As Indiana Health Care Provider Goes Fully Virtualized, it Gains Head Start on BYOD and DR Benefits
Indiana Health Provider Moves to 100 Percent VirtualizedData Center and is on Track to Realize BYOD and DRInitiativesTranscript of a BrieﬁngsDirect podcast on how Associated Surgeons and Physicians, LLC wentfrom a 100 percent physical to a 100 percent virtual infrastructure. Listen to the podcast. Find it on iTunes. Sponsor: VMwareDana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and yourelistening to BrieﬁngsDirect.Today, we present part one of a two-part sponsored podcast series on how a mid-market health services provider has rapidly adopted server and client virtualization. In doing so, theyve gained signiﬁcant new beneﬁts, including the ability to move to mobile, bring your own device (BYOD), and ultimately advanced disaster recovery (DR). Today well hear how Associated Surgeons and Physicians, LLC in Indiana went from 100 percent physical to 100 percent virtualized infrastructure, andhow both compliance and efﬁciency goals have been met and exceeded as a result. [Disclosure:VMware is a sponsor of BrieﬁngsDirect podcasts.]Stay with us now to learn more about creating the right prescription for allowing users todesignate and beneﬁt from their own device choices, while also gaining an ability to bettermanage sensitive data and to create a data-protection lifecycle approach.Here to share his story on the best methods and technologies for better IT and business results inthe health services sector, were joined by, and we welcome, Ray Todich, Systems Administratorat Associated Surgeons and Physicians. Welcome, Ray.Ray Todich: Hi. How are you?Gardner: Im good. Let’s take this ﬁrst at a high level. A lot of organizations are looking toimprove their IT and expand their business. They have various goals for compliance and makingsure that their users are kept up-to-date on the latest and greatest in respective clienttechnologies. Yet Im curious what attracted you, at the beginning, to go to much higher totallevels of server -- and then client -- virtualization.Todich: When I ﬁrst started here, the company was entirely physical. And as background, I camefrom a couple of companies that utilized virtualization at very high levels. So Im very aware ofthe beneﬁts, as far as administration, and the beneﬁts of overall redundancy and activities -- the
software and hardware used to allow high performance, high availability, access to people’s data,and still allow security be put in place.When I came in, it looked like something you might have seen maybe 15 years ago. There were a lot of older technologies in place. The company had a lot of external drives hanging off the servers for backups and so on. My ﬁrst thing to implement was server virtualization, which at the time, was the vSphere 4.1 package. I explained to them what it meant to have centralized storage, what it meant to have ESX host, and how creating virtual machines (VMs) would beneﬁt them considerably over having physical servers in the infrastructure.I gave them an idea on how nice it is to have alternate redundancy conﬁgured correctly, which isvery important. When hardware drops out, RAID conﬁguration goes south, or the entire servergoes out, youve just lost an entire application -- or applications -- which in turn gives downtime.I helped them to see the beneﬁts of going virtualized, and at that time, it was solely for theservers. Technology more important Gardner: So over the past 10 or 15 years, as you pointed out, technology has just become so much more important to how a health provider operates how they communicate to the rest of the world in terms of supplies, as well as insurance companies and payers and so forth. Tell me a little bit about Associated Surgeons and Physicians. How big is the organization, what do you do, how have they been growing?Todich: Pretty rapidly. Associated Surgeons and Physicians is a group of multi-specialtyphysicians and practices in Northeast Indiana and Northwest Ohio.It began at the practice level and then it really expanded. Were up to, I think, 14 additionallocations and/or practices that have joined. Were also using an electronic medical record (EMR)application, given to us by Greenway, and that’s a big one that comes in.Were growing exponentially. It went from one or two satellite practices that needed to piggybackGreenway, to probably 13 or 14 of them, and this is only the beginning. With that type of growthrate, you have to concern yourself with the amount of money it costs to serve everybody. If youhave one physical server that goes out, you affect hundreds of users and thousands of patients,doctors, and whatnot. It’s a big problem, and that’s where virtualization came in strong.Gardner: When I go to the physician’s ofﬁce, and I just happened to be there yesterday, theyvegotten so efﬁcient at moving patients in and out, that the scheduling is amazing. It has to be tight.
