Over the past few years, VMware vSAN has made significant progress with healthcare technologies. Working closely with InterSystems, VMware has helped to improve vSAN for mission-critical healthcare environments.

1. Healthcare on vSAN
Christian Rauber Staff Solutions Architect
Mike Lonze Dir. Healthcare Alliance Engineering
#vmworld #HCI3062BU
HCI3062BU
Todd Winey Dir. Partner Programs InterSystems

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• This presentation may contain product features or functionality that are currently under development.
• This overview of new technology represents no commitment from VMware to deliver these features in
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• Features are subject to change, and must not be included in contracts, purchase orders, or sales
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• Technical feasibility and market demand will affect final delivery.
• Pricing and packaging for any new features/functionality/technology discussed or presented, have not
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• This information is confidential.
Disclaimer
The information in this presentation is for informational purposes only and may not be incorporated into any contract. There is no commitment or obligation to deliver any items
presented herein.

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Agenda
3
State of the Union Healthcare
Challenges, risks, and architecture
Achieving Operational Excellence
Recommended practices
Healthcare on vSAN
Before and after

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Healthcare
State of the Union – Todd Winey
Challenges, risks, and architecture

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InterSystems Healthcare Mission
Empower sustainable health system
transformation through unified health
information

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InterSystems Overview
• Global leader in healthcare data management and analytics
• #1 KLAS rated EHR-Independent HIE technology
• Leading International EHR and Core Technology that
Supporting Epic Domestically
• Privately held, stable, and profitable business built on
partnerships
• Unparalleled performance, scalability, interoperability, and
reliability
• HealthShare and IRIS for Health are at intersection of
healthcare transformation for payers, providers, and life
sciences providing real time access to clinical data100+
Countries
>500M
Patient Lives
2/3
US Patient Records
#1 HIE
KLAS EHR-Independent
What we do
Cambridge HQ

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and power leading healthcare software solutions.

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What’s behind digital transformation in healthcare?

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Information Intensity
0
5
10
15
20
25
30
35
40
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Terabytes
1 TB of Data Over Time: All other Data Healthcare Data
Healthcare data is growing 60% faster than data
from other industries
From 2016 to 2025, the amount of healthcare
data will grow 3300%
Derived from IDS, 2014, 2017

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SetsofFactsperDecision
10
100
1000
William Stead, et al
Academic Medicine. 86(4): 429-434, April 2011.
1990 2000 2010 2020
Year
Human Cognitive Capacity
More importantly,
it already exceeds
the decision
making capacity of
the human mind

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Precision
Medicine
Need continuous,
rapid innovation
Machine
Learning
Mobile Apps
Big Data
Internet of
Things
Web Services
Patient Care
Compliance
Supply Chain
Financial
Management
Staffing
Operations
Need stability, reliability
& gradual change
Healthcare IT Must Balance Two Worlds – Bimodal IT

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Hyperconvergence is where Healthcare IT Is Headed
• Continual pressure to reduce operational costs
• Healthcare margins are under pressure on multiple fronts. HCIT has been a traditional laggard on IT.
• Continual pressure to ensure availability
• Mobile access, 24/7 operations, compressed diagnostics times
• Continual pressure to maintain more systems that are “mission critical”
• Meaningful use made EHRs even more “meaningful”
• Continual pressure to improve security of data, devices and overall systems.
• Breaches of patient data carry serious reputational risk
• Continual pressure to make systems available to MORE users
• Doctors, nurses, care coordinators, patients, administrators, payers

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HCI in Healthcare – A path to simpler infrastructure
Simpler is always better, most digital transformation efforts fail due to
complexity
• HCI can improve availability
• Increase scalability
• Elasticity and data efficiency
• Thereby decreasing hardware costs
Simpler infrastructure can be more secure
• Increase device security
• Data protection
• and security via fewer attack surfaces

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HCI Offers a path to cloud operations
• HCI can be deployed on-premise, or in the cloud
• Flexibility of server choice
• Mix of older hardware and operating systems
• Transitioning to cloud native operations – Kubernetes, containers
• Giving organizations flexibility and control over environments
• HCI paves the way for public cloud and hybrid infrastructure
• All managed in the same way

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Healthcare and technology
are evolving at a rapid pace

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Application delivery is no
longer a “request” it is
expected

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Healthcare
Challenges
Projects are driven by
applications
and physicians
IT is not perceived as a
partner
Silos expose the barrier
between infrastructure
and application delivery
Silos and perception
should not impact
business

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Clinicians unable to update patient records
Extended wait times for basic services
Delayed results can impact patients, hiring, legal
Technology related burnout rates
New projects and funding put on hold
Risks
Healthcare

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Architecture is much more than
Healthcare on vSAN
Architecture
Deploying
VDI sessions
EMR InfrastructureClinician Workloads

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Operational excellence is
Healthcare on vSAN
Architecture
Streamlining processes
Empowering the staff
to research and seek
out alternatives
Proactively
collaborating with
department heads and
application owners
Minimizing the impact
to users and the
business
Ensuring the “utility”
stays on

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Achieving Operational Excellence
Recommended practices

