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1 SOLUTIONS BACKUP/RECOVERY/ARCHIVING CONSOLIDATION MANAGEMENT/UTILITIES VIRTUALIZATION Healthy IT Dell helps Nova Scotia hospitals reduce the number of servers by 84 percent, reduce the data center footprint by 65 percent, and cut energy costs by two-thirds Customer PROFILE COUNTRY: Canada INDUSTRY: Healthcare FOUNDED: 2006 NUMBER OF EMPLOYEES: 115 WEB ADDRESS: CHALLeNGe HITS-NS needed to replace unreliable, out-of-production, and unsupported servers to improve the availability of a critical healthcare management system solution Virtualized Dell PowerEdge servers provide a simple, reliable platform to run MEDITECH Client Server; VMware Infrastructure 3 hosts redundant virtual servers that help ensure the availability of the patient care application and enable the repurposing of servers to create a disaster recovery facility It is increasingly common for businesses to describe essential operations as mission critical. Health Information Technology Services- Nova Scotia (HITS-NS) understands the true meaning of the term because this IT organization guarantees the availability of patient records for 34 of Nova Scotia s hospitals. After all, what could be more critical than ensuring that doctors, nurses, and other healthcare professionals have continuous access to patient records so that they can base treatment on complete information? BeNeFits Dell and VMware infrastructure reduce the number of servers by 84 percent through consolidation and helps assure that hospital staff always has reliable access to patient records Dell PowerEdge servers help reduce data center footprint by 65 percent and cut energy costs by two-thirds Rapid disaster recovery helps ensure no interruption of patient care

2 HITS-NS provides ongoing network, systems, and application support for Nova Scotia s hospitals. The key application HITS-NS supports is the MEDITECH Client Server Hospital Information System (HIS). Because it is integral to nearly every hospital task, MEDITECH must be available 24/7. Unplanned downtime presents an unacceptable risk to patient care, says Gary Stronach, manager of technical services at HITS-NS. Even planned downtime is very disruptive. In a hospital environment, we take 24/7 literally the information must always be accessible. MEDITECH C/S stores and tracks patient health records throughout 34 of Nova Scotia s hospitals. Any doctor in any of these medical facilities, even a small three-bed clinic, can access patient health records. With MEDITECH C/S handling everything from admissions, lab work orders, diagnostic imaging including access to stored images and pharmacy operations, the application is a vital part of Nova Scotia s healthcare system. through its partnerships with software companies, detailed product road maps, and advice on best practices, Dell contributes to our goal of improving the availability of our services. In 2001, HITS-NS chose to run MEDITECH C/S on Data General AViiON servers (available through EMC Corporation, which acquired Data General in 1999) due to the application s stringent hardware certification requirements. But when support for Data General servers ended, we needed to replace them, says Stronach. In 2004, Stronach approached major server vendors for proposals to replace the seven racks of Data General AViiON servers. He chose Dell for both the quality of its products and the breadth of its services and third-party relationships. Stronach recognized that the wide range of services, support, and partner products available through Dell would help him fortify the resiliency of the patient information system. I can get more than just reliable servers by working with Dell, says Stronach. Through its partnerships with software companies, detailed product road maps, and advice on best practices, Dell contributes to our goal of improving the availability of our services. The organization as a whole is what really sets Dell apart from its competitors. Redundancy enhances the availability of critical patient care applications Stronach selected Dell PowerEdge servers because they were certified to run the HIS software and offered a number of ways to connect the servers to the network. The servers could be flexibly configured with multiple network interfaces, so they fit easily with HITS-NS s existing storage infrastructure that houses all the patient records. We connected the Dell PowerEdge servers to an EMC Symmetrix DMX Fibre Channel storage system using redundant Fibre Channel connections, says Stronach. We also configured redundant Ethernet network interfaces. All that redundancy is important to ensure availability. The Dell servers flexibility in supporting so many network interface connections really simplified the upgrade. Dell remote management helps simplify server support for HITS-NS IT staff The remote connection capabilities of the Dell PowerEdge servers simplified server management. We only have four server administrators, so we cannot afford to have someone on site overnight, Stronach says. The Dell remote access cards that come with How it works HArDwAre Dell PowerEdge 1955 blade servers with quad-core Intel Xeon processors Dell PowerEdge 1850 and PowerEdge 1855 servers with dual-core Intel Xeon processors EMC Symmetrix DMX storage system SOFTWARE MEDITECH Client Server Hospital Information System Nightingale Practice Management Application VMware Virtual Infrastructure 3 services Dell Silver Enterprise Support

