Cancer Treatment Centers of America (CTCA) is dedicated to the fight against cancer. It strives for excellence in every aspect of its operations, but it found that its mission-critical messaging system could not keep pace with the organization’s
rapid growth. CTCA also wanted to provide employees with greater flexibility in accessing email, such as support for a variety of mobile devices. The organization worked with Microsoft Partner Network member New Resources Consulting to upgrade to Microsoft
Exchange Server 2010 and establish a complete disaster recovery site for redundancy. CTCA employees now have a reliable solution that includes the ability to work from anywhere without a complicated authentication process, so they can be more responsive to
patients’ needs. The IT team now spends less time supporting the messaging infrastructure and can focus its efforts on more strategic work.
When patients with complex and advanced-stage cancer need a dedicated team to join them in their fight, many turn to Cancer Treatment Centers of America (CTCA) for comprehensive cancer care. CTCA searches for and provides innovative therapies to heal
the whole person, improve quality of life, and restore hope. The organization’s cancer hospitals and clinics include facilities in Philadelphia, Pennsylvania; Zion, Illinois; Tulsa, Oklahoma; Goodyear, Arizona; and Seattle, Washington. It also plans to open
a hospital in Newnan, Georgia, in 2012.
||Since we moved to Exchange Server 2010, we definitely are benefitting from using the range of opportunities to enhance messaging system reliability, security, and productivity.
Director of Infrastructure, Information Technology,
Cancer Treatment Centers of America
To ensure that CTCA provides the highest levels of patient care, every aspect of CTCA needs to run efficiently, including its IT infrastructure. One of the IT systems that employees depend on most is email, which they use to exchange clinical and operational
information, communicate with current and prospective patients, schedule meetings, and more. “Our messaging system is used very heavily, both for widespread communications and impromptu collaboration by nurses, doctors, and other employees,” says Eric Sato,
Director of Infrastructure for Information Technology at Cancer Treatment Centers of America. “For example, our oncology information specialists constantly send email to potential patients, often with scanned documents attached.”
“We definitely consider messaging a mission-critical, tier-one application,” adds Scott Johnson, Data Center Manager at Cancer Treatment Centers of America. “On the IT side, we do a lot of alerting through email, such as notifying employees of planned system
downtime. On the treatment side, our doctors and nurses definitely use email to communicate about and with CTCA patients.”
For some time, CTCA had relied on successive versions of Microsoft Exchange Server to satisfy its messaging needs. By 2010, CTCA was quickly outgrowing its messaging environment, which was based on Microsoft Exchange Server 2003, and recognized that the
environment could not meet some of its emerging needs, such as support for mobile workers, encryption consistent with regulations under the Health Insurance Portability and Accountability Act of 1996 [HIPAA], and comprehensive disaster recovery.
The existing CTCA messaging environment was becoming unreliable, and it also had never been set up to provide adequate redundancy, which compounded the problem. “With no redundancy setup, we had no protection against users experiencing downtime,” says
Victor Sanchez, Senior Server Administrator for Information Technology at Cancer Treatment Centers of America. In fact, the IT team avoided making software updates for more than a year because the server setup was so difficult to manage. “We tried not to touch
the messaging environment,” continues Sanchez. “We did not want to risk system downtime in our number-one means of communication.”
The organization needed to set up a more consistent email recovery mechanism to address the outages and unreliable email delivery that employees experienced. Space to store records of all email activities was limited. If the accumulated records were not
removed promptly, it would negatively affect system performance. “When the drives filled up, employees could go without email backup for several days, and two or three times, the system went down entirely,” says Sanchez. Certain IT staff members had to closely
monitor the system, clearing the backup drives a minimum of every two days to avoid downtime.
In addition, employees had to accommodate CTCA mailbox size limitations, which typically meant dealing with the hassles of using .pst files to store and retrieve their email. For example, one CTCA employee had a 2-gigabyte mailbox and a 20-gigabyte .pst
file, which slowed the performance of Microsoft Office Outlook 2003 messaging and collaboration client, which the organization used on its workstations at the time. Using .pst files was not only impractical; it was also risky because there was no backup for
those stored messages.
||Since moving to the Exchange Server 2010 messaging environment, I no longer am plagued by my former daily worries about the system going down and wreaking havoc on hospital communications.
Senior Server Administrator for Information Technology, Cancer Treatment Centers of America
The CTCA IT team dedicated a tremendous amount of time to maintaining the Exchange Server 2003 infrastructure and helping employees deal with issues. “From a support perspective, it took valuable time to restore a mailbox or an individual message because the
entire mail store for that particular user had to be restored,” says Sato. “That inefficiency affected employees as well, who had to wait without email while the IT team resolved the issue.”
