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Blade runner: blade server and virtualization technology can help hospitals save money but they are far from silver bullets.

According to a recent report by Stamford, Conn.-based Gartner Research, blade servers are the fastest growing segment of the server market. There's a reason: server consolidation through this eight-year-old technology presents a way to control the costs inherent in a data center. Hospital executives who have implemented blade servers have been able to shrink their footprint, reduce maintenance and energy costs, and can tell their staffs and communities that they are contributing to a greener environment. Server virtualization has been found to demonstrate similar benefits.


But replacing a room full of servers with a slim box is an evolving field, especially when it comes to CIOs' oldest Is it worth it?

Most agree the ROI case for blade servers and virtualization is compelling. "A quick benchmark is $3,000 dollars per server per year--that's the rule of thumb that I use," says Gary Weiner, a senior consultant at Dallas-based ACS Healthcare Solutions (and former hospital CIO). The cost savings come from a few areas, starting with the reduction of capital expenditures for refreshing/installing new servers. Savings can also be recouped from reducing electrical, heating and cooling expenses and networking, along with the reduction in floor space and infrastructure, UPS requirements, rack space and maintenance costs on the servers. "Some of the money is recouped immediately," Weiner adds, "and a common payback is 12-18 months. You can put a very good ROI together for virtualization."

For Ed Dullard, CIO of 458-bed Alameda County Medical Center in Oakland, Calif., that alluring ROI led to more ambitious plans. "We're a public hospital, the safety net hospital for Alameda County, so we really have to come up with ways to cut costs and operate on a lean shoestring," he says.

Dullard, who has been using blade severs and virtualization since 2006 was originally looking for ways to increase storage in his facility, whose data center is 11 miles away. Dullard says once the hospital got a SAN (storage area network), executives began looking for other opportunities, realizing that servers could be virtualized and put up on it. "We had to maximize the effect of our dollars spent and found virtualization was a good way to help us out," he says. Virtualization also became a cornerstone of his disaster recovery plan.

According to Weiner, most midsize hospitals have about 300 servers, of which 40-60 percent can be virtualized. St. Vincent's Hospital Manhattan (New York), part of the two hospital St. Vincent Catholic Medical Centers system, experienced typical reductions. "Basically what we accomplished is a reduction of 50 percent of our servers," says Senior Vice President and CIO John McDaniel, who is using a combination of blades and virtualization. McDaniel says he was able to cut his operating costs to maintain the servers in half.

"If you look at my total cost savings, it's a pretty synergistic effect," he says. "By taking those servers out, I can deploy the staff on other projects, while reducing the footprint and the server maintenance cost of hardware and power."

For McDaniel, the energy savings meant more than dollars--he was also able to demonstrate the hospital's dedication to "green," part of its enterprise strategy.

McDaniel found another plus to virtualization, employing stacks of unused servers as the EMR implementation began. It's a peripheral benefit to the technology that becomes even more useful as hospitals implement greater numbers of applications: the old servers can be re-used to support complex development and testing environments with limited resources. "We needed multiple environments for test, production, and development, and those are typically three different servers," he says.

Dullard agrees that virtualization was able to save him the costs of multiple "test," "live" and "training" servers for his implementations at Alameda. "It saves you so much money and effort, both in time and personnel, to set up the environments. Then you don't have the excess box when the training environment goes away," he says.

Yet while CIOs using blades often give rave reviews, there are reasons the technology hasn't exploded. Currently, there are no standards for blades and chassis (the blade enclosure, which holds multiple blade servers and provides power, cooling, connections and networking), or for inter-connectivity of peripherals like switches and common and open APIs for blade management software.

Gartner Research predicts it will be more than five years before blades and chassis are standardized across vendors. Due to this lack of interoperability, hospitals can become locked to one vendor's technology. To maximize ROI, Gartner advises investing in blade chassis technology as early as possible in its life cycle, since changes in the chassis technology may render components obsolete.

Another blade consideration is server administrators. According to Weiner, staff must be trained in managing the blades. "That's something I'm finding they're not accepting easily," Wiener says. "It's a technology shift and you have to ensure that your staff is appropriately trained."

And when it comes to virtualization, CIOs need to remember that not all applications should be virtualized. Weiner says that high transaction-base applications, like an Oracle database running on Windows, for example, might not pay off. "Since virtualization is basically sharing processor and memory, an application that uses a lot of memory won't deliver economies of scale," he says. "You have to decide what the diminishing return for your investment is."

Weiner advises CIOs to also be careful if an application requires external access to serial ports or specialized boards (a good example is transcription software); usually, he says applications that need access to external equipment or additional internal boards can't be virtualized.

To ensure a "no surprises" approach, both CIOs and consultants agree it is critical to engage vendors in a virtualization discussion. "The vendor needs to assess all your systems to make sure they have the appropriate hardware and storage design, because that becomes very critical in your virtualization environment," says Weiner. "It's about designing it properly for performance." He encourages CIOs to have a conversation with the CTO of their software vendor. "I often get different answers from the CTO than from the corporate line."

That's where McDaniel began. "Part of our strategy was to reach out to our vendor partners and say, 'This is very important to us, our goal is to reduce footprint, reduce power consumption, reduce maintenance costs on those servers,'" he says. "We had very positive participation from a number of our partners."

McDaniel and Dullard are taking virtualization to the next step with virtualized desktops, where application upgrades can be done in one fell swoop, and where many say there can be real savings in terms of redeployed FTEs.

But from desktops or servers, FTEs or power, it's clear there are savings in the technology. "Were we driven by the economy?" Dullard asks. "Our economy is always bad here in the public hospitals. Leveraging virtualization was the natural next step."

On the Horizon

Gartner says that blade servers are a rapidly changing technology and will continue to evolve. Changes they predict in the next two years are:

* Blade server aggregation that will allow logical joining of servers so two two-socket blade servers can form a four-socket blade server.

* Faster I/O connections that will likely require chassis replacement.

* Improved I/O controls that will aggregate/disaggregate and prioritize bandwidth to individual blades.

* More flexible storage options.

* Deeper integration with virtualization, along with further integration of virtual machine management and physical machine management.

* Management software enhancements, as blade vendors focus new functionality, integration and interface enhancements on their blade management tools.

The Skinny on Blade Servers

Blade servers are self-contained, all-inclusive computer servers designed for high density. Introduced in 2000, blades take up less space and power because many components of standard servers have been removed. A blade enclosure, which can hold multiple blade servers, provides services such as power, cooling, networking various interconnects and management.--Wikipedia


* Blade servers and virtualization can reduce infrastructure, maintenance, heating, electric, cooling and equipment costs.

* Blade server technology is evolving and some elements may become obsolete.

* There is very little interoperability between blades.

* Hospitals can virtualize 40 to 60 percent of their servers, and old servers can be reused for testing.

* Not all applications lend themselves to virtualization -especially those with high memory requirements.

* CIOs should engage their vendors in virtualization discussions.
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Author:Lawrence, Daphne
Publication:Healthcare Informatics
Date:Mar 1, 2009
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