1. Implementation Issues in Establishing VDI-Based Mobile Hospital Environment
During the implementation of the mobile hospital environment using VDI, several concerns arose regarding the design of fault-tolerant system architecture, the privacy and security of patient healthcare information, a mobile device management, the speed and seamlessness of the internal wireless network, the support of screen resolution of legacy clinical applications on tablet PCs, and user education. The followings described the major issues that were derived and resolved in more detail.
Regarding the design of fault-tolerant system architecture, high system availability and stability should be considered to enable the organization-wide adoption of the VDI system. The clustering architecture and dual implementation of servers were considered in our system.
Regarding the privacy and security for the protection of patient healthcare information, secure communication methods and institutional privacy policies should be developed. Technically, the system security was reinforced by employing transmission protocols such as PC-over-Internet protocol (PCoIP) and AD based authorization. We classified end-user groups into private and public users and restricted unauthorized user access to the VDI system with AD-based authorization technique. Demands for the use of the VDI system outside the hospital were issued and supported by allowing access through the VPN and the firewall. The authority was granted only to healthcare faculty in our hospital.
In addition, security concerns created mobile device management challenges. For efficient management, it was necessary to adopt a mobile device management (MDM) system that gave IT staff the ability to view and control all mobile devices.
The speed and seamlessness of the internal wireless network were frequently cited as requirements by the end users who accessed the VDI system using their mobile devices. Thus, the internal wireless network infrastructure should be thoroughly tested before launching a VDI system. Additionally, as the use of the VDI system grew more frequent, it was necessary to expand the access circuit to maintain the network speed.
Regarding the support of screen resolution of legacy clinical applications on tablet PC, during our implementation process, the initial VDI client program did not support the 1,024 × 768 resolution of our clinical application on the iPad and Galaxy Tab. Verification problems were discovered and resolved before launching the system. Finally, education was necessary for users to become familiar with the user interface of VDI client application, especially when using the system with iPad or Galaxy Tab. Efficient education methods and materials are likely to be a key success factor in system adoption. We utilized online and offline educational methods such as video materials and offline courses.
2. Patient Satisfaction Results
Seventeen patients and 18 patients' next-of-kin participated in the survey. Twelve (34.3%) survey participants were men and 23 (65.7%) were women. Eleven (31.4%) participants were aged 30-39 years, 5 (14.3%) were 40-49 years old, 8 (22.9%) were 50-59 years old, and 11 (31.4%) were 60 years or older. The participants were from the departments of pediatrics, cardiology, neurology, otolaryngology, rehabilitation medicine, pulmonology, and urology. shows the general demographic characters of the participants.
General demographic characteristics of the participants
Six questions about sufficiency of explanation, easy to understand, trustworthy, necessity, and satisfaction to mobile consultation service were classified as a single averaged variable labeled Patient Satisfaction by factor analysis (Cronbach's alpha, 0.8448).
shows the results of the survey, which displayed a "satisfied-level" degree of satisfaction, with average scores over 4 points across all categories. Analysis showed that patient satisfaction did not differ by gender, age, or specialty. A statistically significant difference in patient satisfaction was found between respondents of patients (mean, 4.2) and their next-of-kin (mean, 4.5; p = 0.0369).
Patient satisfaction and 3 influence variables
shows the results of a cross tabulation between patient satisfaction and the 3 influence variables. The results were statistically significant for all 3 items of influence at a level of significance of p < 0.05. The results revealed a significant positive relationship with the patients' decisions on revisiting the hospital and whether the use of VDI improved the brand image of the hospital (p < 0.05).
Cross tabulation of patient satisfaction and 3 influence variables
3. Physician Interview Results
According to the interviews with the 7 physicians who provided the mobile consultation service, the physicians found it useful to be able to explain the patient's progress and results while presenting visual information and, in particular, to be able to instantly check the patient's charts and answer the patient's questions.
However, the degree of physician's satisfaction with the VDI system seemed to differ greatly depending on the user's proficiency with the VDI applications and with iPad operation. In fact, some physicians expressed difficulties in using VDI applications with an iPad, for examples, double-clicking (for 3 physicians), setting up the network (for 4 physicians), and using the automatic screen rotation/hold functions (for 3 physicians). Additionally, concerns arose about the insufficient battery life of iPad and potential extended time of consultation.