually, with the Remote PC, because typically, if you’re in a revenue operation center, someone that’s collecting money, all the application stack is on their PC at work. The Citrix technology of Remote PC, we just put the media A, the virtual delivery agent on that PC and then they have the exact same ability to go to the landing page where they can get any Citrix application and run their desktop remotely.


[0:06:45.7] BR: This is going to show how old I am, this is sort of like the old Timbuktu application we used to have, where you’re essentially looking – you’re working from your desktop.


[0:06:55.0] JS: Yup, it’s all delivered through the Citrix channel, you have the ability to span at across multiple desktops, you have the ability to plug in peripherals that you might need at the office and you’ve taken them home. Like the old PC Anywhere days, yeah.


[0:07:10.2] BR: Yeah, Timbuktu, PC Anywhere, yeah, that’s pretty interesting. Is this more lightweight though? I mean, you talk about the ICO protocol and those kinds of things. I assume that Citrix has a way to do that without just sucking up bandwidth.


[0:07:28.0] JS: Yeah, it follows the same protocol stack as any virtual desktop. You deliver the desktop stream through the ICO channel and it’s really tiny, 128, 256K. Depending on what that employee’s role is, really small.


[0:07:49.2] BR: It’s interesting. A lot of the scaling up has been around the business application switch, you know, there’s a lot of different ways that can do that. If they had a – give me the different ways, they can do that VDA which is a virtual desktop architecture, is that what you just said?


[0:08:10.6] JS: Virtual delivery agent.


[0:08:12.2] BR: Yeah, Citrix is great for acronyms by the way. Virtual delivery agent, that’s one way, what’s other ways that people are doing it?


[0:08:23.4] JS: Depending again on how mature the environment is, a lot of customers were lucky in that they had existing capacity in their app and desktop workload environment. On prem, servers, you know, the traditional way, server storage network, and we just turned up capacity there. Giving them the ability to do application, specific applications for users that are not in the clinical environment. HR, accounting, basically any application that way and then they deliver it through their existing on-prem workload.


A lot of customers already had their foot in the door with Azure or AWS, mostly, some Google. We ended up just taking their template of their current delivery and then making it available for that cloud worker. Citrix actually has a cool feature with AWS called Scale, where you can bring out DR environments up and down as needed. You’re not paying for the cloud delivery workload, if you’re not needing it. It’s not sitting there online consuming, processing in dollars.


[0:09:38.3] BR: It’s interesting because I want to talk futures here a little bit. You know, does this accelerate a move to the cloud in the future? Because all of a sudden, people had to scale all this stuff up and we had extenuating circumstances, you know. Before, you were there when we were trying to move to the cloud, and we had all sorts of push back. “Security in the cloud,” and you know, you name it. To be honest, what we were doing in 2011, it was, you know, a lot of, we didn’t have a choice of going to AWS and going to all the different stacks that were out there. We had to do some interesting things. 


Will this, moving forward – because I believe we’re going to see – tele-visits I think are going to take hold as a result to this. I think we’re going to see changed behaviors. Will remote work take a hold as a result – I’m not asking you that question because we can’t really predict that, will remote work take hold?


But I’ve just virtualized for – let’s 10-fold what it was yesterday and it’s now out in the cloud and it’s working. IT organizations have gotten the experience of moving it out there. The tools that are available, and quite frankly, in today’s day and age, how easy it is.


Do you think that some health IT organizations are going to sit back and go, “Wow, I really thought this was going to be harder than this?”


[0:11:02.3] JS: Yeah, I think they are going to, if they hadn’t already, if they had a small cloud presence, they’re going to realize how easy and scalable and moveable and resilient that it is and hopefully never pull back from it now.


[0:11:19.5] BR: What are some of the mistakes that you think people are going to make as they try to scale this up. Because I’m sure somebody’s listening to this and going, “It wasn’t easy!” What are some of the mistakes that people might make? 


[0:11:31.3] JS: The mistake is turning up too fast. Obviously, in a situation where let’s use AWS for example. There is a lot of painstaking effort that goes into image continuity. If you’re not starting from square one and trying to create a brand-new vanilla image, you want to use your testing image, you have to make sure that that converts over correctly and that you have a mature enough cloud environment to be able to scale that on like a moment’s notice, with a flip of a switch. 


Taking your current image and making sure that it works in Amazon is the hard part of all this. Issues with connectivity, to be able to get authentication, and a lot of hospital systems use Octa now, so you need to make sure that communication flow and transit is all there working before you even start turning this on. We’ve had a bunch of customers, even small ones, that have just decided to put up a thousand desktops in the cloud just to get people available.


