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Virtualization technology what the doctor ordered for health care IT

According to four execs, virtualization technology -- whether for servers, storage, backup or desktops -- saves money and helps health care providers carry out their mission.

While virtualization technology is approaching maturity in many IT shops, it's just coming of age in health care providers' data centers. It may prove to be a golden age, however, as the push to virtualize gains momentum on all fronts -- servers, storage, backup and desktop. And so far, hospital IT execs say, there's little not to like.

"We were either going to many physical servers or to virtualization. It made sense in terms of space and manageability to move to a much larger virtual platform," said Alan Hite, director of IT systems at Adventist Health System in Lake Mary, Fla.

Jeff Szymanski, director of data center operations for the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, agreed: "Without virtualization, we would have more staff or we would have to outsource or build a new data center."

Szymanski began the push for using virtualization at UPMC in 2005, but ran into a stumbling block -- major electronic health record (EHR) vendors had not yet adapted their applications to run on virtual servers. Since then, however, such vendors as Cerner Corp., Epic Systems Corp. and McKesson Corp. have implemented support for virtual machine (VM) platforms.

That lack of vendor support for VM environments held back virtualization in health care IT, IDC analyst Scott Lundstrom wrote in a recent white paper. Another factor in health care organizations' slow adoption of virtualization is size -- plenty of them have IT operations that are too small to benefit from virtualization. But hospital consolidation is creating larger hospitals from smaller ones, and that process inevitably will make using virtualization more attractive.

Although very small hospitals may still be on the sidelines, medium-sized and large hospitals have embraced virtualization with full force -- the bigger the hospital, the more servers to virtualize, the greater the savings. UPMC is the largest employer in western Pennsylvania and the second-largest employer in the state, according to Szymanski. In its study of UPMC's virtualization initiative, IDC's Health Industry Insights market research group estimates the organization has avoided $80 million in capital and operating costs from 2005 to 2008.

Even so, smaller organizations are able to do much more with less than ever before. "We save $3,500 per server every time we provision a virtual server," said Robert McShinsky, senior systems administrator at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Meanwhile, the South Central Foundation in Anchorage, Alaska, is benefiting from keeping its IT staff lean -- only four engineers are needed to manage 120 virtual servers. "There's no way we could have done that without [using] virtualization," said Chris Smith, South Central's operations director and CIO.

Adventist Health: Success with virtual server clusters

Adventist Health, which describes itself as the largest nonprofit Protestant health care provider in the U.S., began by running Cerner's medical charting application on virtual servers. Now it is in the middle of a push to using virtualization that encompasses all branches of IT. "In 2008, things really started to explode," Hite said.

Needing to refresh its hardware and to run more instances of the Cerner application, Adventist Health expanded the number of its VMware Inc. virtual servers. Since then, the organization has enlarged its virtual server clusters to host new systems and has continued consolidation at the same time. Plans include implementing its picture archiving and communication system, or PACS, on virtual servers.

In addition to deploying storage and virtual server clusters at the organization's main data center in Lake Mary, Adventist Health rolled out similar deployments on a smaller scale at its constituent hospitals, which range in size from a few dozen beds to several hundred. (Overall, AHS-IS, the information services division of Adventist Health, handles IT for 26 of the system's 37 hospitals, and has 500 employees in nine states.)

Currently, the organization's typical configuration is a cluster of three VMware hosts connected to an IBM N Series or NetApp Inc. storage device. Hite also is evaluating desktop virtualization. "It's good that data is not on the desktop. The more we can leave in the data center, the better off we'll be," he said.

Dartmouth-Hitchcock: Using virtualization to consolidate storage

Starting in 2005, Dartmouth-Hitchcock began deploying Microsoft Virtual Server 2005, which it saw as a simpler and less costly alternative to VMware software, according to McShinsky. In 2008, the medical center moved to Microsoft Windows Server Hyper-V, the successor to Virtual Server.

