Separating Cloud Hype from Reality in Healthcare – a

Real-Life Example at HMA

Tim Graf, VMware

Matthew Ritchart, Health Management Associates

PHC5254

#PHC5254

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VMware Sr. Systems Engineer for Healthcare

Supports over 50 healthcare providers in Florida

17 years experience designing, building & delivering IT solutions

10 years working with virtualization technologies

Matthew Ritchart

Operations Manager for Heath Management Associates Inc.

6 years in Healthcare IT

3 years directly supporting a hospital environment

Responsible for virtual architecture and direction

About Us

Tim Graf

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Today’s Discussion

Moving into the future of Healthcare IT

What HMA is doing that’s different…

And Why they’re doing it.

Lessons learned along the way

How to get there in a hurry

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Enabling America’s Best Local Health Care

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About Health Management Associates

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• Rapid consolidation of key industry players underway

• Not just hospitals, but doctor practices as well

Industry consolidation

• Bring Your Own Device mentality entering Healthcare

• Reliable, available, cost-effective cloud architecture

• Users are much more aware of technology and their access to it

Macro changes

• Changing the mindset of buying and implementing to producing and optimizing

• Provide better structured and more agile applications faster

Rapid deployment of resources

• Rapid replacement of aging healthcare systems

• Advanced technology needed to produce better results with less resources

Technology opportunity

Healthcare Moving to the Future

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99% virtualized

Over 250 ESXi hosts running 4,000 virtual machines

1.5% IT spend

80% Meaningful Use 2.0 compliant

HMA IT

Rapidly adding facilities through acquisition

Hybrid cloud directive from management

Infrastructure as a Service

Key Stats

Strategic Objectives

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The cloud fixes everything!

• Not the answer to all of IT management's woes

• Does not solve process or policy issues

• Simply a way to deliver applications and infrastructure

The Cloud never goes down!

• Jan 10th 2013; Dropbox is down for ~16 hours

• Jan 31st 2013; Amazon’s own website is down for 49 minutes

• February 1st 2013; Microsoft Office 365 is down for ~2 hours

Cloud storage is cheaper than physical storage!

• Is the savings worth losing control of your data?

• Even Gartner currently only suggests cloud storage as an alternative for non-mission-critical applications

• How would you recover from truly lost data? What are the consequences?

Service Level Agreements means we never have to worry about explaining outages!

• Make sure to understand what exactly is promised in the SLA

• Recuperation on monetary loss does not resolve user experiences with failed services

Common Cloud Hype

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Software-Defined Data Center

All infrastructure is virtualized and delivered as a

service, and the control of this data center is

entirely automated by software. Abstract. Pool. Automate.

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Extending the Private Cloud to the Hybrid Cloud

Seamless

Extension of

the Data Center

Public Cloud

Software-Defined

Data Center

Private Cloud

Any Application, Any Place… No Changes

Software-Defined

Data Center

Common Management &

Orchestration Platform

Unified Network

Architecture

Common Security Model

One Support Call

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VMware Sr. Systems Engineer for Healthcare

Supports over 50 healthcare providers in Florida

17 years experience designing, building & delivering IT solutions

10 years working with virtualization technologies

Matthew Ritchart

Operations Manager for Heath Management Associates Inc.

6 years in Healthcare IT

3 years directly supporting a hospital environment

Responsible for virtual architecture and direction

About Us

Tim Graf

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Agile Healthcare Platform

• Infrastructure and Operations was tasked with

building a new platform for healthcare, more advanced

than anything we had produced or seen.

• It needed to have the scalability of a public cloud while

retaining patient data on premise.

• We were also tasked with monitoring, maintaining,

automating and securing the platform with a minimal

operations time investment.

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New goals for I&O have shifted our priorities and needs

• Just keeping the systems running is not enough

• Proper management, monitoring, documentation and capacity planning

• High speed and reactive deployments

Focus shifts from maintaining to producing

• Implementing new technology

• Designing new solutions

• Planning for future development

High Stability and availability requirements

• We run systems that affect patient’s lives

• Stability needs to match or exceed previous generations

In-house Application Development

• HMA is designing and rolling our in house developed applications

• Development requires an entirely different mindset and offering

New Mentality for HMA IT

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• 99.999% Uptime (5.26 min/year downtime) High Availability

• Zero impact failovers

• Minimal or no manual intervention

Seamless Fault Tolerance

• Systems need to be always “up” at the infrastructure level

• Systems also always need to be “available” at the user level Zero Downtime

• Not just high performing infrastructure

• Perceived at the user level to be high performance High Performance

• Privacy, Recovery, Audit

• HIPAA, Sarbanes–Oxley Security

• Enable easy scaling as required for projects

• Predictive assessments to always have capacity available Growth

HMA Platform Goals

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To provide all the requested features we had

to step around the usual datacenter build

and produce a physically separated

environment that was virtually local. It had

to grow as we did and still be manageable.

