A Virtual Coup: The Server Room of the Future

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The server requirements of any modern hospital are daunting; the back-end processing power necessary to operate multiple health information systems across an enterprise of any size requires an ever-shifting configuration of blades, proxies, failover systems, and disaster-recovery solutions. It’s no wonder, then, that a five-hospital system with 2,000 beds and 120 radiologists working on a common PACS has turned to a cutting-edge alternative. According to OhioHealth Information Services, Columbus, the server room of the future may not be a room at all.

In 2005, Brian Pace, technical architect for OhioHealth, was looking for a cost-effective way to implement the bevy of new software solutions for which his hospital’s staff was clamoring—and to facilitate a new, comprehensive business-continuity and disaster-recovery strategy. Late that year, OhioHealth first began to consider moving some of its servers to a virtualized environment—including the servers for its Synapse® PACS solution from FUJIFILM Medical Systems USA Inc, Stamford, Conn. “When we started to work on it in late 2005, there was some exposure to the idea of virtualization, but not a tremendous amount of acceptance,” Pace says, “but OhioHealth is very forward thinking, from an IT standpoint. We get on the cutting edge pretty quickly."

A traditional PACS server deployment could grow to as many as 20 servers; in the virtual enviroment, fewer physical devices are needed to produce the same results

A traditional PACS server deployment could grow to as many as 20 servers; in the virtual enviroment, fewer physical devices are needed to produce the same results

OhioHealth decided to start with mission-critical servers, including some of its PACS servers; the organization turned to VMWare Inc, Palo Alto, Calif, for the technology necessary to bring the selected servers into the virtual environment. The process began in mid-2006 with VMWare's ESX Server 2 solution, which the organization used to virtualize HP Blade physical servers, initially running 60 virtual machines on four physical hosts. Less than three years later, OhioHealth has now converted approximately two thirds of its servers to the virtual environment.

The virtual machines used in this virtualization model are tightly isolated software containers that behave exactly like physical computers and contain their own software-based CPU, RAM hard disk, and network interface cards. Multiple virtual machines can share the hardware of any x86 computer—in this case, a server—but remain completely separate from one another.

“We had limited disaster recovery for a lot of our systems, including PACS, so this really gave us a lot of flexibility,” Pace recalls. “We’re converting our physical machines to virtual machines and our physical hosts to virtual hosts, creating a low-budget, physical-server disaster-recovery solution.” The virtual-server copy of that physical server is synced nightly, so backup is never more than 24 hours behind. “The PACS servers are on replicated real-time storage, so we can simply bring those up at our disaster recovery site,” Pace says. “We have a replication process where we can replicate specific virtual machines from one site to the other on a daily basis.”

After moving to ESX 3, the next version of the VMWare virtualization solution, OhioHealth was able to expand the virtualization further; today, around 500 of its servers are virtualized, running on just over 30 hosts. “The upgraded product could handle more virtual machines, allowing us to do more memory on each,” Pace says. “We weren’t limited as much to a certain type of server. It’s our mindset that there are very few servers that couldn’t be turned into a virtual machine.”

Tips to Ease the Virtual Transition

  • First, take it slowly. Rather than attempting to virtualize everything at once, opt for a phased approach.
  • Second, get the right training. Some virtual vendors offer online or onsite courses; take advantage of them.
  • Third, check compatibility. Vendors usually offer compatibility matrices that can help you ensure that your hardware is optimal for a virtualized environment.
  • Fourth, get third-party vendors involved. Working with them as you move into the virtual environment facilitates seamless integration of all your applications, from billing systems to RIS and PACS.
  • Fifth, collaborate with other institutions. Hospitals already using the system have learned its ins and outs the hard way and can pass on valuable