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Virtualized platform for apps, servers pays off for some healthcare providers

Migrating clients and servers to a virtualized platform can help health care providers cut support and maintenance costs, but such projects can take years to realize.

Emory Healthcare in Atlanta was something of a pioneer, at least in the health care industry, when it migrated its clients, then its servers onto Citrix System Inc.’s Xen virtualized platform several years ago. And, like most trailblazers, it faced more challenges than those that came after.

For one thing, hypervisors weren’t yet a commodity that most hardware vendors were offering for free, so the choice of computing platforms was limited, said Rick Aaron, director of healthcare virtualization at Emory. “We basically chose Citrix because [it was] the first virtualization vendor that our preferred blade server vendor supported.” Few other health care organizations had taken the server virtualization plunge, so Emory’s IT staff had to figure a lot of things out by trial and error.

Even so, the Citrix XenApp, Citrix’s virtual desktop application,  paid for itself in two years, through savings in desktop support, software maintenance and workstation lifecycle costs, Aaron said. “When a workstation breaks, we just plug in a new one and the applications are up and running in minutes.” The bottom line: “We’re spending $350,000 to $450,000 a year on desktop replacement, down from $1.2 million,” Aaron said.

Another major source of savings is being able to manage client applications and patches centrally, and to deploy updates automatically across thousands of workstations. Thus, the desktop administrative staff, which manages 10,500 devices and 14,000 internal customers, went from 24 to 19 employees.

Ensuring security and compliance for mobile devices also is easier, because nothing gets stored on them. “When a tablet or laptop is stolen, all they get is a piece of equipment -- no data,” Aaron said.

On the server side, virtualizing applications on Citrix’ XenServer platform has let Emory “carve up one blade into as many applications as we want to” and workflows that automatically allocate resources or move applications between blades as needed, said David Williams, Emory Healthcare’s Citrix architect. Virtualization hasn’t enabled the IT staff members to get rid of servers, but it has allowed them to support a rapidly growing body of applications without adding any, he explained.

Moving to virtualized platforms

Emory Healthcare is starting to have a lot of company. Health care organizations have lagged behind other regulated industries, such as financial services, but now a growing number of hospitals are moving to rationalize and virtualize their computing infrastructure, largely because they're overwhelmed by the number of applications with dedicated servers and storage boxes, and they “are outgrowing their data centers at alarming rates,” said Jack Wagner, executive consultant at Vitalize Consulting Solutions Inc. in Reading, Mass.

Hospitals keep adding new electronic medical records (EMRs) and clinical information systems, each of which could add another 15 to 20 servers to the data center, Wagner noted. In many cases, “they didn’t plan for that growth when they built their data centers,” he said, and can’t afford to build a new one. A virtual platform enables organizations to save money on server hardware, cooling equipment and energy, and it often frees up data center space, he added..

Take the case of Mount Sinai Medical Center in New York, where space and energy costs are at a premium. The center recently began virtualizing on servers from Palo Alto, Calif.-based VMware Inc. “We were running out of data center space and wanted to reduce our energy footprint,” said Andrew Pizzimenti, the center’s senior director of voice and data services. “We went from 500 to 700 servers one year; that’s not sustainable.” Furthermore, New York state’s power utility is offering funding to companies that can lower energy usage in their data centers.

An initial assessment of capacity utilization pinpointed a number of applications that were using only about 10% of their dedicated servers’ capacity, Pizzimenti said. Deploying VMware has enabled the medical center to consolidate at least 15 applications onto a single blade server, said Lynn Kasner Morgan, Mount Sinai’s vice president for IT.

Complexity, resource allocation challenges

Still, the virtualized platform is not without its challenges. Managing virtualized servers is “in some ways a lot easier, because you don’t have to physically move or touch them,” said Henry Escobar, Mount Sinai’s director of distributed network services. “But to get that extra flexibility [of resource allocation], you pay a price in complexity.”

Instead of each application having its own machine and dedicated storage, everyone depends on the same resources. This means Unix, storage area network and network support groups that were accustomed to managing independently must now communicate regularly to identify incipient problems before they become serious, Escobar noted. “That has required a change in attitude.”

Ensuring service levels across dozens of virtualized client applications also can be challenging, health care IT executives report.

When Emory’s IT team deployed Citrix XenApp, for instance, it discovered that some applications were resource hogs. “The EMR system worked fine,” Williams said, but multimedia applications, such as streaming video and even Microsoft Office could slow response time for everybody else on the  server.

Organizations also can get in trouble if too many -- or the wrong type of -- back-end systems share the same hardware box, Vitalize’s Wagner said. Web servers, application servers and front-end servers are generally good candidates for a virtualized platform, but a database server could wind up utilizing all available resources, he noted. Application vendors typically provide minimal hardware requirements for any virtualization platform they support, although the IT department should do its own baseline testing, he added. When will we be done with our virtualization project? Never.

Lynn Kasner Morgan, vice president for IT, Mount Sinai Medical Center

Complicating matters, some medical application vendors have resisted supporting any virtual platform. While such applications can still run in a virtual environment, IT sources expressed concern about potential vendor finger-pointing if something goes wrong. Also, nonsupport can make it hard to allocate resources between applications dynamically, said Simon Crosby, chief technology officer in the Citrix Data Center and Cloud Division.

“If an application is Web-enabled, it’s easy,” Crosby said, because the database and application are more or less decoupled. However, with a traditional, Windows-style back-end application, where the client processes chunks of the database in memory, it may not be possible to run additional copies of that application on a virtualized platform and still guarantee database consistency. “So, if you run out of horsepower for that application, you’ll have to buy another server,” he said.

Bridging the health care, virtualization gap

The good news is that virtualized platform vendors such as VMware and Citrix are actively working with leading health care application vendors to port their software over.

Indeed, the virtualization market has been catching up lately with the needs of customers, of health care organizations in as well as of health care organizations in particular, IT executives report.

For example, Emory is pilot-testing Citrix’s XenDesktop, which promises to pretty much solve the application resource-hog problem. The software “carves out virtual areas” with a set minimum capacity for each client, “so one user doing an email search doesn’t affect the other 49 users,” Aaron said. The product also enables desktop applications and profiles to roam with doctors and nurses making their rounds, so they can log into a different computer and continue exactly where they left off.

Still, a full-scale virtualized platform is a serious undertaking. It can take three to six months “if you want it done right, more if you have a lot of data and servers,” Vitalize’s Wagner said.

Then, more applications and features will have to be brought in, and performance fine-tuned. “When will we be done with our virtualization project?” asked Mount Sinai’s Morgan. “Never.”

Elisabeth Howritt is a contributing writer based in Waban, Mass. Let us know what you think about the story; email

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