Every minute is accounted for. Downtime is just very detrimental and backs up everything. Youcan think about it, I suppose, like an airport. If one ﬂight gets backed up, the whole rest of thecountry does. Is that the case with you all there too, that this critical notion of time managementis so paramount?Todich: Oh, it’s absolutely massive. If we have a snag somewhere, or even if our systems arerunning slow, then everything else runs slow. The ability that virtualization gives us is the core orheart of the entire infrastructure of the business. Without an efﬁcient heart, blood doesn’t move,and we have a bigger problem on our hands.Gardner: How about this in terms of the size of the organization? How many seats are youaccommodating in terms of client, and then what is it about an IT approach to an organizationsuch as yours that also makes virtualization a good ﬁt?Todich: Right now, we have somewhere around 300 employees. As far as how many clients thisoverall organization has, it’s thousands. We have lots of people who utilize the organization. Thereality is that the IT staff here is used in a minimalist approach, which is one thing that I saw aswell when I was coming into this.One or even two persons to manage that many servers can be a nightmare, and on top of that,you try to do your best to help all the users. If you have 300-plus people and their desktops,printers, and so forth, so the overall infrastructure can be pretty intimidating, when you don’thave a lot of people managing it.Going virtual was a lifesaver. Everything is virtualized. You have a handful of physical ESXhosts that are managing anything, and everything is stored on centralized storage. It makes itconsiderably efﬁcient as an IT administrator to utilize virtualization.The right answerThat’s actually how we went into the adoption of VMware View, because of 300-plus users,and 300-plus desktops. At that point, it can be very hairy. At times, you have to try and divinewhat the right answer is. You have this important scenario going on, and you have this one andanother one, and how do you manage them all. It becomes easier, when you virtualizeeverything, because you can get to everything very easily and cover everyone’s desktops.Gardner: And you have a double whammy here, because youre a mid-market size company anddon’t have a large, diversiﬁed IT staff to draw on. At the same time, you have branch ofﬁces andsatellites, so youre distributed. To have people physically go to these places is just not practical.What is it about the distributed nature of your company that also makes virtualization and View5.1 a good approach for a lean IT organization?
Todich: It helped us quite a bit, ﬁrst and foremost, with the ability to give somebody a desktop,even if they were not physically connected to our network. That takes place a lot here.We have alot of physicians who may be working inside of another hospital at the time.Instead of them creating a VPN connection back into our organization, VMware View gave themthe ability to have a client on their desktop, whether it be a PC, a MacBook, an iPod, an iPad, orwhatever they have, even a phone, if they really want to go that route. They can connectanywhere, at anytime, as long as they have an Internet connection and they have the View client.So that was huge, absolutely huge.They also have the ability to use PC-over-IP, versus RDP, That’s very big for us as well. It keepsthe efﬁciency and the speed of the machines moving. If youre in somebody else’s hospital,youre bound to whatever network you are attached to there, so it really helps and it doesn’tbother their stuff as much. All youre doing is borrowing their Internet and not anything else.Gardner: Of course, we get back to that all-important issue for these physicians, surgeons, andpractitioners about their time management, scheduling, understanding where they are supposedto be an hour from now, and in what ofﬁce. All of that is now getting much more efﬁcient as aresult.Todich: Yes, absolutely.Data Gardner: Tell me a bit more about your footprint. Weve spoken about vSphere 4.1 andadopting along the path of 5.1. You even mentioned View. What else are you running there tosupport this impressive capabilities set?Todich: We moved from vSphere 4.1 to 5.1, and going to VMware View. We use 5.1 there aswell. We decided to utilize the networking and security vCloud Networking package, which atthe time was a package called vShield. When we bought it, everything changed, nomenclaturewise, and some of the products were dispersed, which actually was more to our beneﬁt. Werevery excited about that.As far as our VDI deployment, that gave us the ability to use vShield Endpoint, which takes youranti-virus and ofﬂoads it somewhere else on the network, so that your hosts are not burdenedwith virus scans and updates. That’s a huge.The word huge doesn’t even represent how everybody feels about that going away. Its not goingaway physically, just going away to another workhorse on the network so that the physicians,medical assistants (MAs), and everybody else isn’t burdened with, "Oh, look, its updating," or"Look, its scanning something." Its very efﬁcient.
