Get on Board With Virtualized Servers

As any PACS administrator can attest, the cost of advanced imaging technology is higher than the price of a new CT or PET scanner. As the number of DICOM images attained per scan increases exponentially, software and hardware alike have a hard time keeping up with the load; no matter how powerful your PACS, without the back-end server power necessary to keep it running, you might as well be reading from a light box. That’s why tech-savvy hospitals are turning to a new solution that just might revolutionize the server room as we know it: virtualized server environments. Scott Starkey, director of digital imaging for OhioHealth Information Services, Columbus, Ohio, is responsible for maintaining Synapse PACS (from Fujifilm Medical Systems USA Inc, Stamford, Conn) across five primary OhioHealth hospitals. “We’re about 2,000 beds, total,” he says. “We have more than 120 radiologists reading at all five sites. From OhioHealth facilities, the radiologists read remotely for a dozen other central Ohio hospitals.” Starkey and his team began looking at the possibility of virtualizing as part of OhioHealth’s business-continuity and disaster-recovery strategy. “We had a stand-alone production system, and had the ability to recover from a disaster from both spinning disk and tape,” Starkey explains. “A few years ago, we had a human-error problem that led to extended downtime. A recovery time of zero wasn’t part of our initial strategy, so we worked with Fuji to implement a business-continuity solution. Working with a vendor to validate your strategy is critical.” Just ask Reynold Yordy, business manager for Fujifilm’s Managed Services Division. Yordy was sold on virtualized server environments after hearing about a demonstration of virtualization software at a trade show. The software vendors demonstrated moving a server from one physical host to another while playing a video, showing how the video streamed continuously despite the shift. After that, Yordy and his team were sold. There’s No Place Like Oz It wasn’t quite as easy, though, as clicking their heels three times and landing in the virtualized environment of their dreams. Yordy and his team wanted to convert one of Fujifilm’s data centers—a remote image-archiving center for customers outsourcing storage—to a virtualized environment, but first they had to prove that the technology wouldn’t lead to server inefficiency and increased downtime. "Moving into a virtual environment took considerable planning," Yordy notes. "We worked with each area of our organization to help them understand what virtualization was all about." Now the remote-archiving data center runs on eight processing cores—but only four are physical processors. Virtualization cut Fujifilm's total cost of ownership by 50%. "At the end of the day, it was about the customer," Yordy says. "We could provide higher levels of service for our application at a competitive price." Price was a key consideration for the team at OhioHealth as well. “It’s always an important initiative for anyone with a lot of hardware because of power requirements and physical environments,” Starkey says. “That’s germane to everybody. Servers cost a great deal of money, so there’s an economy of scale to virtualizing, but we’re looking more toward business continuity and disaster recovery. The perfect solution would be cost prohibitive, and that’s where virtualization really helps us.” How does it work? Many of OhioHealth’s mission-critical servers—and 18 PACS servers—are now virtualized across a live remote second data center, where Starkey and his team replicated their SAN, redundant server farm, and redundant network infrastructure. “Now, if our data center suffers a major problem, we switch over to the remote data center,” he says. The physical servers are HP Blade units, virtualized using VMWare ESX; Starkey and the OhioHealth technical teams manage them using an ESX program called Virtual Center. “That allows us physically to move live operating servers between physical hardware, so if we start to see a hardware problem, we can move that virtual server,” Starkey explains. OhioHealth is also beginning to virtualize the desktop end of its PACS, offering referring physicians the ability to read reports and view images via Synapse client. “We’re testing the use of VMWare and a virtual access suite to push out the client to referring physicians' workstations,” Starkey says. “Doing that for referring physicians will allow us to offer much better customer service. Increasing referrals is about a lot more than just virtualizing, but we have heard from our radiologists that because of the changes we’ve made in the infrastructure, their confidence in the stability of the system has significantly improved over the past year.” Add Infrastructure Support Virtualizing has given OhioHealth the ability to expand the number of DICOM and Web servers in use greatly, without much additional cost. “Where it might have been sufficient to deploy three, four, or five servers for a facility, we can now deploy a multiple of that,” Starkey says. “Cost can be a significant motivator for a smaller community hospital looking to do this, but with virtualizing PACS, you have to be sure to build the proper infrastructure.” When preparing to virtualize, Yordy suggests keeping in mind the following pointers. First, take it slowly. Don’t jump in and virtualize everything at once; instead, opt for a phased approach. Second, get training. While many IT teams tend to think they’re bulletproof, that isn't necessarily the case. Some virtual vendors offer online and on-site courses; be sure to take advantage of their training. Third, check compatibility. Your provider should offer a compatibility matrix, allowing you to make sure your hardware is optimal for the virtual server. Fourth, get vendors involved. Hospitals usually have multiple third-party applications, including billing systems, radiology information systems, and PACS. Work with your vendors as you move into the virtual environment to make sure all applications integrate seamlessly. Fifth, collaborate. Seek advice from hospitals already using the system because there are many tips and tricks that initial users learned the hard way (for example, virtual servers perform better with a single processor.) Pointers learned by others through trial and error can decrease the difficulty of the process significantly. Starkey’s experience jibes with Yordy’s advice. “Learning how to balance the virtualized environment on the physical environment was the most difficult part,” Starkey says. “It’s a learning curve. You need to work very closely with your vendor; not all applications are capable of being virtualized. There’s a lot of policy work when you change from a physical to a virtual environment. If people virtualize and use a single point of hardware, their entire enterprise could be at peril," he adds, based on the possible failure of that single piece of hardware. In the end, however, the benefits of virtualizing far outweigh the risks. “If we have a problem, we can replace the server very quickly,” Starkey says. “With server consolidation, we’re using less power, less air conditioning, less physical space in our data center, and so on. A recovery time of zero has been achieved, in part, by using virtualized servers, and that was really our objective.” The cost savings have been substantial: the price to use VMWare Virtual Server on a DL685 Blade is around $1,000, while the cost of a similar configuration on a physical server would be about $15,000. Yordy’s team is pleased with virtualization as well. “The results of moving to a virtual environment have been amazing, and we are just hitting the tip of the iceberg," he says. "As virtualization continues to gain in popularity, more and more tools will be developed to allow us further to exploit the benefits virtualization affords. We're excited about what the future has in store."