If it’s not ransomware dominating the healthcare IT news outlets over the last two years, it is the nightmare stories of health systems that are subject to sudden VMware and Citrix licensing cost increases – sometimes upward of 1000%. In some cases, the vendors have even sued their own customers, as seen here.
The entire application delivery and virtualization landscape changed when Citrix was acquired by Vista Equity Partners and Evergreen Coast Capital in early 2022. Later in 2023, VMware was purchased by Broadcom, who spun off VMware’s Horizon App Delivery solution rebranded as Omnissa.
As we’ve seen across industries, acquisitions – whether by equity partners like Vista and Evergreen or large corporations like Broadcom – often bring about changes in strategic priorities, operating models, and long-term vision. While these shifts can introduce efficiencies or new innovations, they can also lead to a greater focus on profitability, sometimes at the expense of customers.
The focus shifts to margins and away from customer success. This has become evident with Citrix and VMware as they have not only drastically increased licensing costs, while reducing support staff and quality, but in some cases even suing their customers.
These price hikes are weighing heavy on hospitals who depend highly on Citrix and VMware application delivery technologies, which make up roughly 40% of their Epic infrastructure and licensing footprint. Health systems often pay tens of millions of dollars per year for these solutions to deliver Epic to their clinicians. Now health systems are facing ridiculous cost increases while they are already operating at a 2%, or even negative, margin.
Simply put, the two largest application delivery and virtualization vendors are negatively impacting the way health systems can provide patient care.
Traditionally, health systems only had two options for delivering the Epic application to their providers – Citrix or Horizon. Over the last 18 months, emerging technologies have entered the fold, giving health systems a way out of the pigeonhole they’ve been forced into with unexpected licensing cost increases.
I will briefly cover the three most popular alternatives that are being explored and tested by a large portion of the Epic community – Epic Hyperdrive deployed on endpoints, Island, and Azure Virtual Desktop.
Epic Hyperdrive
Epic has long been built on the values of customer support and customer relationships. They lead with what they believe is right for their customers and will often adjust their software or build new modules to help their customers solve common issues.
Epic has recently refactored their application to become more latency tolerant, enabling it to be installed directly on users’ endpoint devices rather than the traditional application delivery architecture that requires a large amount of infrastructure and corresponding Citrix or VMware licenses.
The shift to deploying Epic’s Hyperdrive application on endpoints has become increasingly popular across the Epic community as it has given health systems a quick, proven solution to reduce their Citrix and VMware licensing dependency.
The deployment model that has been proven by many Epic health systems also does not require upskilling or investment in new technologies as it leverages existing configuration management toolsets that the organization likely already has in place today and can also be managed through Epic’s Kuiper management module.
It is important to note that deploying Hyperdrive on endpoints does not completely eliminate the need for third-party solutions as Hyperdrive should not be installed on unmanaged devices for users accessing Epic from an external network.
Island
Island is an emerging technology in the Epic space that has quickly caught the attention of both Epic and Epic customers for its ability to fully replace Citrix and Horizon, while also adding features that go above and beyond what any application delivery technology can provide today.
Labeled as “The Enterprise Browser”, Island has taken the traditional application delivery architecture and decentralized the management plane to make configuration management and reporting more streamlined. And, as “The Enterprise Browser”, Island is deployed to the end user the same way a browser, like Google Chrome, is. Meaning it does not require the mass amount of compute and storage infrastructure that Citrix and VMware do, nor does it require unaffordable licensing.
Island is deployed very quickly to endpoint devices using existing software configuration management tools. Once it is deployed, it is administered through the Island management portal accessed via URL.
A user simply launches their Island browser from an internal or external device registered within the health system’s Island tenant, and the list of the applications to which they have access is immediately available to them with their customized browser settings and at the last screen they were on before they signed out.
The management portal provides admins with access to configuration and management features that are not available with legacy application delivery technologies such as real-time screen rendering to block sensitive patient data to certain user profiles, watermarks with QR codes to protect screen captures on kiosks, forensics modules to help security teams trace bad actors, and reporting to detect invalid certificates or login attempts plus much more.
The speed at which Island is deployed, simplified management, additional security features, minimal to no infrastructure investment, and a complete replacement of Citrix and Horizon application delivery infrastructure and licensing make it an extremely attractive option for health systems’ Epic and non-Epic applications.
Epic has not publicly announced Island as an exploratory platform, however both organizations are working closely to test Island for Epic Hyperdrive.
Azure Virtual Desktop
Microsoft created a native application delivery solution called Azure Virtual Desktop (AVD), which has become a popular alternative that Epic health systems are testing as a replacement for Citrix or Horizon.
Although the architecture is like traditional application delivery solutions, AVD is an attractive solution as it eliminates customers’ needs for Citrix or Horizon licensing drastically reducing the total cost of ownership to run Epic in the cloud.
It still requires virtual machines acting as session hosts to support the Epic Hyperdrive application, so it does not eliminate the application delivery infrastructure, but health systems often benefit from the consumption discounting that they already have in place with Microsoft plus their existing licensing contracts with Microsoft that often include AVD. This makes it much more financially attractive compared to Citrix and VMware.
Because Azure Virtual Desktop is a native Azure service, it provides health systems with support advantages, reduces third-party complexity and simplifies management.
While AVD has been Generally Available from Microsoft for multiple years, it is still an Epic exploratory platform as it is not widely adopted in a production setting and requires careful testing.
As Citrix and Omnissa push their customers away, these other three companies are doing right by their customers to develop cost-effective alternative solutions with feature parity, or, in some cases, feature enhancement. Those are the companies that customers want to partner with.
Epic is working tirelessly with their customers, Microsoft and Island to validate these solutions, and I hope to see them as target platform soon so all health systems can stop focusing on their bill and instead focus on delivering the best patient care possible.
We are working with several health systems to find immediate application delivery alternatives that also align to their long-term vision. If you need assistance with creating a roadmap to displace legacy application delivery technologies or need help implementing your roadmap, please reach out to EHC Consulting.
