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Developing a virtualized environment no easy task in health care

Health care organizations are moving forward with server virtualization whether electronic health records (EHR) vendors are ready or not. In fact, many vendors aren't supporting

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a virtualized environment yet. Nevertheless, the technology offers so many benefits over physical servers -- from lowering hardware costs to facilitating systems interoperability and health information exchange, to faster disaster recovery -- that health care providers simply cannot wait for EHR software vendors to catch up.

Yet health care is a little different from other businesses, because of the life-and-death needs of patients and their caregivers. Virtualization helps build redundancy of resources into the network, while saving space and energy, said Pacer Hibler, network engineer at the New Hanover Regional Medical Center in Wilmington, N.C.

"In every decision we make in regards to virtualization … we think about whom we're impacting on the other end," Hibler said.

Most medical software vendors Hibler deals with are either supporting virtualization or planning to in the near future because they understand most hospitals will be doing it to relieve data center overload. "We're not trying to be a beta environment. … We can't just start throwing stuff into a virtualized environment," he said.

Hibler and two peers -- Todd Bruni, director of identity and configuration management at Christus Health in Irving, Texas; and Bill Gillis, eHealth technical director at Boston-based Beth Israel Deaconess Medical Center -- have advice for hospitals that are virtualizing their network servers in preparation for the great health IT expansion that EHR systems invariably bring.

This tip will help providers select the virtualization platform that best fits their needs. In a separate tip, the interviewees offer advice for taking things to the next level and using a virtualized environment as a private cloud.

Mixing and matching server virtualization vendors

Microsoft, VMware Inc. and Citrix Systems Inc. are the big players in server virtualization. Years ago, VMware was the standard, but a case can be made for using each vendor in certain situations, Bruni said. About 60% of the 2,500 servers in Christus Health, which runs 40 hospitals in six U.S. states and Mexico, are virtualized, he estimates.

What we've tried to do is say, "We're going to be a hypervisor-agnostic shop."

Todd Bruni, director of identity and configuration management, Christus Health

Network administrators run virtual environments with hypervisors, applications that allow multiple operating systems to run on a single piece of hardware. Free, feature-limited versions of hypervisors -- namely, Citrix XenServer, VMware vSphere Hypervisor and Microsoft's Hyper-V -- allow network administrators to experiment with configurations before they commit to the licensing fees required by the free versions' big brothers. Admins' needs vary from site to site: One might want the features of a particular hypervisor; another might prefer a different hypervisor based on its greater compatibility with the applications and operating systems it will control. Still others might want to base their decision on potential pricing once an environment outgrows the free hypervisor and its needs require licensing. Each hypervisor has its tradeoffs, so experimenting with the free ones helps an admin sort them out.

Some shops, including Hibler's and Bruni's, use both Citrix and VMware virtual server/hypervisor setups. Christus Health is looking into whether Hyper-V makes sense in certain applications. It all comes down to how well applications perform.

"What we've tried to do is say, 'We're going to be a hypervisor-agnostic shop,'" Bruni said. "We originally put our stake in the ground and said, 'VMware-only,' but we started finding out that not only do we have requirements, but … vendors [have] different hypervisor requirements."

For instance, some independent software vendors are pushing his organization to use Microsoft's Hyper-V instead of VMware, Bruni said. His team wants to build flexibility into the network to accommodate that best they can.

In the meantime, the hybrid model works well -- though it takes two groups of IT specialists to run it, and they don't always speak each other's language, Hibler said. "We're broken up into VMware teams and Citrix teams. Our VMware virtualization guys do not manage our Citrix virtualization and vice versa," he said.

How to plan for and expand a virtualized environment

So, how does one figure out what to virtualize and whether to create a single-vendor or hybrid setup? Patience is a virtue when it comes to virtualizing health care networks. Consult software vendors and find out whether an upcoming version of an application will support virtualization. Wait until the release to roll that app into your own virtualized environment, said Hibler, whose facility took several years to complete its 200-plus virtual server network.

Getting your EHR vendor at the planning table is "a prerequisite for the success" of any virtualization project, Bruni said.

If the vendor says it doesn't support server virtualization but offers a Software-as-a-Service choice among its product lines, talk to your contact and find out which virtualization platform the SaaS EHR uses. Odds are that platform will work best for your shop.

Some legacy software vendors might throw up their hands and say, "If it works, it works" in a virtualized environment, Hibler said. Chances are, however, your facility won't be relying on those apps for use in critical patient care, but, rather, to support critical apps.

Because different vendors' systems -- and their capabilities -- vary so widely, hospitals looking to consolidate and virtualize servers should hire outside help with the project, "so they're not constrained by their lack of knowledge," Gillis said.

Hospital IT leaders should seek out similarly sized peers n similar circumstances and ask them how they made the transition from physical to virtualized environments, Hibler advised. "When we went forward, we knew we weren't the only people trying to do this."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in January 2011

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