3 dell PowerEdge servers and VMware software allowed us to add layers of redundancy that help provide high availability. Hospital staff members now have reliable access to information so they can always provide consistent, high-quality patient care. the servers simplify remote server management by enabling remote connection to the servers for troubleshooting or restarting services. Dell blade server density and manageability helps save HITS-NS IT staff time and effort Stronach and his team also selected Dell PowerEdge 1855 blade servers for their DNS and DHCP servers. The compact, powerful nature of the Dell blade servers lets us get more processing power out of a smaller footprint, he says. Blade management is also simplified, with a single interface to manage all 10 blades in the chassis. Eventually, we could move MEDITECH C/S to blades to take advantage of the space savings and unified management interface to simplify server management for our staff. The Dell PowerEdge blade servers proved to be exceptionally easy to service, saving the small IT group a lot of time and effort. We can now deploy 10 blade servers in the same hour it used to take to deploy 2 physical 1U servers. Management and maintenance time is reduced by a factor of 10 because of the ease of removing the blade from the enclosure for servicing. Over the three years we have been using them, we ve had no major problems with the Dell PowerEdge blades, says Stronach. But if we do have an issue, we can quickly remove a blade from the chassis for maintenance. No recabling is necessary. Quick response of Dell support services helps prevent prolonged downtime Stronach selected Dell Silver Enterprise Support for the Dell servers to help ensure that any problems are fixed promptly. We ve had very few issues, says Stronach. But Dell support services have never let us down. We get on-site service from trained technicians within four hours. So if we encounter a problem, a certified technician is here almost immediately to make sure the problem is solved and our services are minimally affected. Dell also trained our technical staff to diagnose server issues and get service before they become bigger problems. Dell PowerEdge servers reduce data center footprint by 65 percent The Dell PowerEdge servers provide more processing power in a smaller footprint. One Dell PowerEdge server provides processing capacity equivalent to the larger 4U Data General AViiON servers it replaced. The improved performance of the Dell servers helped Stronach reduce his data center footprint from seven racks to two and a half. The floor space in the data center we use is expensive. A smaller footprint saves us money by saving us space, he says. We can repurpose the saved space to add new servers for running additional applications. In the end, we went with three racks. This still gave us ample opportunity to scale while maintaining our costs. Dell blade servers cut energy costs by two-thirds The improved energy efficiency of the Intel Xeon processors and the design of the blade chassis help reduce energy costs at HITS-NS. Fans are located in the Dell blade chassis instead of the actual servers, so there are fewer of them, lowering energy consumption. More efficient cooling also reduces the potential for hot spots. We ve found that the Dell PowerEdge blades run much cooler than an equivalent number of 1U servers, says Stronach. They also consume less energy. I estimate that we ve saved two-thirds of our energy bill since we moved to blades. Simple and reliable Dell infrastructure helps HITS-NS deliver new services The compact and simplified Dell platform has made the entire data center much easier for Stronach s four-person team to manage. The staff uses their newly found time to deploy additional applications that benefit other healthcare providers in Nova Scotia not just the hospitals and clinics that use MEDITECH C/S. A year after the migration to Dell, HITS-NS installed the Nightingale Practice Management application for the primary healthcare information management project that doctors offices and clinics across Nova Scotia use for maintaining patient medical records, scheduling, and billing. Through MEDITECH Client Server we are providing a lot of operational functionality to the larger healthcare facilities, says Stronach. We wanted to offer doctors offices across the province the same capabilities. Because of their high density and simplified management, Stronach turned again to Dell PowerEdge 1855 blade servers to host the Nightingale application. The Dell PowerEdge blade servers continually impress us by being easy to install and maintain, he says. With 10 servers in a 7U space, we are adding the power to host a demanding application, serving hundreds of doctors offices, without adding much to the footprint in our data center. Virtualization improves application availability At Stronach s request, Dell presale engineers included hardware and software recommendations for an eventual migration to virtualization in their initial proposal. Those recommendations included the purchase of VMware Infrastructure 3 virtualization software. We felt that running our applications on a

