May 4, 2012 – Virtualization hasn't really taken the health care industry by storm, but in the past few years it's becoming increasingly commonplace for organizations large and small to either jump or dabble in storage, server and desktop virtualization by using software to divide physical servers and desktops into multiple virtual environments.

Nearly every health care provider over 150 beds has some form of virtualization in its IT ecosystem, according to Jeff White, a principal at Aspen Advisors, a health care consulting firm. That movement has picked up steam as health care executives-and vendors-have gotten over the FUD (fear, uncertainty and doubt) of trading physical iron for software to run key operations, he says."A few years ago many executives worried about the reliability of a virtualized environment, and many of those fears were based on health IT vendors being reluctant to support their applications in the environment," White says. "But the benefits of it in terms of management and controllability have really proven out, and virtualization has really started being embraced the past couple years."The reason for that change of heart of the C-level and HIT vendors wasn't based on an epiphany, but a reality: The stunning and accelerating growth of electronic data that needs to stored and processed makes purchasing physical servers to keep up a suicidal financial decision.Dick Csaplar, senior research analyst, virtualization and storage, at Aberdeen, a research and analyst firm based in Boston, recently surveyed end-users across a number of industries and found that electronic data is increasing 35 percent across the board, and for large organizations the data growth is 44 percent annually, effectively doubling their data every two years."Nearly every business process is being computerized, and no IT group in any industry can go to their executives and say they need to double their storage capacity every two years," Csaplar says. "Our surveys find that the No. 1 issue facing IT leaders across all the industries is how to handle the growth of data."However, virtualization isn't necessarily a slam dunk. One of its chief selling points has been the potentially enormous cost savings, but HIT leaders at organizations committed to virtualization say they haven't seen much in the way of lower infrastructure costs.And while those leaders have been effective in selling the other virtues of server and storage virtualization, there is still reluctance on taking the next step to desktop virtualization. In addition, cloud computing is starting to create significant waves in the health care industry, but organizations are still trying to figure out what, exactly, cloud computing is, and if the reliability and security issues can be worked out to enable them to move their data and operations into the cloud.First, costs. It seems apparent that if, instead of buying physical servers, you put a virtual software layer that enables you to use the processing power of your server farm to run all your applications, you're going to save a lot of money in a line-item expense that has increased dramatically over the years.But that's not how things work out, says Michael Minks, director of operations for the 11-facility Seton Healthcare Family, based in Austin, Texas. Seton Healthcare Family is part of the the Ascension Health not-for-profit network comprising more than 500 health facilities. "You just shouldn't go into virtualization expecting cost savings," Minks says. "The physical servers you have to purchase to run multiple virtual servers on are pretty high-end, expensive machines, and when you layer on the management tools and virtual server licenses, you might end up saving a little money, but not much." Ascension Health has about 40 percent of its servers virtualized, Minks estimates, and continues to consolidate its data center via virtualization.The real pay-offs are in efficiency, Minks and others agree. The old model was to run each application on its own physical server, which meant that data centers were crowded with servers that were using a sliver of their processing power. A virtual environment enables that physical processing power to be used to operate multiple virtual servers running different applications.Jerry Williams, the SQL DBA/Developer at CommuniCare Health Services, says that one reason efficiencies were so important for the organization is that HITECH, meaningful use and other federal programs and regulations have changed the game.CommuniCare manages several nursing and rehabilitation centers, specialty care centers and assisted living communities across five states. Before the wave of new reporting demands, the documentation at the facilities used to be done mostly during business hours, and mostly on paper. But now, Williams says, the applications, chief among them the HealthMEDX Vision system used for clinical documentation and host of other functions, are being used around the clock."In terms of documentation, we were basically an 8 a.m. to 5 p.m. organization, and the night shifts had very little interaction with our applications," Williams says. "But now we're a 24/7 organization and those users are banging at our systems day and night. Three years ago we had about 10 terabytes of electronic data, and now we have more than 20 terabytes." For back-end storage, the organization implemented the FalconStor Network Storage Server (NSS) to virtualize much of its environment and improve its disaster recovery abilities. On the server level, it deployed VMWare virtual machines to enable it to have about 10 to 1 compression for its application servers."The hardest part of virtualizing our server environment was figuring out what we really needed," Williams adds. "Our approach had been to find out what the specs were for each application and build to those specs, but in truth the application specifications were for a high water mark that was two or three times what those applications really needed."

