1. “At the Forefront of World Class Information Technology in Healthcare” Building a 21 st Century Virtualized Enterprise Architecture Dr. Zafar Chaudry, MD, MSc, MIS, MBCS, CITP Director of IM&T 31 October 2007

2. “At the Forefront of World Class Information Technology in Healthcare” Highlights  Who Are We?  Healthcare Challenges  IT Challenges  What Did We Find?  Our Existing Infrastructure  Our Strategy  Virtualized, SAN attached Infrastructure  Data Replication / Information Lifecycle Management  What Did We Get?  VM Lessons

3. “At the Forefront of World Class Information Technology in Healthcare” Who Are We?  Europe’s Largest Women’s Provider  Europe’s Largest Neonatology Unit  Europe’s Largest Genetics Laboratory  £80 million turnover ($160 / €112 million)  £3 million ($6 / €4.2 million) on IT  1,600 employees – 5 sites  Ranked 8 th in UK (out of 270+)  IT & IS Technical Team of 12 (total: 60 WTE)  Delivered 8,000 Babies  Performed 11,000 Operations  Performed 900 IVF Cycles  Foundation Trust – “independent business”  Rated “Excellent” for “Quality of Services” & “Use of Resources” by Healthcare Commission

4. “At the Forefront of World Class Information Technology in Healthcare” Healthcare Challenges Healthcare Increasing Costs Increasing Demand Clinician Shortages Increasing Medical Errors Increasing Litigation Patient Data Privacy Legislation Increasing Audit Requirements Adopting New Technology Limited IT Budgets Limited Hospital IT Skills

5. “At the Forefront of World Class Information Technology in Healthcare” 1. Info growing 3X/yr 3. Info Governance & Compliance Increasing The Only Things Not Growing: Time, Staff and Budget! The Mounting Pressure on IT 4. Complexity Rising - Content is growing fastest - Have to keep info LONGER - Number of Devices, connections, tools, etc. Managing Growth 2. User Expectations are Growing - Always available, more capabilities Impact Areas: - Bus. Intelligence - Technology - Bus. Continuity - Backup, Recovery AND Archive - Compliance - Content Management

6. “At the Forefront of World Class Information Technology in Healthcare” More types: Financial Clinical Operational Quality Imaging More growth: Health Information stored on disk arrays grew 200%+ in 2006 Health Information: Unstructured Data Growth More uses: EPR, PACS, Collaboration, Knowledge Management, Data Analytics Information types Information regulations Information growth Information uses More regulations: Healthcare Information Retention, E-mail Retention

7. “At the Forefront of World Class Information Technology in Healthcare”  Server “sprawl”  PCs used as servers everywhere – under desks, in cupboards  Novell Domain & GroupWise  Data Everywhere  Data held on PCs, floppy discs, not backed up  Data that is backed up is on tape (costs ballooning; tapes accumulating)  Data not archived  Data deleted e.g. e-mail deleted by users  No E-mail retention  Data “sprawl”  Demand for new Applications & Data Storage increasing exponentially  Clinical Records retention: 8 yrs for Gynae / 25 yrs for OB What Did We Find?

8. “At the Forefront of World Class Information Technology in Healthcare” April 2005 Infrastructure

9. “At the Forefront of World Class Information Technology in Healthcare”  Simplification: data / systems / infrastructure for easier centralised management  Standardisation: systems / servers / business processes  Virtualisation: systems / teams / hardware  Automation: reduce manual working Our Strategy – “Adaptive Enterprise”

10. “At the Forefront of World Class Information Technology in Healthcare” January 2007 Infrastructure

11. “At the Forefront of World Class Information Technology in Healthcare” Data Replication / ILM

12. “At the Forefront of World Class Information Technology in Healthcare” What Did Virtualisation Give Us? New server commissioning in 10 minutes ESX Server 1 DNS/DHCP ESX Server 2 WM ServerWin2K AS ESX Server 3 SQL Server Call for Upgrade

13. “At the Forefront of World Class Information Technology in Healthcare” ESX Server 1 DNS/DHCP ESX Server 2 WM ServerWin2K AS ESX Server 3 SQL Server WM Server SQL Server Call for Upgrade New server commissioning in 10 minutes Ability to move Servers in “real-time” What Did Virtualisation Give Us?

14. “At the Forefront of World Class Information Technology in Healthcare” ESX Server 1 DNS/DHCP ESX Server 2 Win2K AS ESX Server 3 WM Server SQL Server Powered Off for Upgrade Always Powered On New server commissioning in 10 minutes Ability to move servers in “real- time” Zero downtime maintenance of physical server hardware What Did Virtualisation Give Us?

15. “At the Forefront of World Class Information Technology in Healthcare” ESX Server 1 DNS/DHCP ESX Server 2 WM ServerWin2K AS ESX Server 3 SQL Server  Upgrade Finished Powered On Again WM Server SQL Server New server commissioning in 10 minutes Ability to move Servers in “real-time” Zero downtime maintenance of physical server hardware What Did Virtualisation Give Us?

16. “At the Forefront of World Class Information Technology in Healthcare” Next Generation – Jan 2008 – VI3

17. “At the Forefront of World Class Information Technology in Healthcare”  Simplified infrastructure  Server Consolidation  Server standardisation (Windows 2003 platform)  Virtualisation (VMWare ESX 2.5.2)  Ability to use less hardware  Consolidation of 8:1  Power savings of 80%  Storage Consolidation (EMC Clariion CX 500)  Data Protection (Full DR – Clariion CX500)  Data Value Classification: Information Lifecycle Management (tiered data)  Optimised storage  File age, type, size, access, availability, usage, age, recovery – FC / SATA  Capacity Expansion from 500GB to 6.5TB FC & 22.5TB SATA What Did We Get?

18. “At the Forefront of World Class Information Technology in Healthcare” VMWare Lessons  Be careful of the consolidation ratio  Watch out for Microsoft licenses:  1 Enterprise per 4 VMs  1 SQL Server per processor  Costly  Cost can quickly skyrocket – VM licenses aren’t the cheapest  Training – knowledge transfer  Hardware needs to have dual processors  Hardware needs a lot of RAM (12GB min)  Right partner – as expertise in area is a problem  Certain applications will not virtualise  VMotion only works across servers with same generation processors – could end up with multiple clusters (VM “sprawl”)  Evaluate sub-contractors carefully – check VMware certifications

19. “At the Forefront of World Class Information Technology in Healthcare” Questions