"We now have over 330 virtual servers, or 65% of our environment. It saves money on hardware and space -- more space is reserved for seeing patients," McShinsky said.

Dartmouth-Hitchcock, with its major data center in Lebanon, N.H., and smaller ones in Nashua, N.H., and Bedford, N.H., is using virtualization to consolidate storage as well, with several Fibre Channel storage area networks (SAN) each consisting of as many as 10 Hewlett-Packard Co. (HP) StorageWorks EVA (Enterprise Virtual Array) 8000 series devices. McShinsky's staff uses Microsoft System Center Virtual Machine Manager and Data Protection Manager to manage the SANs and perform backups.

We now have over 330 virtual servers, or 65% of our environment. It saves money on hardware and space -- more space is reserved for seeing patients.

Robert McShinsky, senior systems administrator, Dartmouth-Hitchcock Medical Center

Dartmouth-Hitchcock also uses HP's VLS (Virtual Library System) disk-based tape emulation storage, which includes a data deduplication feature that reduces the amount of data. In the move to consolidate storage, the medical center has not eliminated backup tape cartridges completely, however; those that remain are encrypted and stored off-site at a secure location.

Although SAN storage offers the benefits of high throughput and the ability to manage storage volumes to assure high availability, McShinsky is fighting to keep costs under control. "Disk is cheap, but not as cheap when it's on a high-performance SAN," he said. Data deduplication helps, but he is also looking at thin provisioning via Virsto Software Corp. Thin provisioning allocates storage to applications only as needed, a feature that can cut storage costs significantly.

Next up is a multimillion-dollar project that will move Dartmouth-Hitchcock from what McShinsky describes as a "homegrown" EHR application to an Epic EHR system that will be deployed on Citrix Systems Inc.'s XenApp, an application virtualization platform that can send applications to desktop computers or act as a terminal server to desktops.

South Central: Virtualized storage preserves uptime

The South Central Foundation deployed VMware on Windows Server systems in 2006, and subsequently migrated to VMware ESX.

"We felt it was more mature than Hyper-V. There's almost no delay, and no downtime," said Smith, who was particularly impressed with the ESX software's ability to move a guest VM from one live host to another with no interruption in service. Similarly, VMware VMotion virtualized storage software lets administrators move storage volumes from one part of a SAN to another without sacrificing uptime, he noted.

For virtualized storage, South Central is using NetApp SANs in its primary and backup data centers. "Disk-to-disk backup happens several times a day," Smith explained, adding, "We know there's quite a bit of savings. There is a little bit of an extra cost for software around snapshotting and easy replication of your data."

Next on the horizon is an 18- to 24-month migration to Cerner applications following a deal inked a few months ago. The applications, which will be hosted on Citrix XenServer, run the gamut from computerized physician order entry and e-prescribing to lab work and X-rays. "We're trying to consolidate down to a couple of key vendors like Cerner," said Smith.

Smith is further weighing different options for a future desktop infrastructure, such as using desktop virtualization and a broad rollout of Windows 7, he said.

UPMC: Using consolidation cuts electric bills

UPMC has 11 satellite data centers, one of which, a 27,000-sq.-ft. operation, had 45 server racks before virtualization. Now that total is down to five racks of virtual servers. Absent that consolidation, UPMC would have had to build another data center. Overall, the UPMC virtualization project is 90% complete, according to Szmanski.

UPMC is using VMWare, mainly on IBM AIX severs with some HP and Sun Microsystems servers as well. The environment is managed by a combination of HP ServiceCenter and IBM Tivoli software. Szymanski praised his ability to take down virtual servers when necessary without having to take down a physical machine. 

For UPMC, using virtualization goes hand in hand with a green IT initiative that has enabled the organization to keep its kilovolt-ampere consumption constant in the past five years. Like many of his peers, Szmanski has yet to commit to a desktop virtualization strategy, but is discussing those technologies with IBM and Microsoft.

Stan Gibson is a contributing writer based in Boston. Let us know what you think about the story; email

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