Transcript of a BriefingsDirect podcast on how Associated Surgeons and Physicians, LLC went from a 100 percent physical to a 100 percent virtual infrastructure.

1. Indiana Health Provider Moves to 100 Percent Virtualized
Data Center and is on Track to Realize BYOD and DR
Initiatives
Transcript of a BriefingsDirect podcast on how Associated Surgeons and Physicians, LLC went
from a 100 percent physical to a 100 percent virtual infrastructure.
Listen to the podcast. Find it on iTunes. Sponsor: VMware
Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and you're
listening 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, they've gained significant new benefits, including the ability to move to
mobile, bring your own device (BYOD), and ultimately advanced disaster
recovery (DR).
Today we'll hear how Associated Surgeons and Physicians, LLC in Indiana
went from 100 percent physical to 100 percent virtualized infrastructure, and
how 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 to
designate and benefit from their own device choices, while also gaining an ability to better
manage 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 in
the health services sector, we're joined by, and we welcome, Ray Todich, Systems Administrator
at Associated Surgeons and Physicians. Welcome, Ray.
Ray Todich: Hi. How are you?
Gardner: I'm good. Let’s take this first at a high level. A lot of organizations are looking to
improve their IT and expand their business. They have various goals for compliance and making
sure that their users are kept up-to-date on the latest and greatest in respective client
technologies. Yet I'm curious what attracted you, at the beginning, to go to much higher total
levels of server -- and then client -- virtualization.
Todich: When I first started here, the company was entirely physical. And as background, I came
from a couple of companies that utilized virtualization at very high levels. So I'm very aware of
the benefits, as far as administration, and the benefits of overall redundancy and activities -- the

2. 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 is
very important. When hardware drops out, RAID configuration goes south, or the entire server
goes out, you've 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 the
servers.
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-specialty
physicians and practices in Northeast Indiana and Northwest Ohio.
It began at the practice level and then it really expanded. We're up to, I think, 14 additional
locations and/or practices that have joined. We're also using an electronic medical record (EMR)
application, given to us by Greenway, and that’s a big one that comes in.
We're growing exponentially. It went from one or two satellite practices that needed to piggyback
Greenway, to probably 13 or 14 of them, and this is only the beginning. With that type of growth
rate, you have to concern yourself with the amount of money it costs to serve everybody. If you
have 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, they've
gotten so efficient at moving patients in and out, that the scheduling is amazing. It has to be tight.

3. Every minute is accounted for. Downtime is just very detrimental and backs up everything. You
can think about it, I suppose, like an airport. If one flight gets backed up, the whole rest of the
country does. Is that the case with you all there too, that this critical notion of time management
is so paramount?
Todich: Oh, it’s absolutely massive. If we have a snag somewhere, or even if our systems are
running slow, then everything else runs slow. The ability that virtualization gives us is the core or
heart 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 you
accommodating in terms of client, and then what is it about an IT approach to an organization
such as yours that also makes virtualization a good fit?
Todich: Right now, we have somewhere around 300 employees. As far as how many clients this
overall organization has, it’s thousands. We have lots of people who utilize the organization. The
reality is that the IT staff here is used in a minimalist approach, which is one thing that I saw as
well 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’t
have a lot of people managing it.
Going virtual was a lifesaver. Everything is virtualized. You have a handful of physical ESX
hosts that are managing anything, and everything is stored on centralized storage. It makes it
considerably efficient as an IT administrator to utilize virtualization.
The right answer
That’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 divine
what the right answer is. You have this important scenario going on, and you have this one and
another one, and how do you manage them all. It becomes easier, when you virtualize
everything, because you can get to everything very easily and cover everyone’s desktops.
Gardner: And you have a double whammy here, because you're a mid-market size company and
don’t have a large, diversified IT staff to draw on. At the same time, you have branch offices and
satellites, so you're 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 View
5.1 a good approach for a lean IT organization?