[0:12:41.7] BR: Yeah, I am sorry I’m just laughing because I remember like getting the desktop right, we took a long time to get that desktop right and we had a past in dev environment. You know, we implemented best practices to move the stuff along but once we get that right and we thought, “Oh we’re good, we are going to scale.” Then we started scaling and realize, “Oh gosh we got latency, we’ve got bandwidth” because we were getting it from Texas to Vegas and other things. So, we learned a whole bunch of stuff, people just have to do that over the course of two weeks, but we essentially took nine months of really a lot. 


[0:13:21.1] JS: It is amazing when everybody is focused on it how fast that stuff comes together, you know? That is what we’ve seen in the last week is if you have every team, IP team in your corporation looking at it, it all gets done really fast. I am not saying it is perfect, but it is doable and it has come together. 


[0:13:41.8] BR: That is an interesting point, focus is an amazing catalyst within health IT because a lot of that time was, “Alright let’s go talk to the security team, make sure they’re okay. Let’s go talk to the legal team make sure the contracts are alright.” I have heard people saying, “Oh we got a contract done in an afternoon. We had our security team vet it within a couple of hours.” I was like those things people just don’t appreciate it in health IT. Those two things I just said are usually about two and a half to three months. 


[0:14:15.2] JS: Yep, exactly. 


[0:14:17.8] BR: It is unbelievable. Well, and the other thing is, absolutely, the challenge we had taking that much time but we had the luxury of time and you guys kept pushing back on me that my timelines are too short and how everybody is just dealing with it in a couple of weeks. But you know I am just picturing people going to a thousand and this thing is breaking. I mean when it breaks though, it breaks for everybody if you do it wrong.


[0:14:47.5] JS: Right, well the nice thing about Citrix cloud is you have, what they call resource zones, and you can turn them on and off as needed so that if you want to speed up AWS and try it out, you add it to your delivery groups, you know, not trying to get technical but you have resource and the resources available and if it is broken you just turn it off. So, that you can figure out what the problem is with it and that has been the trial and error every transition, every night, for the last two weeks of: 


“Hey is it available? What routes is it taking? How come it is much slower? Do we have domain controllers in the cloud that can authenticate us quickly? How can we get communication open to our multi-factor?” Whatever it is, whether it is Azure AD or Octo or something else, that’s the thing that happens after hours. We get that set up and we turn it on and figure out what is broken, get a couple hundred users, or try to get a few hundred users in there to try to test it. 


And once we see that communication stream, the transit that is broken we end up fixing it up on the spot or stopping the change. 


[0:16:03.8] BR: Yeah, so how much of this is common across different BDI environments? 


[0:16:09.1] JS: It is almost the same just with the dependencies and names and the exchange.


[0:16:14.7] BR: You don’t want to get in trouble with anyone for saying it is almost the same? But they really have started to converge. I mean if you look at Citrix BDI and you look at VMware’s BDI, I mean they’re mature stacks now.


[0:16:29.5] JS: Yep, and they are all available on the cloud so that all you needed to do is have your image ready and sign a contract and they start. You have the ability to get in and start building.


[0:16:42.5] BR: Is there anything people need to – this is the age-old question, which is licensing, right? You will get tired of me talk about licensing but the – are people going to be surprised? Because after this, after they get to a certain point in this then we are going to go back to normal then people are going to start to see licensing. Is there anything that should be considering, I mean not now, you want to get through the crisis but as they’re looking at it?


[0:17:11.3] JS: So, for the crisis period, Citrix is offering like we said the discounts and for a different period like when you sign up with Citrix Cloud it is usually for a three year or five-year term. They are offering 12-month, 13-month, I haven’t seen any shorter than that right now but they are offering that small term, and then that term is not renewable. So, when a year from now when hopefully this is all blown over, you have to renegotiate your deal with them. So, licensing is a big factor, but they are definitely coming up with some creative ideas to get people on board so. 


[0:17:53.7] BR: Yeah, get them onboard, get them used to the technology but also offering a service to healthcare by helping them ramp up, which otherwise they wouldn’t normally have been able to do. Are people doing this mostly on Prem or you are finding a lot of it on – 


[0:18:10.5] JS: There is a lot of it. So, before, if this last two weeks wouldn’t have happened, I would have said the majority of the Citrix customers across the United States are still on Prem but now because of this crisis, everybody is turning forward to the cloud because the expertise doesn’t need to be there to start up your cloud. 