That’s where the vCloud Suite came in.

The Plan: Cloud-Ready Datacenter

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vSphere/vCloud

• Scalability

• Cost

• Manageability Operations Manager

• End-to-end Visibility

• Sprawl containment

HA/FT Stretched Clusters

• Zero Downtime

Storage DRS

• Built for Growth

• High Performance

• Cost Optimization

Business Manager

• Cloud Cost tracking

Configuration Manager

• Cost Management

• Granular control

Impactful vCloud Solutions

Automation Center

• Rapid provisioning

• Self-Service

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Multi-Cloud Architecture

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Lessons Learned

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Not all applications provide high availability

• Single threaded sections or processes

• Non-load balanced front end

• Connections to other single threaded applications

Identify application availability failures

• Press vendors/developers on HA strategy

• Communicate dependencies or issues to project owners

Provide workarounds

• VM Fault Tolerance

• VM High Availability

• Database mirroring

All Applications Are Not Created The Same

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Match your biggest requirements

• Project Identification

• Application role

• Location

• Production, test, development

• Backup policy

Produce a written naming policy

• Explain advantages

• Important to get buy-in

Always conform

• Everyone matches the convention

• Once one application gets by, they all will

NAMING CONVENTIONS!!!!!

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Agile Thin Provisioned Environment

• 700VMs, 140TB

• 6 months of production

• 10 Applications

Legacy Thin Provisioned Environment

• 2,500 VMs, 350TB

• Over 5 years of production

• 100+ Applications

Storage DRS With Thin Provisioning

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Allows standardized LUN and Datastore creation

• Pick a maximum datastore size and set standards for builds

• Drives down over-allocation of storage with pre-set sizes

Helps quickly identify storage trends and allocation

• You can view cluster storage resources as a whole

• No need for individual management of LUNs or Datastores

Datastores can move freely across the entire S-DRS pool

• Remove “Keep VMDKs Together” settings to allow free movement

• Will auto-balance I/O and Storage without storage admin intervention

Easy additions of new LUNs allows for quick scalability

• Add a LUN; make a Datastore; add to S-DRS cluster; profit

• Allows S-DRS to handle moving VMs to new Datastores

S-DRS Pools to Save Storage Management Time

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Pool All Of The Things!

Application per Cluster Mentality

•Created a resource management nightmare

•Constant monitoring and hardware additions needed

•Drastic hardware differences

•Overly complicated hardware maintenance

•Storage must be monitored per application, per datastore

Pooled (IaaS) Mentality

•All clusters are now general clusters with the same N+1 failover

•Hardware management is one platform, scalability is limitless

•Once a cluster is “loaded” and base-lined, minor trending is required

•Applications can easily span clusters and can be live motioned

•Storage can be monitored per SDRS cluster

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A New Standard for Agility

Storage/ Availability Servers Networking Security Management/

Monitoring

2008 2012 SDDC

Weeks Days/ Hours

Minutes/ Seconds

Software-Defined Data Center Services

Virtual Data Center

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Cloud Path: VMware vCloud Suite

Management

VMware vCenter™

Operations

Management Suite™

VMware vFabric®

Application Director

Physical Infrastructure (Server, Storage, Network)

VMware vSphere®

Cloud Infrastructure

Software-Defined

Networking and Security

Software-Defined

Storage and Availability

Extensibility

VMware vCloud

APIs

VMware vCloud

Connector™

VMware vCenter

Orchestrator™

Virtualization

VMware® vCloud®

Automation Center

VMware vCloud Director®

VMware vCloud

Networking and

Security™

VMware vCenter

Site Recovery

Manager™

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Choose the virtualization platform that’s proven

to deliver the lowest total cost of ownership.

Why VMware

Choose the only IT partner that’s 100% focused

on the future of your IT infrastructure.

Choose the only IT partner that gives you the

ability to virtualize, automate, and control all

data center resources.

Choose the only virtualization platform that’s

battle-tested in the largest, most demanding

enterprise environments.

Build for the

Future

Virtualize

Everything

Maximize

Uptime

Minimize TCO

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Q & A

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Contact Information

Any questions, comments, or just want to chat about virtualization,

please feel free to shoot us an email

Matthew Ritchart

• MATTHEW.RITCHART@HMA.COM

Tim Graf

• TGRAF@VMWARE.COM

THANK YOU

Separating Cloud Hype from Reality in Healthcare – a

Real-Life Example at HMA

Tim Graf, VMware

Matthew Ritchart, Health Management Associates

PHC5254

#PHC5254