Network and securityGardner: You mentioned the networking part of this, which is crucial when youre goingacross boundaries and looking for those efﬁciencies. Tell me a bit more about how the vCloudnetworking and security issues have been impacted.Todich: That was another big one for us. Along with that the networking and security packagecomes a portion of the package called the vShield Edge, which will ultimately give us the abilityto create our own DMZ the way that we want to create it, something that we don’t have at thistime. This is very important to us.Utilizing the vShield Edge package was fantastic, and yet another layer of security as well. Notonly do we have our physical hardware, our guardians at the gate, but we also have another layer,and the way that it works, wrapping itself around each individual ESX host, is absolutelybeautiful. You manage it just like you manage ﬁrewalls. So it’s very, very important.Plus, some of the tools that we were going to utilize we felt most comfortable in, as far assecurity servers for the VDI package, that you want them sitting in a DMZ. So, all around, itreally gave us quite a bit to work with, which were very thankful for.Gardner: How long did it take you to go from being 100 percent physical to where you are now,basically 100 percent virtual?Todich: Weve been going at it for about about a year-and-a-half. We had to build theinfrastructure itself, but we had to migrate all our applications from physical to virtual (P2V).VMware does a wonderful job with its options for using P2V. It’s a time saver as well. Foranybody who has to deal with the one that’s building the house itself, it can really be a help.VMware, in itself, has the ability to reach out as far and wide as you want it to. It’s really up tothe people who are building it. It was very rapid, and it’s so much quicker to build servers ordesktops, once you get your infrastructure in place.In the previous process of buying a server, in which you have to get it quoted out and make sureeverything is good, do all the front-end sales stuff, and then you have to wait for the hardware toget here. Once it’s here, you have to make sure it’s all here, and then you have to put it altogetherand conﬁgure everything, so forth. Any administrator out there whos done this understandsexactly what that’s all about.Then you have to conﬁgure and get it going, versus, "Oh, you need another server, here, rightclick, deploy from template," and within 10 minutes you have a new server. That, all by itself, ispriceless.Gardner: Weve talked a lot about software, but tell me a bit about your partners. It sounds as ifyou went along a pretty comprehensive hardware upgrade path as well. Did you also go to things
like solid-state drives? Did you look for storage efﬁciencies through modernization? Tell me a bitabout the hardware infrastructure path.Centralized storageTodich: Im a bit of a storage junky. I love storage and what it can do. Im a ﬁrm believer thatcentralized storage, and even more the virtualized centralized storage, is the answer to many,many, many issues. So I did a lot of research on whose price was efﬁcient and whose hardwareand software packaging was efﬁcient.I came from an IBM storage background, but after doing a lot of research, I kept coming back toCompellent, which Dell had purchased. I really liked what Compellent was doing. Even more so,I started to do some research on EqualLogic, and that’s what we ended up going with. We endedup with Dell’s EqualLogic centralized storage, and I cant speak enough of how great that stuff is.I believe they took some of the technologies of the Compellent storage and moved it down toEqualLogic. It’s highly intelligent storage. Were very happy with that. And we went with anentire Dell overall package. Our infrastructure in the data center is everything Dell, theirsimplicity and their efﬁciency.They make great hosts. Right now for out hosts we use Dell R710 servers as our ESX host, and Ibelieve were going to move to 810 as well. They can expand a lot more.As I said, were using EqualLogic. Were even using Dell’s Force10 as our backbone iSCSIinfrastructure. Im a ﬁbre guy by trade initially, and it just seemed more efﬁcient to use iSCSIbackbone, which has been priceless as well. Its cost efﬁcient and the quality is just as good. I seeno difference.Gardner: Okay. Weve talked a lot about infrastructure and how youve set things up. Lets talk abit more now about what you get for all that investment, work, and progress. One of the things,of course, that’s key in your ﬁeld is compliance and theres a lot going on with things likeHIPAA, documents, and making sure the electronic capabilities are there for payers andprovided. Tell me a bit about compliance and what youve been able to achieve with theseadvancements in IT?Todich: With compliance, weve really been able to up our security, which channels straight intoHIPAA. Obviously, HIPAA is very concerned with people’s data and keeping it private. So it’s alot easier to manage all our security in one location.With VDI, its been able to do the same. If we need to make any adjustments security wise, it’ssimply changing a golden image for our virtual desktop and then resetting everybodys desktops.It’s absolutely beautiful, and the physicians are very excited about it. They seem to really getahold of what we have done with the ability that we have now, versus the ability we had twoyears ago. It does wonders.
