A health care organization's server virtualization implementation should start small, with noncritical applications that do not affect patient care, suggested Todd Bruni, director of identity and configuration management at Christus Health in Irving, Texas. (In a related tip, Bruni and two other health IT professionals provide advice on developing a virtualized environment in a health care setting.
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Over time, the more advanced -- and consolidated -- an organization's virtual environment gets, the closer it gets to creating a private cloud.
That's what happened at Beth Israel Deaconess Medical Center. A few years ago, as part of an eClinicalWorks LLC electronic health record (EHR) deployment to roughly 200 affiliated ambulatory physicians, the hospital virtualized servers on VMware Inc. technology. One at a time, one virtual server -- including the EHR software integrated with a practice management app and billing system -- was deployed to each practice. The hospital originally considered building a server farm for the physicians, but opted for a virtualized model instead.
In those days before meaningful use, adopting an EHR system was optional -- so building a server farm would have been tantamount to constructing a grand hotel and risking low occupancy if, for example, only 50 physicians bought in, said Bill Gillis, eHealth technical director at Boston-based Beth Israel Deaconess. Virtualizing made it more like a housing development in which the hospital's IT staff built little houses as needed, he said.
A couple of years into the project, Beth Israel Deaconess realized it inadvertently had built the first -- or one of the first -- private clouds in health care, said Gillis with a laugh. As innovative as it was coincidental, the hospital's virtualized private cloud model has many attributes that are attractive to other health care networks looking for a model from which to crib their own EHR infrastructure: It's scalable but it doesn't require a huge hardware outlay or data center footprint at the start.
"Lo and behold, apparently we built a private cloud. At least that's what everybody told us," Gillis said. "We didn't go into this thinking, 'Hey, let's build a cloud.' It was, 'We want a subscription-type service,'" in which physicians could get rid of their homegrown technology and tap into Beth Israel Deaconess' infrastructure with only an Internet connection and their desktop machines.
Virtualization implementation, private cloud can enable HIE
Beth Israel Deaconess' server virtualization made good on some of its potential: for example, cutting energy costs and requiring a much smaller data center footprint than the physical server setup it replaced. At first, 200 physicians' worth of servers and storage area network hardware took up less than one full rack at a colocation facility. Now the cloud takes up two and a half racks, and is built to accommodate approximately 350 physicians by year's end.
If something happens -- whether it's a small or big disaster, we can swing this environment over to an off-site data center and be back up and running as usual.
Pacer Hibler, network engineer, New Hanover Regional Medical Center
Beth Israel Deaconess still is constrained by client requirements. Gillis said. For example, end users still need a minimal set of hardware and applications on their end. Ideally, the hospital also would like to deploy virtual desktops in a hardware-agnostic way so physicians could manage apps from their laptops, tablets and smartphones, without any hardware requirements. That could happen in the future. For now, IT staff are trying to make all the systems talk to each other.
"Interoperability is where [we are] steaming toward today," Gillis said, referring to the general movement in health IT to combine data from various proprietary systems into a patient -accessible EHR. Virtualization can help enable interoperability, which in turn can enable health information exchange (HIE) -- the holy grail of federal health IT authorities -- among hospitals across the country.
Beth Israel Deaconess' virtualization implementation will let physicians within its private cloud exchange data. That's the first step in the hospital network's HIE project, which eventually will extend outside its cloud to other area hospitals and later to the whole country.
"I'm talking about it as if it's easy," Gillis said. "Quite frankly, we've been working on it for a month or two, and it's probably the most complex clinical health information thing I've ever tried to achieve --more complex than building this cloud. There are so many moving parts, so many pieces that need to work and flow. It is challenging."
With server virtualization, little need for hardware configuration
Meanwhile, virtualization doesn't require a lot of hardware configuration when a user or application requires more memory or storage; it requires only the assignment of more virtual resources, pointed out Pacer Hibler, network engineer at New Hanover Regional Medical Center in Wilmington, N.C. Testing, customizing and adjusting become simpler -- and more forgiving -- than when you're working with physical servers. "You just have to trend your environment, watch your servers, and give and take as you need," he said.
Server virtualization helps compliance with Joint Commission requirements for disaster preparedness planning, said all those interviewed for this story. (Joint Commission accreditation qualifies hospitals to receive Medicare and Medicaid reimbursements.)
A virtualization implementation does not guarantee swift disaster recovery, it does make recreating a network from a remote location much faster -- spooling up a server per minute in Gillis' facility, for example, compared to hours or days to reconfigure a physical server on the exact same hardware.
"Our plan with virtualization," Hibler said, "is if something happens -- whether it's a small or big disaster, we can swing this environment over to an off-site data center and be back up and running as usual."
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