As medical technology has been advancing at a rapid pace, Healthcare IT (HIT) has faced an increasingly growing demand for integration of computers hosting medical software. While this also introduces a regulatory aspect that I will analyze in a future post, I want to focus here on the integration of medical software and its impact on servers and, more specifically, virtualization.
Twenty years ago, when the virtualization revolution was just getting started, servers were all physical setups. At that time and even today, they were dedicated to background services for office related tasks, such as email and web or office applications.
Over the last two decades, medical device companies have created hardware-based server solutions that, by nature, need to be integrated in and managed with the rest of the IT infrastructure. This can be difficult, as such servers are normally considered to be an “external” component and not standard equipment, meaning they must be managed separately, causing additional work, costs and complicating processes.
There exists a huge variety of medical software with a widely varied range of technical specifications that needs to be then integrated into these servers. The most demanding of these software are those needing high computing power and even graphical acceleration for 3D or algorithm acceleration. They are used for planning, simulating treatments or to display advanced 3D representations of medical images as well as routing big amounts of data across several devices in the network. All those pose the greatest challenge to the IT infrastructure as well as the IT budget.
Today’s HIT infrastructure includes, in most cases, a virtualization environment which runs parallel to a stack of physical servers that either host older software or processes or need to exist separately. While the two worlds coexist, virtualization grows steadily. In fact, worldwide 80% of general purpose servers are already virtualized. Neither of these two environments, however, are by default ready for hosting these high demand medical software applications. So, if the existing HIT infrastructure is not capable of hosting new generation medical software, what are the options?
- Buy new, powerful server hardware dedicated to the new software
or - Upgrade the virtualization infrastructure to provide the necessary power
Although there may be other ways, I’ll stick to these two options for now and list the pros and cons of each.
1. Purchase New Dedicated Server Hardware
Pros
- Easy: Buy the hardware based on technical specifications, sometimes directly from the software manufacturer
- Possibly cheaper: On the free IT market, it is possible to find good offers even for powerful servers
Cons
- Obsolescence: Software computational load grows quickly and hardware needs to be replaced frequently, causing additional costs in the long term
- Maintenance: In some situations, third party hardware is managed separately, requiring additional maintenance efforts
- Downtime / availability: If the server is down due to hardware failure, it may take days to have it up and running again, depending on spare parts availability and service contracts agreements
2. Upgrade Virtualization Infrastructure
Pros
- Little to no downtime: In the case of hardware failure, within minutes the virtualization environment can automatically regenerate the machine to its last status, executing it on a healthy part of the server’s cluster
- Shared resources: New upgrade hardware can be purchased exceeding the specs of the new software, allowing for the sharing of resources
- Low maintenance costs: Seamless hardware upgrades without any server downtime or within minutes are possible at any point in time. Medical software service costs stay low because virtual machines can be restored from a backup without a time-consuming full software installation
- In-house maintenance: The Healthcare IT team can, for the most part, service the servers themselves
- Sustainable: The possibility to extend and upgrade the infrastructure makes virtualization more future-oriented
Cons
- High initial investment: Depending on the existing infrastructure, the budget needed to achieve high central processing unit (CPU) and graphical processing unit (GPU) computational power can be high
- High competence needed: Adding GPU to a virtualization environment can be complex; without skilled IT technicians, the initial setup can be very cumbersome
- Oversubscription might not be possible: The virtual machine dedicated to such medical software might need to reserve resources (e.g. CPU, RAM, GPU). Some software needs the required resources at any point of time. Dynamic assignment of resources cannot be applied to software that needs to deliver complex calculations in a short amount of time. Resource reservation is necessary but not always well accepted in IT
So, which is the right choice? To me, despite the cons, virtualization is still the best option. Among all the pros, I see minimal downtime as a very, if not the most important aspect. Depending on how mission critical the medical software is, it may directly impact the time-to-treatment and possibly even the quality of treatment.
Costs, in terms of money and time invested, are also a convincing factor. Consider, for example, that a full server reinstall may take three service days because it covers not only the technical part but also the entire functionality testing of the software. Instead, the possibility of backing up a virtual machine and roaming from one hardware to another dramatically decreases external service costs, thereby also reducing internal personnel time.
Last but not least, sustainability is a huge consideration. To keep up with the pace of software demands, you need a flexible infrastructure that can evolve and adapt as much as possible. Sustainability is therefore best addressed by virtualization.
While the higher initial investment to upgrade to virtualization infrastructure might seem overwhelming, in the long run it brings a number of fundamental advantages. Whichever you choose for your hospital, make sure to take the above pros and cons into consideration!
What are your thoughts about virtualization versus hardware servers? Comment below or send me an email at digitalor@brainlab.com. I’d love to hear from you!