4. 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 a
lot 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 them
the ability to have a client on their desktop, whether it be a PC, a MacBook, an iPod, an iPad, or
whatever they have, even a phone, if they really want to go that route. They can connect
anywhere, 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 keeps
the efficiency and the speed of the machines moving. If you're in somebody else’s hospital,
you're bound to whatever network you are attached to there, so it really helps and it doesn’t
bother their stuff as much. All you're doing is borrowing their Internet and not anything else.
Gardner: Of course, we get back to that all-important issue for these physicians, surgeons, and
practitioners about their time management, scheduling, understanding where they are supposed
to be an hour from now, and in what office. All of that is now getting much more efficient as a
result.
Todich: Yes, absolutely.
Data Gardner: Tell me a bit more about your footprint. We've spoken about vSphere 4.1 and
adopting along the path of 5.1. You even mentioned View. What else are you running there to
support this impressive capabilities set?
Todich: We moved from vSphere 4.1 to 5.1, and going to VMware View. We use 5.1 there as
well. We decided to utilize the networking and security vCloud Networking package, which at
the time was a package called vShield. When we bought it, everything changed, nomenclature
wise, and some of the products were dispersed, which actually was more to our benefit. We're
very excited about that.
As far as our VDI deployment, that gave us the ability to use vShield Endpoint, which takes your
anti-virus and offloads it somewhere else on the network, so that your hosts are not burdened
with virus scans and updates. That’s a huge.
The word huge doesn’t even represent how everybody feels about that going away. It's not going
away 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, it's updating," or
"Look, it's scanning something." It's very efficient.

5. Network and security
Gardner: You mentioned the networking part of this, which is crucial when you're going
across boundaries and looking for those efficiencies. Tell me a bit more about how the vCloud
networking and security issues have been impacted.
Todich: That was another big one for us. Along with that the networking and security package
comes a portion of the package called the vShield Edge, which will ultimately give us the ability
to create our own DMZ the way that we want to create it, something that we don’t have at this
time. This is very important to us.
Utilizing the vShield Edge package was fantastic, and yet another layer of security as well. Not
only 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 absolutely
beautiful. 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 as
security servers for the VDI package, that you want them sitting in a DMZ. So, all around, it
really gave us quite a bit to work with, which we're 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: We've been going at it for about about a year-and-a-half. We had to build the
infrastructure 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. For
anybody 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 to
the people who are building it. It was very rapid, and it’s so much quicker to build servers or
desktops, 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 sure
everything is good, do all the front-end sales stuff, and then you have to wait for the hardware to
get here. Once it’s here, you have to make sure it’s all here, and then you have to put it altogether
and configure everything, so forth. Any administrator out there who's done this understands
exactly what that’s all about.
Then you have to configure and get it going, versus, "Oh, you need another server, here, right
click, deploy from template," and within 10 minutes you have a new server. That, all by itself, is
priceless.
Gardner: We've talked a lot about software, but tell me a bit about your partners. It sounds as if
you went along a pretty comprehensive hardware upgrade path as well. Did you also go to things

6. like solid-state drives? Did you look for storage efficiencies through modernization? Tell me a bit
about the hardware infrastructure path.
Centralized storage
Todich: I'm a bit of a storage junky. I love storage and what it can do. I'm a firm believer that
centralized 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 hardware
and software packaging was efficient.
I came from an IBM storage background, but after doing a lot of research, I kept coming back to
Compellent, 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 ended
up with Dell’s EqualLogic centralized storage, and I can't speak enough of how great that stuff is.
I believe they took some of the technologies of the Compellent storage and moved it down to
EqualLogic. It’s highly intelligent storage. We're very happy with that. And we went with an
entire Dell overall package. Our infrastructure in the data center is everything Dell, their
simplicity and their efficiency.
They make great hosts. Right now for out hosts we use Dell R710 servers as our ESX host, and I
believe we're going to move to 810 as well. They can expand a lot more.
As I said, we're using EqualLogic. We're even using Dell’s Force10 as our backbone iSCSI
infrastructure. I'm a fibre guy by trade initially, and it just seemed more efficient to use iSCSI
backbone, which has been priceless as well. It's cost efficient and the quality is just as good. I see
no difference.
Gardner: Okay. We've talked a lot about infrastructure and how you've set things up. Let's talk a
bit 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 there's a lot going on with things like
HIPAA, documents, and making sure the electronic capabilities are there for payers and
provided. Tell me a bit about compliance and what you've been able to achieve with these
advancements in IT?
Todich: With compliance, we've really been able to up our security, which channels straight into
HIPAA. Obviously, HIPAA is very concerned with people’s data and keeping it private. So it’s a
lot easier to manage all our security in one location.
With VDI, it's been able to do the same. If we need to make any adjustments security wise, it’s
simply changing a golden image for our virtual desktop and then resetting everybody's desktops.
It’s absolutely beautiful, and the physicians are very excited about it. They seem to really get
ahold of what we have done with the ability that we have now, versus the ability we had two
years ago. It does wonders.