Desktops are next

Williams' next frontier, and it's a vast one, is virtual desktop infrastructure, he says. He's "100 percent in favor" of virtualizing desktops to manage applications from central servers, but has not fully convinced management at CommuniCare Health Services on the merits of VDI.Virtual desktop infrastructure is different than the more common desktop virtualization: desktop virtualization delivers specific apps via a virtual environment, while VDI provides the entire desktop in a virtual environment."It's a real paradigm shift for the desktop, and management is leery about what will happen if we have a network outage," Williams says. "We are in a full client/server environment on the desktop, and if the entire network went down users would still be able to do some things locally. My contention is that if your network goes down you're going to lose your main documentation functions anyway, and productivity losses would be the same either way. I want to virtualize desktops because of the gains in performance, management and scalability we could achieve, but others aren't quite comfortable enough to make that transition yet."Minks at Ascension Health also is a proponent of virtualizing the desktop, and has managed to make some significant headway. The health system is running its electronic health records systems, from Cerner Corp., in a virtual Citrix environment, and has most other clinical applications virtualized. That desktop virtualization effort was launched to address a specific issue: the difficulties faced by roaming clinicians to continue sessions between desktop PCs.But Ascension Health has been cautious, Minks says. "We've virtualized the clinical desktop but have built in a 'break the glass' back-up system that would enable access to clinical applications if that virtual environment goes down. So we've addressed clinical roaming, but we still have 9,000 fat PCs running in our environment. The transition will take some time."And that holds true across the industry, says White from Aspen Advisors. There are a number of compelling reasons to virtualize desktops, and like server/storage virtualization, they center around administration and management.The ability to centrally manage updates from a central server environment instead of having to download application updates and security patches on a PC-by-PC basis is a huge time-saver, as is initial configuration management for new devices on the network. IT staff are understandably enamored about being able to do all those tasks just once and also have more control over the desktop environment that so often is compromised by end-users downloading unauthorized software and getting into other kinds of PC shenanigans.But again, virtualization on the desktop is no slam dunk, White says, from either a technological or financial standpoint.A significant technology issue for VDI, for example, is the difficulty in getting peripherals such as printers, scanners and bar code readers to connect reliably to a virtual environment, he says. "While the VDI technologies work well in delivering applications, not all computer peripherals work well, which is a pretty big issue for end-users," White says. "The computing environment is stable-virtual desktop technology has been on the market for years-but there are still those peripheral connectivity issues."And VDI also has lost a key selling point in terms of cost, he adds. When fully-loaded PCs cost north of $1,000, there was a compelling financial argument for virtual desktops because the computing model can work with thin-client computers or stripped-down desktops. But PC costs have dropped dramatically in recent years, so for a few hundred dollars organizations can get powerful desktops.The costs for central processing units (CPU) and random access memory (RAM) are three times more expensive in a server environment than they are for comparative power on PCs, White says, so that's another cost factor that needs to be considered. "While there are good reasons in terms of service levels and application administration and management for virtualizing desktops, at this point it's hard to make an argument from a return on investment perspective," White says.

Cloud now? Cloud how?

Any discussion today about managing storage, servers and desktop wouldn't be complete without touching on cloud computing, the hot new thing that enables data, processing power and applications to be hosted and managed via the online computing "cloud." But discussing the cloud requires a definition of what it is, and no one seems to agree on that. "It's like a unicorn, everyone knows what it looks like but no one has actually seen one," offers Minks from Ascension Health Information Services.He adds that Ascension Health is actively formulating an enterprise cloud strategy, but is already in the cloud by most definitions: its EHR from Cerner is hosted via the vendor's Kansas City data center; it already operates some applications via Web sites; and it's starting to utilize pure cloud services from Dell Inc. that fire up virtual servers to provide processing power when Ascension Health servers are nearing capacity.But moving significant amounts of data and its server and storage operations is something that still needs to be analyzed in light of how that fits in with the organization's server/application virtualization efforts, Minks says.No matter how the cloud shapes up, virtualization has helped set the stage by getting executives and IT leaders focused on maximizing service and efficiency for their IT infrastructures.Brookings Health System in South Dakota, for example, has virtualized about 95 percent of its server infrastructure and is looking into VDI, says Brian Sterud, the information management director. And as the cloud matures, he sees significant potential into moving data and application hosting into the cloud."We are a small organization [49-bed hospital, 79-bed nursing home] that is not going to ever build the Taj Mahal of data centers," he says. "But if I can have our environment remotely hosted and cut my costs while getting all the bells and whistles, I'm going to get that type of high-end data center. We've been able to get our executives comfortable with virtualization by educating them about how it works-there's no magic. If the cloud matures in the same way as virtualization, I think we'd all be comfortable with it."This story originally appeared at Health Data Management.

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