The Need for Disaster Recovery Capabilities
The previous messaging system design at CTCA had resulted in the lack of a proper disaster recovery environment. “As CTCA started to expand, we sought to ensure high availability for all employees, which included gaining more flexibility across multiple
data centers,” says Sato. “We knew that we needed to upgrade our messaging system to bring us closer to our goal of maintaining 100 percent messaging-system uptime and availability and also support our projected growth.”
The organization’s previous messaging environment consisted of stand-alone production servers located in Schaumburg and Zion, Illinois. The CTCA backup servers were in Zion, Illinois, and had to be manually brought online in the event of an outage. “Our
traditional setup did not have any disaster recovery solution in place, other than manually restoring from backup to an alternate Exchange Server and mounting the mail data store,” says Johnson. “This was a cumbersome process that was very time-consuming and
disruptive. We needed something that would better prepare CTCA for emergency situations.”
Support for More Flexible Use
CTCA also wanted to boost workforce efficiency by making it easier for employees to gain access to email from home and elsewhere. Physicians, administrators, and other employees encountered issues when trying to use smartphones for work; long delays
and difficulties when synchronizing calendars and contacts among their various computers and mobile devices were common. “CTCA doesn’t follow a typical 9-to-5, five-days-a-week work schedule, and as smartphones grew in popularity, employees’ expectations of
being able to work from anywhere also rose,” says Sato. “They wanted straightforward mobile communication abilities and easier remote access to their email.”
CTCA doctors, nurses, and others had to go through an often cumbersome, time-consuming process involving the use of a virtual private network (VPN) to check their email remotely. CTCA had set up the messaging infrastructure so that some employees could use
Microsoft Office Outlook Web Access while on-site—to send and receive email messages from a hospital’s mobile workstation, for example—but not outside the organization’s firewall.
The organization also wanted its Mac users, several CTCA executives among them, to have an easier time accessing email. “We wanted to streamline the messaging experience for all employees so that they could make even more effective use of their time,” says
CTCA determined that the time had come to find a new messaging system, and it looked no further than Microsoft Exchange Server 2010. “CTCA has a very strong partnership with Microsoft. We use a number of its enterprise solutions, and many of our engineers
have expertise and certifications in Microsoft technologies, so it did not make sense for us to go with anything other than Exchange Server 2010 for our email,” says Sato. “We were especially excited to take advantage of the Database Availability Groups and
the opportunity to split our server resources among multiple data centers to give us a highly available environment.” Database Availability Groups are groups of up to 16 mailbox servers that host a set of databases and provide automatic database-level recovery
from failures that affect individual servers or databases.
||We count it as a huge measure of success that there has been no messaging system downtime since the upgrade to Exchange Server 2010.
Senior Server Administrator for Information Technology, Cancer Treatment Centers of America
CTCA wanted to ensure that it designed the optimal messaging solution, so it interviewed multiple potential partners and selected New Resources Consulting, a member of the Microsoft Partner Network, to provide guidance during the Exchange Server 2010 implementation.
“Our New Resources Consulting expert already had conducted more than 20 Exchange Server 2010 upgrade projects. He was extremely knowledgeable and highly organized, so we felt good about our choice,” says Sanchez.
In December 2010, CTCA began working with both New Resources Consulting and a Microsoft technical specialist to make key decisions, draw up a project plan, and follow Microsoft best practices. The consultant from New Resources Consulting prepared the organization’s
Active Directory service structure and helped with troubleshooting. “We encountered some problems with command lines in Exchange Server 2010, but our consultant knew exactly what to do,” says Sanchez. The consultant used the Windows PowerShell command-line
interface to resolve the issues. New Resources Consulting then worked with CTCA IT staff members to transfer his knowledge to them, at which point they built the servers and began to move mailboxes to the new system.
CTCA upgraded 100 to 200 user accounts per day to the Exchange Server 2010 environment. “We chose to gradually move email accounts to the new solution because we were worried that our help-desk staff could not support the number of calls that might result
from an overnight upgrade,” explains Sanchez. “We expected 20 percent of employees to need help initially using Exchange Server 2010, but only 2 percent ended up calling for assistance.” Even during the transition, when some mailboxes had been upgraded and
others were still on the old system, employees had no difficulty with email communication between systems.