7. Gardner: Ray, are there any other aspects to compliance and being in alignment with what the
market expects of you?
Todich: Upgrading to a virtual infrastructure has helped us considerably in maintaining and
increasing meaningful use expectations, with the ability to be virtual and have the redundancy
that gives, along with the fact that VMs seem to run a lot more efficiently virtually. We have
better ways to collect data, a lot more uptime, and a lot more efficiency, so we can collect more
data from our customers.
Exceeding expectations
The more people come through, the more data is collected, the more uptime is there, the more
there are no problems, which in turn has considerably helped meeting and exceeding the
expectations of what's expected with meaningful use, which was a big deal.
Gardner: I've heard that term "meaningful use" elsewhere. What does that really mean? Is that
just the designation that some regulatory organization has, or is that more of a stock-in-trade
description?
Todich: My understanding of it, as an IT administrator, is basically the proper collection of
people's data and keeping it safe. I know that it has a lot in with our EMR application, and what
is collected when our customers interact with us.
Gardner: I'm going to guess, Ray, that you have a variety of personality types, when it comes to
IT adoption. I know people who are just dying to get the latest and greatest. And then I have
folks 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 keep
everyone 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 to
them. It still is and it always will be, especially in their field. These people are here to help other
people and they have to be able to get their data. At some point, they have to be able to get it
whenever, 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. It's the simplicity of, "Doc, you could be sitting at a coffee shop
in New Hampshire, and if you need, for whatever reason, to be able to get into your computer at
work, you launch your View client and away you go, as long as you have Internet" I think that
spoke to them.

8. Gardner: Are there any milestones or achievements you've been able to make in terms of this
adoption, such as behaviors and then the protection of the documents and privacy data that has
perhaps moved you into a different category and allows you to move forward on some of these
regulatory designations?
Todich: It's given us the ability to centralize all our data. You have one location, when it comes
to backing up and restoring, versus a bunch of individual physical servers. So data retention and
protection 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’t
necessarily take it that seriously, until disaster hits. It’s probably the same thing with people and
tornadoes. When they're not really around, you don’t really care. When all of a sudden, a tornado
is 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. What
happens 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 you're recording people’s private health information. If you lose
certain data that’s very important, it’s very damaging across the board. So to be able to retain our
data 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, I'll
have to lay it on that one, because in IT, everybody knows that software upgrades come.
Sometimes, software upgrades don’t go the way that they're supposed to, whether it’s an EMR
application, a time-saving application, or ultrasounds.
If you take a snapshot before the upgrade and run your upgrade on that snapshot, if everything
goes great and everybody is satisfied. You can just merge the snapshot with the primary image
and you are good to go.
If it doesn’t work out in your favor, you have the ability to delete that snapshot and you're back
to 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 that
you've been describing DR benefits, you can start to pick and choose data center locations,

9. maybe even thinking about software-defined networking and data center. That then allows you to
pick and choose a cloud provider or a hosting model. So are you thinking about being able to
pick up and virtually move your entire infrastructure, based on what makes sense to your
company over the next say 5 or 10 years.
Todich: That’s exactly right, and the way this is growing, something that's been surfacing a lot in
our neck of the woods is the ability to do hosting and provide cloud-based solutions, and
VMware 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, we'll have the
option to do that, which is very important, and it helps with uptime as well. Stuff happens. I
mean, you can be at a data center physically and something happens to a generator that has all
the 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 and
everybody is still up. You may see a blip or you may not, and nothing is lost. That leaves
everybody to deal with the data-center issue and everything is still up and going, which is very
nice.
Creating redundancy
Gardner: I imagine too, Ray, that it works both ways. On one hand, you have a burgeoning
ecosystem of cloud and hosting, of providers and options, that you can pursue, do your cost
benefit analysis, think about the right path, and create redundancy.
At the same time, you probably have physicians or individual, smaller physician practices, that
might look to you and say, "Those guys are doing their IT really well. Why don’t we just
subscribe to their services or piggyback on their infrastructure?" Do you have any thoughts about
becoming, in a sense, an IT services provider within the healthcare field? It expands your role
and even increases your efficiency and revenues.
Todich: Yes, our sights are there. As a matter of fact, our heads are being turned in that direction
without even trying to, because a lot of people are doing that. It’s a lot easier for smaller
practices, 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. We'll do that.
Gardner: Great, we've had a wonderful discussion, part one of a two-part sponsored podcast
series, on how a mid-market health services provider has rapidly adopted server and client
virtualization. We’ve seen how Associated Surgeons and Physicians, LLC has gained significant
benefits from virtualization by extending the benefits to mobile, embracing BYOD, and then
moving into advanced DR.

10. We've seen how they used a VMware-centric infrastructure approach to go from a 100 percent
physical 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 and
Physicians 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: VMware
Transcript of a BriefingsDirect podcast on how Associated Surgeons and Physicians, LLC went
from a 100 percent physical to a 100 percent virtual infrastructure. Copyright Interarbor
Solutions, LLC, 2005-2013. All rights reserved.
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