To correct the problem, Concentra converted the Web application to a thin-client application using Citrix Systems' MetaFrame middleware. This way, the server would execute the client code rather than push it to the mobile devices. "It centralizes the application in the data center so that it's in one place instead of on every desktop and handheld," Wilson says. Only the screens and user input and output are sent between the Citrix server and the handheld, so it uses less bandwidth and requires upgrades only at the server.
The new applications for physical therapists and physicians now run in most of Concentra's 250 clinics across the country. Some 1,000 physicians and physical and occupational therapists use the applications in lieu of voice dictation and handwritten notes to document patient visits.
When a patient arrives for an appointment, for instance, his or her name appears on the doctor's handheld computer. The physician can pull up information about the reason for the visit (say, an injury from a fall off a forklift) and the patient's previous visit and treatment. That information is fed from a Sybase database that handles patient data.
The browser applications, collectively called ChartSource, run on a combination of Windows 2000 and Citrix MetaFrame NT servers in Concentra's Addison data center. Concentra's clinics have 56-Kbps frame relay connections to the data center. The MetaFrame thin client software helps minimize Concentra's frame relay WAN costs because it doesn't use much bandwidth, Wilson says.
Indeed, Concentra's wireless applications already have paid for themselves: Wilson says the company is saving about $3 million a year in transcription costs for physicians, which is about what it cost to develop the custom wireless applications.