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InterSystems and Epic - vSAN Work
• 18+ months of validation across multiple high performance
scenarios
• Multiple shared clients
• Continued evaluation and validation of our evolving platforms –
vSAN and InterSystems IRIS
• Analytical Database – Clarity
• End User Compute – Hyperspace

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Sizing matters
Epic on vSAN™
Planning and sizing
The number
of VMs/hosts
Current CPU (family),
RAM, and the size
of the database
Network architecture
(Call them before
they call you)
Epic Hardware
Configuration Guide

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IntertSystems and Epic Operational Databases on vSAN
Recommended practices
Networking
≥25GB
Non-blocking
High-buffer switch
(e.g. Dell S5048 or
Mellanox S2410)
Best practices
vSAN networking
CPU
≥Intel 6132
RAM
≥512GB per host

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Epic Cogito and Clarity on vSAN
Recommended practices
Networking
≥25GB
Non-blocking
High-buffer switch
(e.g. Dell S5048 or
Mellanox S2410)
Best practices
vSAN networking
CPU
≥Intel 6132
RAM
≥512GB per host

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Epic Caché, Cogito and Clarity on a single vSAN Cluster
Recommended practices
Networking
≥25GB
Non-blocking
High-buffer switch
(e.g. Dell S5048 or
Mellanox S2410)
SPBM
Set non-Prod Caché
VMs to IOPs Limit
CPU
≥Intel 6132
RAM
≥512GB per host

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Minimum of two disk groups per host
NVMe (MU/WI) for cache tier
NVMe (MU/RI) or SAS (MU) for capacity tier
SPBM RAID 1 for all VMDKs, FTT=2
Do not enable DD/comp
Recommended practices
Epic Caché on vSAN

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Minimum of two disk groups per host
NVMe (MU/WI) for cache tier
NVMe (MU/RI) or SAS (MU) for capacity tier
SPBM RAID 1 for data and log VMDKs, FTT=1
Do not enable DD/comp
Recommended practices
Epic Cogito on vSAN

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Minimum of two disk groups per host
NVMe (MU/WI) for cache tier
NVMe (MU/RI) or SAS (MU) for capacity tier
SPBM RAID 1 for ALL data and log VMDKs, FTT=2
SPBM IOPS Limit for All Cogito data and log VMDKs
Do not enable DD/comp
Yes, Epic Caché and Cogito coexist on the same vSAN cluster.
Epic Caché and Cogito on vSAN

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Epic Hyperspace or Cerner Millennium vSAN Cluster
Recommended practices
Networking
≥25GB
Non-blocking
High-buffer switch
(e.g. Dell S5048 or
Mellanox S2410)
SPBM
RAID5
CPU
≥ Gold
≥ 2.4
≥ 14 Cores
RAM
≥512GB per host

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Minimum of two disk groups per host
NVMe (MU/WI) for cache tier
NVMe (MU/RI) or SAS (MU) for capacity tier
SPBM RAID 5 for ALL VMDKs, FTT=1
Do enable DD/comp
Recommended practices
Epic Hyperspace or Cerner Millennium vSAN Cluster

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Solving Healthcare on vSAN

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Answer key
Why
RAID1?
Why disable
DD/comp?
Why two disk
groups min?
Why networking?
2x

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Behind the answers
Users reported slower
response times
Applications themselves
were running slower
Business processes were
taking much longer to
complete

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The Core Issues
Network is reporting
it's sunny outside
VM is resourced
Storage is reporting
that it's raining outside
Here we hit the
mother of all silos
Packet drops and
retransmits at the
ASIC only support can
investigate
VM is
sufficiently sized and
has adequate
resources
>200ms
response times

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Copying large data sets
across the network
Running very large reports
Load testing using
HCIBench, sample
data sets
What failed?
What worked?
Solving the problem before it becomes a problem
Upgrade
the switch
Coordinate
with OEM
Upgrade to
latest code

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Why Healthcare on vSAN
There should be
no mystery or suspense
in production
Small hospitals can leverage a
single ecosystem
Manage and scale
as needed
Prod EMR VDI POD Infrastructure
vCenter®

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Why Healthcare on vSAN
A freedom of choice—manage
collectively or independently
The same methodology on a
single platform
Simplifies business processes
Larger Hospitals
EMR VDI Test
vCenter vCenter

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SPBM explained
vSphere® vSAN
vSAN Datastore

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Healthcare on vSAN
Before and after

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Before vSAN
Different array types
Different networks
Multiple contracts
and expertise
Constant context switching
Managing multiple ecosystems

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After vSAN
Improved flexibility on vCenter to
vSAN, host version interoperability
vCenter is now compatible with
vSAN hosts with higher versions in
same release line
Helps accommodate scenarios
such as urgent fixes and security
patches
vSAN 6.7 U1 vSAN 6.7 U2 vSAN 6.7 U3
Custom BaselinesCustom BaselinesCustom Baselines
System Baseline System Baseline System Baseline
vSphere Update Manager
vmware.com
Required on
Major Version
Upgrades
VAMI
vCenter
6.7 GA
HCL Database Release Catalog