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Not all health care applications are candidates for virtual systems

Can all health care applications run on virtual systems? Learn which clinical systems are not good candidates for virtualization, and find out how to evaluate others.

The one thing that many virtual systems advocates will try to tell you is that “everything” is a candidate for virtualization. There is no “one size fits all” in the health care applications environment. If such a thing existed, the health care CIO’s life would be pretty simple. He could buy any off-the-shelf system and plug and play.

Unfortunately, the reality is far different. In health care, there are a variety of dedicated clinical systems, often U.S. Food and Drug Administration-approved, which are simply outside the scope of a virtual environment for nontechnical reasons. Here are a few clinical systems that cannot be virtualized:

Picture archiving and communication system. Most PACS vendors do not support any type of virtual environment. In fact, it‘s almost impossible to get a PACS vendor to approve a storage area network farm outside the PACS environment, not to mention the thought of running a virtual system of any type.

There are no technical reasons for not virtualizing a PACS, but vendors will say the liability is too risky to support or allow a PACS to be virtualized. Their worry stems from possibility that a virtual system failure could affect what they refer to as a life-critical application.

Yet a PACS process is pretty straightforward: Capture the images from the imaging device. Ensure the integrity of the images. The radiologist approves the images and makes a diagnosis, or requests reimaging before making a diagnosis. Once the radiologist approves the image and makes a diagnosis, the images are stored in the database with the associated patient electronic health record. The PACS’ interface updates the EHR for the patient and the image, and the diagnostic data is now locked and cannot be deleted. Based on this process, a typical PACS could be a good candidate for virtualization.

I have never seen a PACS’ front-end image-capturing device virtualized. The image-capturing device is usually a high-end workstation that could be running a proprietary OS or Microsoft Windows. Its primary function is to capture the image from an imaging device (for example, a computed tomography, or CT, scan or x-ray) and send it across the network to the PACS server. The imaging-capturing device has a specific hardware connection to the imaging device, which makes it unable to be virtualized. These systems are FDA-approved and receive only a few OS updates over their lifetime. There is also no economic reason to pursue a virtual option for an image-capturing device.

Cardiac procedure system. I have never seen a system for the cardiac-angioplasty procedure approved for use with any type of virtualization. These systems are used to insert coronary stents inside arteries to open blockages. They are unique, single-task systems dedicated to one clinical procedure. The servers used for these procedures have databases on standalone disk farms running high-availability RAID. In addition, the front-end procedural PC has unique builds (also FDA-approved), and typically does not run any type of virus protection or auto-update procedure. No physician would want the PC front end deciding to auto-update and reboot itself in the middle of an angioplasty procedure.

There is no 'one size fits all' in the health care applications environment. If such a thing existed, the health care CIO’s life would be pretty simple.

Fetal monitoring system. Although it’s becoming more common to run these systems on standard PCs and laptops with standard Microsoft OS builds, their vendors are not running to push for virtualization -- mostly because of liability issues, not because of technical restrictions. A local PC monitoring system continuously watches a fetus’s vital signs during a prolonged labor, and a central, back-end monitor records the information to a database through the network. In the event of a network outage, the local PC monitoring system keeps the information and will update the server once network connectivity is restored. The audit logs for these systems are also important and become part of the EHR.

3-D imaging system. Three-dimensional imaging systems are relatively new -- the ones in our data center are completely proprietary. Because of their unique role, I don’t see 3-D systems making any virtualization progress in the near future. Such imaging is primarily used for delicate and critical, typically neurological, surgical procedures. Surgeons will study the various image captures from a 3-D system, and go over detailed measurements, sometimes working on the images over a period of days before a surgical procedure.

Surgeons access these systems from the operating room during a procedure, and therefore require them to have the highest-possible availability. Almost all the systems available on the market are vendor-managed. Even though they may reside in a computer room, the extent of the IT department’s support is only to provide them with electrical power, air conditioning, network access, and point-to-point vendor virtual-private-network connectivity.

There are reasons other than the ones we have discussed to take clinical apps off the virtualization list. Here is a checklist to determine whether a particular health care clinical application would be a good candidate for virtualization. If the answer to all these questions is yes, the application is not a good candidate to be virtualized.

Is the system vendor managed?  
Does the system have a proprietary OS?  
Is the system used for life-safety or critical clinical procedures?  
Are updates to the system restricted by the vendor?  
Does the system have high CPU utilization?  
Does the system use a large amount of memory?  
Is the system I/O intensive?  
Does the server have special hardware device connections?  
Does the server have special license restrictions?  
Does the system require a large database?  

Al Gallant is the director of technical services at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Let us know what you think about the story; email

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