[riceart]

> So, for example, one might operate the hospital's apps while sitting in the library at the affiliated university.

Remote Desktop and even PACS are not huge bandwidth consumers in this day and age of 4K streaming. At my large academic institution usually only the radiologists use the PACS client directly on workstations - all the other clinicians are using a “zero footprint” viewer over Citrix like everything else.

[inportb]

That "zero footprint" viewer over Citrix is susprisingly resource-intensive, even at 1080p with lossy compression. If everyone used it (say, if every workstation were a Citrix client), it quickly adds up. During peak hours, it positively chugs. Not sure if networking or compute is the bottleneck here. Perhaps you're right: some institutions have not caught up to this day and age of 4K streaming, and their pre-Netflix infrastructure is buckling under the weight of all these Citrix streams.