Gardner: Ray, are there any other aspects to compliance and being in alignment with what themarket expects of you?Todich: Upgrading to a virtual infrastructure has helped us considerably in maintaining andincreasing meaningful use expectations, with the ability to be virtual and have the redundancythat gives, along with the fact that VMs seem to run a lot more efﬁciently virtually. We havebetter ways to collect data, a lot more uptime, and a lot more efﬁciency, so we can collect moredata from our customers.Exceeding expectationsThe more people come through, the more data is collected, the more uptime is there, the morethere are no problems, which in turn has considerably helped meeting and exceeding theexpectations of whats expected with meaningful use, which was a big deal.Gardner: Ive heard that term "meaningful use" elsewhere. What does that really mean? Is thatjust the designation that some regulatory organization has, or is that more of a stock-in-tradedescription?Todich: My understanding of it, as an IT administrator, is basically the proper collection ofpeoples data and keeping it safe. I know that it has a lot in with our EMR application, and whatis collected when our customers interact with us.Gardner: Im going to guess, Ray, that you have a variety of personality types, when it comes toIT adoption. I know people who are just dying to get the latest and greatest. And then I havefolks who I know, where if it works, they don’t want to budge.So given that you probably had a variety of cultural approaches to IT among your constituents,how have you been able to basically satisfy that diversity? How have you been able to keepeveryone moving along towards some of these newer capabilities?Todich: Just by exposing them to the ultimate efﬁciency that we are creating was a big thing tothem. It still is and it always will be, especially in their ﬁeld. These people are here to help otherpeople and they have to be able to get their data. At some point, they have to be able to get itwhenever, wherever, immediately.Whether they were IT savvy or not, the ability to explain to them, anywhere, anytime, 365, 24x7,really seals the deal right there. Its the simplicity of, "Doc, you could be sitting at a coffee shopin New Hampshire, and if you need, for whatever reason, to be able to get into your computer atwork, you launch your View client and away you go, as long as you have Internet" I think thatspoke to them.
Gardner: Are there any milestones or achievements youve been able to make in terms of thisadoption, such as behaviors and then the protection of the documents and privacy data that hasperhaps moved you into a different category and allows you to move forward on some of theseregulatory designations?Todich: Its given us the ability to centralize all our data. You have one location, when it comesto backing up and restoring, versus a bunch of individual physical servers. So data retention andprotection has really increased quite a bit as far as that goes.Gardner: How about DR?Disaster recovery Todich: With DR, I think there are a lot of businesses out there that hear that and don’tnecessarily take it that seriously, until disaster hits. It’s probably the same thing with people andtornadoes. When theyre not really around, you don’t really care. When all of a sudden, a tornadois on top of your house, I bet you care then.VMware gives you the ability to do DR on a variety of different levels, whether it’s snapshotting,or using Site Recovery Manager, if you have a second data center location. It’s just endless.One of the most important topics that can be covered in an IT solution is about our data. Whathappens if it stops or what happens if we lose it? What can we do to get it back, and how fast,because once data stops ﬂowing, money stops ﬂowing as well, and nobody wants that.It’s important, especially if youre recording people’s private health information. If you losecertain data that’s very important, it’s very damaging across the board. So to be able to retain ourdata safely is of the highest concern, and VMware allows us to do that.Also, it’s nice to have the ability to do snapshotting as well. Speaking of servers and whatnot, Illhave to lay it on that one, because in IT, everybody knows that software upgrades come.Sometimes, software upgrades don’t go the way that theyre supposed to, whether it’s an EMRapplication, a time-saving application, or ultrasounds.If you take a snapshot before the upgrade and run your upgrade on that snapshot, if everythinggoes great and everybody is satisﬁed. You can just merge the snapshot with the primary imageand you are good to go.If it doesn’t work out in your favor, you have the ability to delete that snapshot and youre backto where you started from before the migration, which was hopefully a functioning state.Gardner: Let’s look to the future a bit. It sounds as if with these capabilities and the way thatyouve been describing DR beneﬁts, you can start to pick and choose data center locations,
