How Hudson Cloud Systems Moved Touro Dental from Citrix and VMware to Azure AVD Without Disrupting a Single Clinic Day

By Behan Venter, CTO, Hudson Cloud Systems

Touro College of Dental Medicine was one of our earliest full-scale digital dentistry builds. We designed their original virtual desktop platform back in 2016, long before cloud desktops were ready for heavy imaging and clinical workloads. That first build carried them for years. The recent move from Citrix and VMware to Azure Virtual Desktop is the next chapter in the story, and it turned into one of the smoothest migrations we have ever executed.

The part I am most proud of is that the entire school kept working normally throughout the transition. Students logged in. Faculty tapped in. Clinics stayed open. No one had to rethink how they used their workstation. The technology changed underneath them, but their day did not.

Here is how we got there.

The Original 2016 Platform

When Touro Dental opened, cloud desktops were not yet practical for the kind of performance a dental school needed. So we built a private cloud in the TierPoint datacenter near the Hawthorne campus.

The environment included:

• EMC VxRail all-flash hyperconverged servers running the latest VMware and Virtual SAN

• NVIDIA M100 GPUs for graphics acceleration

• Citrix virtual desktops for both clinical and academic use

• HP Thin Clients running ThinOS

• A dedicated dark fiber connection between the datacenter and the school

• Imprivata tap-in authentication connected to Active Directory

At the time, this was a very modern setup. I had already been working with Citrix for close to twenty years, so we were able to tune the system for high-end imaging, radiology, and AxiUm. It performed reliably for a long time.

We had even hosted another healthcare customer, University Orthopedics, on a full Citrix VDI platform before Touro. That project also went smoothly. By 2016 our team understood how to build clinical VDI environments that simply worked.

Why We Started Planning for Azure AVD

Even while maintaining the Citrix environment, we were always watching the evolution of Azure Virtual Desktop. Each year it became more capable and better suited for production workloads. GPU performance increased. Identity options improved. Cost modeling became more predictable.

By the time Touro launched their Albuquerque campus, AVD was solid enough that we deployed that location directly in Azure with no need for on-prem servers.

The Hawthorne location needed a migration, and it had to be handled carefully. The school runs clinics every day and the workflows are sensitive to downtime or change. We knew the move to AVD had to be gradual and clean.

Rebuilding Hawthorne in Azure

We started by building the full Azure environment long before the cutover. This included:

• Hybrid identity integration with Active Directory and Entra

• A fresh AVD host pool layout for every role on campus

• GPU backed machines that outperformed the older M100s

• The entire application stack rebuilt in the cloud

• AxiUm, Jazz imaging sensors, Invivo, 3Shape, Formlabs, and everything else needed for both academic and clinical operations

• Imprivata tap and go behavior recreated in Azure

• New migration pipelines for personal files and profiles

It was a clean start that allowed us to improve performance while keeping the user experience familiar.

Switching Thin Clients to IGEL

We made a decision early on to standardize on IGEL OS for thin clients. IGEL gave us a much better AVD experience. It booted faster, handled authentication cleanly, and was easier to manage.

We partnered with IGEL during this process, and the rollout went very smoothly. All of the HP devices were flashed to IGEL in stages. The key detail is that users did not need to relearn anything. They tapped the same card, entered the same PIN, and landed in a desktop that looked exactly the way they expected.

A Slow, Predictable, Zero Stress Migration

We approached the transition in a very controlled way.

Pilot Group: We started with a small group of users to verify clinical workflows. They tested imaging, X-rays, AxiUm, scanning, 3D viewers, everything. Once we were confident everything behaved as expected, we expanded.

Simulation Lab: The simulation lab was the first major area to move to AVD. Students logged in using their usual Imprivata cards and were immediately productive.

Clinic by Clinic Migration: From there we migrated the Hawthorne campus one section at a time. For a while, both systems were running side by side. If a workstation had already been flashed to IGEL, it launched AVD. If not, it still connected to Citrix.

This parallel approach was the reason the migration felt invisible to users. They kept their personal files. They kept the same desktop layout. All the applications appeared in the same places. There was no retraining and no friction.

By the time we migrated the last clinic, the entire campus was using AVD without realizing the platform had changed underneath them.

The End Result

Once the migration was complete, we were able to retire the on-prem environment, decommission the VxRail cluster. Touro Dental now runs completely in Azure.

The updated platform gives them:

• Better performance for imaging and AxiUm

• No on-prem hardware to maintain

• Built in redundancy and resiliency

• The ability to scale quickly for new programs and growing class sizes

• A cleaner and more modern user experience

• Easier access from satellite clinics and remote locations

• No Citrix or VMWare licensing

• Secure remote access

This is the same cloud foundation that powers the Hudson Cloud Systems Cloud Portal across dental schools today.

The move from Citrix to AVD took time, careful planning, and a lot of validation, but the end result is exactly what we aim for in every major transition. A stable launch, familiar workflows, and no disruption to the work of teaching and treating patients.