As of December 2011, CTCA has moved 90 percent of its mailboxes to the new environment. IT staff members are checking the remaining accounts to be sure that they are no longer in use before decommissioning the remaining two servers running Exchange Server
Part of the project also involved establishing greater redundancy in the organization’s messaging environment, to help with availability and disaster recovery. The previous infrastructure had included four servers running Exchange Server 2003 in Schaumburg
and two more in Zion. Each ran as a production mail service, and there was limited disaster recovery capability in place. Now the infrastructure includes a primary data center in Madison, Wisconsin, where the organization has four physical servers and two
virtual ones, and a disaster recovery setup in Schaumburg with two physical and two virtual servers. “We now have a dynamic messaging environment,” says Sanchez. “If one server fails, service automatically gets transferred to our facilities in Schaumburg or
to a different server in Madison, so employees have continual access to their email.”
CTCA also switched from using a storage area network (SAN) to using local, direct-attached storage that uses Exchange 2010 to replicate data from site to site, which makes it faster and easier to shift accounts between locations.
As another part of the upgrade project, CTCA consolidated seven voice over Internet Protocol (VoIP) systems into just one and integrated that consolidated system with its Exchange Server 2010 solution, to give employees the ability to receive voicemail messages
as email messages and vice versa.
In addition, the organization now uses the Microsoft Office Outlook Web Access web client to minimize the amount of software on its shared workstations, such as those used by mobile nurses in CTCA hospitals. The CTCA IT team created generic user accounts
for each mobile computer so that the computer remains logged on at all times and can be shared by nurses for convenient access to information and key applications. If nurses need to get to their specific accounts, they can quickly launch Outlook Web Access
from the browser and enter their credentials to ask a doctor or other healthcare worker key questions and receive rapid responses via email.
CTCA successfully designed and implemented a robust messaging infrastructure that operates at the same high level at which the rest of its systems function. “End users and IT staff no longer have to deal with messaging system downtime. Our physicians
and other employees can quickly and easily access their email and voicemail messages from wherever they happen to be, using whatever devices they choose. And overall worker efficiency and mobility have increased,” says Sato. “Since we moved to Exchange Server
2010, we definitely are benefitting from using the range of opportunities to enhance messaging system reliability, security, and productivity.”
Increased Reliability and Availability
Because CTCA now has an up-to-date messaging system with redundancy built into the architecture, employees enjoy greater uptime. “Since moving to the Exchange Server 2010 messaging environment, I no longer am plagued by my former daily worries about
the system going down and wreaking havoc on hospital communications,” says Sanchez. “IT staff members have no more dread—if there’s an issue, the server automatically switches employee accounts to another of our servers with no interruption of service. We
count it as a huge measure of success that there has been no messaging system downtime since the upgrade to Exchange Server 2010.”
||Improving the reliability and flexibility of our messaging system has enhanced caregivers’ ability to serve patients faster and better.
Director of Infrastructure, Information Technology, Cancer Treatment Centers of America
Employees throughout CTCA can trust that messages will get delivered as soon as they send them, and they have confidence that they are receiving their email in a timely manner. And, in case of catastrophe, the IT team has a fully operational disaster recovery
infrastructure that will continue to support “business as usual.” “If CTCA experienced a disaster, a crucial facet of our disaster recovery plan is to use email to send out vital information to our hospitals,” says Sato. “So having Exchange Server 2010 up
and active in multiple locations simultaneously is extremely important.”
Reduced Messaging System Managementby75 Percent
Whereas in the past, IT staff members had to carefully watch the organization’s messaging servers for issues, they now can dedicate themselves to more proactive IT tasks. “Bringing in the capabilities of Exchange Server 2010 has made it possible to extend the
reach of our existing IT team,” says Sato. “We keep a lean staff, so having fewer support issues on a daily basis and the ability to resolve them more quickly means that IT staff members have more time to tackle other, more strategic projects and initiatives.”
When difficulties do arise, the IT team is able to resolve them more quickly than it could in the past, due to the use of the Windows PowerShell command-line interface for scripting management changes. For example, an employee accidentally sent a particular
email message to every CTCA mailbox, and the IT team identified a way to use a single Windows PowerShell command to delete the message from every account. “We estimate that we will be able to cut 75 percent of the time we currently spend supporting our Exchange
Server environment,” says Sanchez. “Plus, we’re able to deliver faster time-to-resolution for email-related issues.”
