Saint Raphael Healthcare System

Hospital Uses Virtualization to Speed Rollout of New Services and Improve Uptime

Saint Raphael Healthcare System runs the Hospital of Saint Raphael in New Haven, Connecticut, which is renowned for excellence in patient care, customer service, and medical education. To maintain its competitive stature, the hospital must constantly introduce new patient and physician services, most of which require technology support. However, the hospital’s data center was approaching capacity and its staff was unable to take on more server management work. To reduce server-related work and increase business agility, Saint Raphael’s is using Hyper-V™ virtualization technology, part of the Windows Server® 2008 operating system. It’s using Microsoft® System Center Virtual Machine Manager 2008 to simplify server management and Terminal Services in Windows Server 2008 to provide easier Web-based application access to users. Saint Raphael’s can now quickly roll out new services.

 

Situation

The 511-bed Hospital of Saint Raphael, a community teaching hospital affiliated with Yale University School of Medicine, is renowned for excellence in patient care and medical education.

With other outstanding hospitals in its service area, Saint Raphael’s has to be as attractive as possible—the preferred provider—for patients and physicians. Key points of differentiation for Saint Raphael’s are the level of personal service it offers patients and its attentiveness to physician needs. Saint Raphael’s has in-house medical staff, but it also depends on community-based private-practice physicians who work with and refer patients to the hospital. Forming and maintaining such partnerships is critical to Saint Raphael’s business model.

“Great physician services are important to our medical staff,” says Paul Acampora, Manager of Customer Service for Saint Raphael Healthcare System. “We want to do everything we can to ensure that physicians are comfortable working with us and that they can efficiently get the information they need to care for their patients. Otherwise, they will work with another hospital.”

We are using Hyper-V to quickly and cost-effectively roll out new services, which makes our hospital a more attractive partner to physicians and other organizations. Paul Acampora Manager of Customer Service, Saint Raphael Healthcare System

Toward this goal, Saint Raphael’s wanted to extend its patient management application (from Misys Healthcare Systems) to its private-practice physician offices. This would enable these physicians to conveniently view their Saint Raphael patient records from their own offices, resulting in better patient care for Saint Raphael’s patients. Conversely, Saint Raphael’s wanted to make private-practice physician patient records available through Misys, so that physicians could view their private-practice patient records from Saint Raphael’s computers.

In launching previous initiatives in support of better patient and physician service, the Saint Raphael IT staff had often faced roadblocks in requisitioning and provisioning supporting technology. It could take months to get needed servers ordered and installed.

In the Misys initiative, Saint Raphael’s would need more than 400 servers to extend the application to serve private-practice physicians—three to four servers to accommodate each of 110 offices. That would add more than 400 servers to Saint Raphael’s existing data center, which was already crowded at 200 servers.

“The server hardware would probably have been cost-prohibitive, meaning that we wouldn’t have been able to implement the project,” Acampora says. “Even if we had the budget for 400 new servers, it would have taken months to order and deploy them. We typically lose a half-day deploying a single server; deploying 400 servers would have taken months and severely impacted my staff’s productivity.” Saint Raphael’s knew that it needed to find a better way to implement new services than rolling out racks of servers.

Saint Raphael’s had already experimented with server virtualization, using Microsoft® Virtual Server 2005 R2. However, that technology had limits—an inability to support server clusters, 64-bit operating systems, and multiprocessor hardware, all of which the latest version of the Misys application required.

To provide hospital employees with easy access to server-based applications from their desktop computers, Saint Raphael’s had also used Terminal Services in the Windows Server® 2003 operating system and Citrix application virtualization products. However, Saint Raphael’s was eager to reduce the cost of these presentation virtualization servers by accommodating more users on each server.

Solution

Although Saint Raphael’s had encountered limits with earlier virtualization technology, it was clear to Acampora that virtualization was a key strategy for the hospital as it looked to expand its services. “The savings potential from virtualization is outstanding,” Acampora says. “Hardware, software licensing, and server management costs are all reduced in a virtual environment. But just as important is the increased infrastructure flexibility that virtualization provides. The portability of virtual machines [VMs] is a key benefit for us—the ability to quickly move a VM to another host server to achieve better performance or availability.”

For example, if a server is running out of memory and causing application performance to bog down, the IT staff does not have to schedule downtime to upgrade the server, which affects user productivity. Instead, the staff can simply move the VM running the application to a more powerful server.