4 the compact, powerful nature of the Dell blade servers lets us get more processing power out of a smaller footprint. virtual platform would improve the availability of the services we deliver to the hospitals, says Stronach. Over time, as the IT staff became more proficient, they began to implement a gradual virtualization initiative on all but the MEDITECH servers. Our plan was to gain experience with virtualization before implementing it on MEDITECH servers, says Stronach. We selected VMware ESX Server because of the high-availability features that it offers. The ease and speed of creating virtual machines eliminates the time and effort needed to provision test servers. With VMware ESX Server, we can create virtual test servers quickly, test their performance, and if our configurations are wrong, start over again, says Stronach. Once we ve configured the application correctly, we can save the entire virtual server image and deploy it as needed in a matter of minutes. That flexibility has helped cut our test-equipment costs and speed the introduction of new applications into production. In 2007, once MEDITECH C/S HIS was fully tested on a virtual platform, HITS-NS purchased two chassis of Dell PowerEdge 1955 blades with quad-core Intel Xeon processors. The ample throughput of quad-core processors helps ensure consistent application performance even as resources are virtualized to host more servers. The improved performance allowed Stronach to confidently begin migrating MEDITECH C/S to a virtual environment. We can have up to 15 virtual servers on a single Dell PowerEdge blade server and still maintain performance, says Stronach. But our goal was improved availability, not consolidation. Although consolidation has distinct benefits, I would have run a single virtual server on a blade just to get the added availability provided by the portability of a virtual machine. HITS-NS consolidates 100 of its physical servers onto 16 virtualized Dell blade servers HITS-NS has consolidated 50 servers running MEDITECH C/S onto 8 Dell PowerEdge blade servers. The organization has also consolidated another 50 servers running related applications onto another set of 8 Dell PowerEdge blade servers. Having fewer servers means my staff has less to maintain, says Stronach. Virtualization also allows me to create backup servers. I might be consolidating 100 physical servers, but once those are virtual servers, I can duplicate them with a few clicks to create a backup server. The ease with which I can create new servers allows me to create redundancy that is just not practical in a physical environment. Stronach has attached his blade enclosures to a storage array via iscsi connections to share storage among the blades. This configuration is necessary for using VMware VMotion to move running virtual machine sessions among blades or even from one enclosure to another. We ve gotten phenomenal performance from these storage arrays to our Dell PowerEdge blade servers over iscsi, says Stronach. Again, the flexibility and breadth of the connections available on Dell servers is, in my opinion, unique. I can have redundant fiber connections, Ethernet connections, or iscsi connections. That capability is important when building redundancy into these systems because it eliminates single points of failure.

5 HITS-NS demonstrates zero downtime for maintenance with VMotion to eliminate the possibility of lost access to patient information VMotion s ability to move running applications among physical host computers means zero downtime for maintenance. Stronach and his team tested the capabilities of VMotion by moving a running MEDITECH C/S application server with clients attached. The users accessing that application server saw no degradation of service, no difference whatsoever, says Stronach. Before virtualizing MEDITECH, if we had to bring down a server it would be down for at least half an hour. For the service we tested, that would have meant 150 users without access to a critical healthcare application for half an hour. That amount of downtime could put patients in life-threatening situations. Server virtualization helps reduce recovery time from days to minutes Currently, Stronach and his staff are in the process of completing the migration of MEDITECH C/S to new Dell PowerEdge 1955 blades running VMware. The migration is freeing up the other PowerEdge servers to create a disaster recovery (DR) site that can run the HIS in a full capacity within minutes. When we are done we will have one rack of Dell PowerEdge 1850 and PowerEdge 1855 blade servers running VMware Infrastructure 3, says Stronach. That small footprint was crucial, because we are running the DR site in someone else s data center where we have limited space, power, and cooling. With VMware we replicate our production images to dissimilar hardware, making DR planning and maintenance much easier because we don t have to maintain identical hardware for the images of the production servers. The new disaster recovery site will have the capacity to run the entire MEDITECH C/S application infrastructure. With the Dell PowerEdge servers and VMware virtualization we will have the ability to failover in minutes, says Stronach. When the entire DR site is up, I plan on running the MEDITECH HIS from the DR site for at least 24 hours a month as a proof of concept, to demonstrate that Nova Scotia s hospitals can continue to use the patient care system despite a worst-case scenario at our data center. Dell road map helps HITS-NS grow cost effectively Dell has advised Stronach on the most costeffective times to deploy new servers. Dell representatives take the time to understand what we are trying to do, says Stronach. I might try to purchase a new blade enclosure, and our Dell account executive will remind me of the product road map and point out that if I wait a few months I can get servers with newer processors. That added guidance really contributes to our bottom line. Improved patient information availability helps hospital staff provide quality care Because HITS-NS is a service delivery organization, not a hospital, its success is measured by meeting service-level agreements (SLAs) with the hospitals. Those SLAs stipulate that services be up 7 days a week, 24 hours a day, and 365 days a year. Dell PowerEdge servers and VMware software allowed us to add layers of redundancy that help provide high availability says Stronach. Hospital staff members now have reliable access to information so they can always provide consistent, high-quality patient care. And improving patient care is our ultimate objective. For more information on this case study or to read additional case studies, go to September Printed in the U.S.A. Dell cannot be responsible for errors in typography, photography, or claims made by partners or customers. Dell, the Dell logo, and PowerEdge are trademarks of Dell Inc. EMC, the EMC logo, and Symmetrix DMX are trademarks or registered trademarks of EMC Corporation. Intel, the Intel logo, and Intel Xeon are registered trademarks of Intel Corporation. VMware, the VMware logo, and VMotion are trademarks or registered trademarks of VMware, Inc. Other trademarks and trade names may be used in this document to refer to either the entities claiming the marks and names or their products. Dell disclaims any proprietary interest in the marks and names of others Dell Inc. All rights reserved. Reproduction in any manner whatsoever without the written permission of Dell is strictly forbidden.

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