maybe even thinking about software-deﬁned networking and data center. That then allows you topick and choose a cloud provider or a hosting model. So are you thinking about being able topick up and virtually move your entire infrastructure, based on what makes sense to yourcompany over the next say 5 or 10 years.Todich: That’s exactly right, and the way this is growing, something thats been surfacing a lot inour neck of the woods is the ability to do hosting and provide cloud-based solutions, andVMware is our primary site on that as well.But, if need be, if we had to migrate our data center from one state to another, well have theoption to do that, which is very important, and it helps with uptime as well. Stuff happens. Imean, you can be at a data center physically and something happens to a generator that has allthe power. All of a sudden, everybody is feeling the pain.So with the ability to have the Site Recovery, it’s priceless, because it just goes to location B andeverybody is still up. You may see a blip or you may not, and nothing is lost. That leaveseverybody to deal with the data-center issue and everything is still up and going, which is verynice.Creating redundancyGardner: I imagine too, Ray, that it works both ways. On one hand, you have a burgeoningecosystem of cloud and hosting, of providers and options, that you can pursue, do your costbeneﬁt analysis, think about the right path, and create redundancy.At the same time, you probably have physicians or individual, smaller physician practices, thatmight look to you and say, "Those guys are doing their IT really well. Why don’t we justsubscribe to their services or piggyback on their infrastructure?" Do you have any thoughts aboutbecoming, in a sense, an IT services provider within the healthcare ﬁeld? It expands your roleand even increases your efﬁciency and revenues.Todich: Yes, our sights are there. As a matter of fact, our heads are being turned in that directionwithout even trying to, because a lot of people are doing that. It’s a lot easier for smallerpractices, instead of buying all the infrastructure and putting it all in place to get everything up,and then maintaining it, we will house it for you. Well do that.Gardner: Great, weve had a wonderful discussion, part one of a two-part sponsored podcastseries, on how a mid-market health services provider has rapidly adopted server and clientvirtualization. We’ve seen how Associated Surgeons and Physicians, LLC has gained signiﬁcantbeneﬁts from virtualization by extending the beneﬁts to mobile, embracing BYOD, and thenmoving into advanced DR.
Weve seen how they used a VMware-centric infrastructure approach to go from a 100 percentphysical to a 100 percent virtualized infrastructure in less than two years, and in doing so,gaining compliance and efﬁciency goals that have met and exceeded their initial goals.So a big thank you to our guest, Ray Todich, Systems Administrator at Associated Surgeons andPhysicians in Indiana. Thanks so much, Ray.Todich: Thank you for having me. I greatly appreciate it.Gardner: This is Dana Gardner, Principal Analyst at Interarbor Solutions. Thanks also to you,our audience, for listening, and don’t forget to come back next time.Listen to the podcast. Find it on iTunes. Sponsor: VMwareTranscript of a BrieﬁngsDirect podcast on how Associated Surgeons and Physicians, LLC wentfrom a 100 percent physical to a 100 percent virtual infrastructure. Copyright InterarborSolutions, LLC, 2005-2013. All rights reserved.You may also be interested in: • AT&T Cloud Services Built on VMware vCloud Datacenter Meet Evolving Business Demands for Advanced IaaS • Thomas Duryea’s journey to the cloud: Part one • VMware-Powered Cloud Adoption Delivers Bevy of Data and Performance Beneﬁts for Revlon, Says CIO David Giambruno • Services Provider BancVue Leverages VMware Server Virtualization to Generate Private-Cloud Beneﬁts and Increased Business Agility • From VMworld, cosmetics giant Revlon harnesses the power of private cloud to produce impressive savings and cost avoidance • VMware CTO Steve Herrod on How the Software-Deﬁned Datacenter Beneﬁts Enterprises