The cloud is already pre-configured, you really need to come to the table with a URL and an entry point into your network. And you could be up and running granted that the image is the biggest thing that’s the problem but with this remote PC solution you could be up and running in probably two to three days. 


[0:18:54.2] BR: Yeah. 


[0:18:54.5] JS: Well that is your whole organization. 


[0:18:58.4] BR: Yeah and that is what we really needed in this situation. Well, you know my famous last question, what am I not asking that I should be asking about? 


[0:19:06.8] JS: Well, I mean you want to keep it all healthcare but a lot of the customers that have been turning up have phone systems that don’t transition to home workers. That is going to be another big point for you maintaining the ability for users to be productive at home is to look at the whole stack of what they need. Besides the virtual desktop it is communications. We have seen a lot of customers that have void related communications, they transition super easy almost like a blink of an eye.


With other customers that have antiquated phone systems and communication device, they are all stuck. People can work from home out of BDI and remote PC, but they also don’t have the ability to just pick up their phone and dial extension 10 and get their boss or whoever else they need to communicate with. So, a lot of this, the new technology like Zoom and Ring Central and other companies that integrate the whole communication stack together like phone, meetings, instant messenger, are ahead of the game right now. 


[0:20:26.5] BR: You know, it is interesting you bring up phones. I can’t think of anything that I left undone more than the phone system at St. Jo’s. I mean, we had a couple of phone systems. We were buying parts on eBay just to keep them running. I don’t say that with pride, I say that sort of as every year we would come to the budget cycle and you have to make choices and there was like the thing is running.


To tear a phone system out of a health system, I don’t think people realize that especially as it has been there for 20 years there is so much logic built into it and there is so much – you know the person who set it up retired 15 years ago and no one works on some of this stuff and there is all sorts of routes in there. So, you think, “Oh this is easy. Let us pull this out and drop and you know voice over IP solution and away we go,” but then you also have to think about the region. You have to think about disaster recovery. 


You have to think about all those things and every time I got a quote from a certain vendor on this, the numbers were so high that I am like the situation almost took care of itself. I am waiting for that cloud vendor who comes in and goes, “Yeah we’ll completely replace your on Prem. It looks like this,” void and away you go. 


But the vendor that I am talking about, which will remain nameless, people can figure out who it is. I mean they were trying to make money on the phones. They are making money on the software, one everything. It was so hard for me to make that decision to pull all of that stuff out.


[0:22:03.3] JS: It is interesting because a bunch of our customers that were smaller like small clinics there has been a few void companies that have come to the table and said the first two months are free, we’ll port all of your numbers, we’ll handle all the communication traffic, we’ll preorder numbers so that we can get you up and running right away, that we don’t have to wait for the term to port but on the scale of like St. Jo’s. We are talking a couple of hundred, maybe 500. 


[0:22:30.2] BR: Yeah. It is interesting. I should probably have somebody on who deals with those larger phone systems and just have a conversation. I think that will be interesting. John thanks for taking the time. It looks like you haven’t shaved, so it looks like you have been held up there for a while.


[0:22:43.4] JS: Yes, I am sheltering at home with no razor. 


[0:22:46.7] BR: Sheltering at home and probably doing as much work that you normally would do because you could do it all from your keyboard anyway. 


[0:22:54.7] JS: Yeah, I think we are averaging about 14 hours a day for the last two weeks. All the decisions get made during the day and then all the changes happen after 6 PM, so. 


[0:23:06.1] BR: Yeah, absolutely and I appreciate it. How can they reach you if they wanted to get a hold of you? 


[0:23:12.5] JS: Oh, the website is We do all sorts of BDI solutions not just Citrix and happy to help. 


[0:23:22.7] BR: Yeah, you do VMware as well and that is one of our sponsors. So, I probably should have mentioned that in the beginning, I mentioned it at the end, hopefully I won’t be in trouble. No, our vendors are great. They know that we are just highlighting certain things to help the industry, so they’re very appreciative. John, thanks for your time. I really appreciate it. 


[0:23:42.7] JS: Thanks Bill. 




[0:23:46.1] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisers, Galen Healthcare, Health Lyrics and Pro-Talent Advisers for choosing to invest in developing the next generation of health leaders. The show is a production of This Week in Health IT. For more great content, you can check out the website at or the YouTube channel. If you want to support the show, the best way to do that is to share with a peer however you do that, send them an email, send them a whatever, a DM, whatever you do that’s what you should do. 


We’ll be back again with more shows as this progresses. We will try to drop one a day until we flatten the curve. Thanks for listening. That is all for now.




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