Hyper-V: the Superior Choice

To increase efficiency and savings, Saint Raphael’s revisited the software market in early 2008 to evaluate the newest entrants on the virtualization scene. It evaluated the Windows Server 2008 operating system with Hyper-V™ technology, Citrix XenServer, and VMware ESX. “VMware was cost-prohibitive for us, and the redundancy features in the VMware and Citrix products were not yet available,” Acampora says. “I refuse to buy a product on the promise that a key feature will be available next year.”

Acampora was drawn to Hyper-V because of its significantly lower cost, its immediately-available clustering and redundancy capability, its support for 64-bit applications, and the fact that it was a Microsoft technology. “We are primarily a Microsoft shop, and we’ve been building that relationship for years,” Acampora says. Also, Saint Raphael’s liked the looks of the overall Microsoft virtualization road map, which spans server, application, presentation, and desktop virtualization and includes thorough virtualization management solutions.

Saint Raphael’s was also interested in using the latest improvements to Terminal Services in Windows Server 2008. “The new Windows Server 2008 Terminal Services provides substantially greater concurrency than previous versions of Terminal Services,” Acampora says. “In a 64-bit environment, we can accommodate more users on each virtual machine, easily move VMs around, and adjust memory and CPU requirements on the fly to keep performance high.”

First Virtualization Efforts

Saint Raphael’s worked with its local Microsoft sales team to learn more about Microsoft virtualization solutions and how the hospital could use them. “Microsoft was very helpful in talking with us about the virtualization market, future Microsoft products, cluster design, and technical issues,” Acampora says. “With its assistance and insight, we were able to move ahead with clustering and formulate a plan for backing up virtual machines with Microsoft System Center Data Protection Manager 2007.”

By deploying one server with eight VMs, we eliminate seven servers. We expect to realize at least an 8 to 1 server consolidation ratio. Paul Acampora Manager of Customer Service, Saint Raphael Healthcare System

Saint Raphael’s deployed Windows Server 2008 Standard and Windows Server 2008 Enterprise with Hyper-V on seven Intel SR1550 servers with two Quad-Core Intel Xeon processors. Acampora’s staff then created four to six virtual machines on each server. “I selected Intel-based servers because they have yielded a cost savings of 25 to 50 percent per server, with a failure rate near zero,” Acampora says. “Using the 1U servers, we have been able to standardize on one hardware platform for most of our needs, giving us the flexibility to use as few as two internal drives to eight internal 2.5-inch drives. This has made purchasing quite easy.”

The VMs run the Windows Server 2008, Windows Server 2003 R2, Windows® 2000, and even the Windows NT® operating systems. These older operating systems run U.S. Food and Drug Administration–approved applications that cannot be changed or upgraded. Running older applications on virtual machines is a perfect way to move them to newer, more powerful hardware and improve application performance. Saint Raphael’s also runs the Misys application, domain controllers, and Distributed File System servers on its VMs. Saint Raphael’s will soon migrate its Virtual Server 2005–based VMs (approximately 20) to Hyper-V. Saint Raphael’s has also configured two Windows Server 2008 Enterprise–based servers as a Hyper-V cluster, to provide high availability for Misys.

Integration with Microsoft System Center Solutions

Saint Raphael’s uses Microsoft System Center Virtual Machine Manager 2008 to manage its virtual landscape. A member of the Microsoft System Center suite of management solutions, it provides centralized management of virtual machines, accelerated provisioning, and easy VM performance tuning. “Integration of System Center Virtual Machine Manager 2008 and Hyper-V was key for us,” Acampora says. “It gives us an easy way to manage Hyper-V servers. Plus, we can manage our Virtual Server 2005–based VMs from the same console until they are migrated to Hyper-V.”

Saint Raphael’s will use Microsoft System Center Data Protection Manager 2007, a disk-and-tape-based backup solution, to back up its VMs. “When we integrate System Center Data Protection Manager 2007 with System Center Virtual Machine Manager 2008, we will have much faster recovery times,” Acampora says. “We will be able to back up servers at close increments—say every 15 minutes—using the System Center Data Protection Manager 2007 Snapshot feature. In the event of a server failure, we will lose only a very small window of data, if any.”

Benefits

By embracing server and presentation virtualization, Saint Raphael’s has been able to immediately roll out the Misys patient management application to private-practice physician offices and similarly move quickly on other service initiatives. This improves the hospital’s competitiveness. Saint Raphael’s is also using virtualization to improve application availability, reduce server costs, and improve application performance.

Faster Introduction of New Services

Saint Raphael’s has been able to roll out the Misys patient management application to private-practice physician offices without enormous hardware and data center investments or a lengthy lag time for ordering and deploying physical servers. “We are using Hyper-V to quickly and cost-effectively roll out new services, which makes our hospital a more attractive partner to physicians and other organizations,” Acampora says. “In this sense, virtualization enhances our business model and our profitability.”