Enhanced Security and Scalability
Although CTCA uses a third-party tool to encrypt email messages, it now has an additional safeguard for the vast amounts of email sent and received among Exchange Server 2010 users, both within and outside of the organization. “With the additional layer
of encryption from Exchange Server 2010, we’ve gained more than peace of mind about the security of our messages,” says Sato. “We have bolstered our ability to comply with regulatory requirements, such as those in HIPAA, which mandate high levels of protection
when sending and receiving patient information.” CTCA implemented Transport Layer Security and established policies to place mail accounts in legal hold for electronic discovery situations that may arise from time to time.
In addition, CTCA can conduct regular software updates because the IT team is no longer worried that doing so will result in unwanted downtime for employees. “We now do regular updates every two months, as opposed to occasional updates about every two years,
which means that we have a far healthier, more secure system,” says Sanchez. CTCA also gained more efficient management of its mobile environment and therefore optimized security over the organization’s information. For example, when employees leave CTCA,
IT staff can immediately disable their user accounts and wipe all email from their mobile devices.
Because CTCA took its planned expansion into consideration when designing its new messaging solution, the upgrade to Exchange Server 2010 also has had a positive effect on system scalability. “Future growth won’t cause us any headaches because we chose Exchange
Server 2010, which gives us what we need out-of-the-box, with no customization necessary,” says Johnson. “We have a flexible, highly available messaging structure that is easy to scale up as we add employees and whole facilities.” That is crucial, as CTCA
prepares to open its Georgia-based hospital in 2012.
Improved User Flexibility for Increased Productivity
IT staff members are not the only ones who appreciate the improvements that came with the messaging system upgrade. The CTCA help desk now receives significantly fewer email-related support calls because the organization resolved its syncing problems,
delays, and other reliability issues when it upgraded to Exchange Server 2010. “Overall, employees’ satisfaction has gone up now that they rarely need anything restored, and if they do, IT staff members can handle it so quickly,” says Johnson.
Following the upgrade, IT staff removed the mailbox size restrictions and showed employees how they could manage their email communications more efficiently and enjoy fast performance from Microsoft Outlook 2010. Employees no longer have storage issues or
concerns about losing valuable information, because they can rely on the archiving and retention capabilities in Exchange Server 2010 to ensure that all of their email is stored and automatically backed up.
Perhaps the biggest change for employees is the increased level of support for mobile devices and remote access. The ability to choose from a variety of mobile devices and to connect directly to the system makes a big difference when it comes to productivity.
“We felt a major push to improve support for mobile communications in our environment, and now our stakeholders can easily receive both email and voicemail messages on their smartphones,” says Sanchez. “Providing that mobile support and doing away with the
need for a VPN has made a lot of CTCA employees happy. By moving to Exchange Server 2010, we’ve given doctors, nurses, and others the ability to stay in closer contact, whether within or away from the hospital environment.”
Increased Responsiveness to Patients
CTCA employees can be more responsive to each other and to patients because of the reduction in email service interruptions. “Improving the reliability and flexibility of our messaging system has enhanced caregivers’ ability to serve patients faster
and better,” says Sato. “For instance, nurses in a patient’s room can quickly access their email to check a fact or send a question to a particular doctor, who now can instantly receive and answer that question from anywhere.”
CTCA employees are able to offer improved service to those outside the hospital setting, such as potential patients. For example, a prospective CTCA patient who was coming to visit one of the organization’s facilities was not able to get transportation from
the airport and called his oncology information specialist (OIS)—the only person the patient knew how to reach—to ask for help. That particular OIS was not working that day, but she checked her voicemail through email on her smartphone and quickly arranged
for a limousine to pick up the stranded traveler. “Because our phone system and Exchange Server 2010 environment work so closely together, our OIS could help the prospective patient in a timely manner, even though it was her day off,” says Sato.
Reduced Costs by at Least 30 Percent
Not only has CTCA gained flexibility, reliability, and overall employee productivity by upgrading to Exchange Server 2010, it also is conserving costs. “Just the move away from the enterprise SAN solution has resulted in storage cost savings of at least
30 percent,” says Sato. “We’re saving money while benefitting from better availability, disaster recovery, and redundancy. Plus, we’re avoiding the costs of lost and delayed email communications.”
Microsoft Exchange Server 2010
Microsoft Exchange Server 2010 can help you achieve better business outcomes while controlling the costs of deployment, administration, and compliance. Exchange Server 2010 delivers the widest range of deployment options, integrated information leakage protection,
and advanced compliance capabilities, which combine to form the best messaging and collaboration solution available.
For more information about Microsoft Exchange Server 2010, go to:
For more information about Microsoft Unified Communications, go to:
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