By extending Misys to private-practice physician offices, Saint Raphael’s has strengthened the hospital’s relationship with those physicians. This, in turn, has the potential to bring in increased revenue through increased patient referrals.

Higher Application Availability

Saint Raphael’s is taking advantage of Windows Server 2008 clustering to provide low-cost high availability for Misys and other critical clinical and administrative applications. “Clustering enables us to deliver 100 percent uptime,” Acampora says. “We can lose one of our hosts and instantly fail-over its VMs to another system. Instead of experiencing a 24-hour outage, our users see only minutes of outage, if that. It enables us to provide better service to our users.”

Reduced Server Hardware Costs 

For the Misys project alone, Saint Raphael’s was able to deploy only 100 servers instead of 400, saving approximately U.S.$1.5 million in hardware costs and another $150,000 in additional project-related hardware. Going forward, Acampora estimates that the hospital’s hardware savings from virtualization will increase, depending on the number of new applications required. “By deploying one server with eight VMs, we eliminate seven servers,” Acampora says. “We expect to realize at least an 8 to 1 server consolidation ratio.”

Also, using the Windows Server 2008 Terminal Services Gateway feature, Saint Raphael’s can publish applications to the Web, which will reduce its need for Citrix servers. Using Terminal Services Gateway, remote users can connect to terminal servers and remote desktops on a corporate network from any Internet-connected device.

With fewer servers, Saint Raphael’s also enjoys lower electrical and cooling costs and purchases fewer keyboard/mouse/video switches and network switch ports.

Lower Server Management Costs

In addition to reduced hardware-related costs, Saint Raphael’s is realizing lower server deployment, management, and operating-system licensing costs. “Server deployment time has gone from four weeks to three days, including the time needed to order a physical server,” Acampora says. “We can deploy a VM within an hour. Faster server deployment translates directly into better customer service. The faster we can deploy servers in support of new services, the better patient care we can provide.”

Using System Center Virtual Machine Manager 2008, Saint Raphael’s IT staff has reduced its server management workload. According to Acampora, “Using virtualization, I can keep my engineers in their offices and out of the data center” (which they previously frequented to check on servers). “We have four engineers who used to spend several hours each day doing manual server management chores. Using System Center Virtual Machine Manager, we can either automate these tasks or engineers can perform them from their offices.”

Previously, deploying a new application required that engineers physically receive the hardware from the loading dock, carry it into the data center, order power and network drops, configure the server, install the operating system and application, and test everything. “None of this happens with VMs,” Acampora says. “We can create a VM in minutes, then install the operating system and application and run tests, all within three days.”

Deploying a Hyper-V–based virtualization solution cost significantly less than competitive solutions. “Hyper-V licensing was 50 percent less than competitive solutions, which is important to us as a not-for-profit hospital,” Acampora says. “With each copy of Windows Server 2008 Enterprise, we get four VMs. Annually, we’ll realize a licensing savings of approximately $20,000.”

Improved Application Performance

As a serendipitous benefit of moving to Windows Server 2008, Saint Raphael’s has seen application performance increase. “Application performance under Windows Server 2008 far exceeds performance under Windows Server 2003, even when running on lighter hardware,” Acampora says.

Saint Raphael’s is also evaluating Microsoft application virtualization using Microsoft Application Virtualization (formerly SoftGrid® Application Virtualization). Using this, Saint Raphael’s would be able to deploy new-application releases faster, using fewer staff hours, and potentially improve application performance. “We’re looking at virtualizing all sorts of applications in our data center,” Acampora says. “With Microsoft virtualization technologies, we have opened up new ways to save money and better serve our patients and physicians.”

 

Microsoft Virtualization
Microsoft virtualization is an end-to-end strategy that can profoundly affect nearly every aspect of the IT infrastructure management lifecycle. It can drive greater efficiencies, flexibility, and cost effectiveness throughout your organization. From accelerating application deployments; to ensuring systems, applications, and data are always available; to taking the hassle out of rebuilding and shutting down servers and desktops for testing and development; to reducing risk, slashing costs, and improving the agility of your entire environment—virtualization has the power to transform your infrastructure, from the data center to the desktop.

For more information about Microsoft virtualization solutions, go to:
www.microsoft.com/virtualization

 

For More Information

For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:
www.microsoft.com

For more information about Saint Raphael Healthcare System products and services, call (203) 789-3000 or visit the Web site at:
www.srhs.org