Healthcare IT teams pivot around HCI during pandemic

'Scary for a CIO' in healthcare IT

DVCH was in the middle of a five-month Nutanix HCI installation when it had to switch gears to support telehealth in its eight primary care sites in the Philadelphia area. DVCH CIO Isaiah Nathaniel said he initially decided to go with HCI to support an expansion, which included opening an urgent care site. DVHC's ninth location would complement its traditional primary care, internal medicine, pediatrics, optometry, OB-GYN, behavioral health and medication-assisted treatment therapy practices.

COVID-19 interrupted DVCH's expansion plans, however. Like many healthcare providers, DVCH needed to adapt its procedures for seeing patients. It implemented telehealth to treat patients remotely, and 75% of its 310 employees began working remotely in mid-March on a rotating basis.

"We were getting ready to launch the Rapid Care site in May, then COVID-19 happened," Nathaniel said. "We had to pivot suddenly. And that was scary to me as a CIO. Our CEO said 'Can we do this? We can't bring employees back to the site, and we can't bring patients in.'"

Isaiah Nathaniel

Nathaniel said he already felt comfortable enough with his Nutanix setup to plunge ahead. DVCH had three-node Nutanix NX clusters at data centers at two of its eight sites. He replaced VMware with Nutanix's AHV virtualization layer, saving $70,000 a year in licensing costs. DVCH replicates data between its data center over the WAN using HYCU data protection software. HYCU, developed specifically for Nutanix HCI, also helped DVCH reduce backups from more than four hours to 30 minutes, Nathaniel said.

Following CDC guidelines, DVCH did not let anyone enter its facilities for the rest of March. After acquiring personal protective equipment, its pediatrics practice began allowing patients to visit in April. Nathaniel said DVCH conducted 2,600 telehealth visits in March, down only slightly from its usual goal of 3,200 to 3,500 patient visits per month.

Nathaniel said he migrated DVCH's EMR system to Nutanix, and improved its performance enough to enable employees to use it remotely for video consultations with patients. Overall, he said he migrated nine servers to the Nutanix clusters in a day.

The healthcare providers were set up for video chats with patients within a week.

Nathaniel said that since switching over, DVCH's doctors can use its medication system to prescribe prescriptions in 15 seconds -- down from three to five minutes.

He added that DVCH is considering Nutanix Frame desktop as a service as it weighs making work-at-home a permanent choice for employees and plans to add two sites by 2022.

"As the entire country is thinking about opening, you're looking at the new normal," Nathaniel said. "We're thinking of making telework an option for our entire workforce. With Frame, we can scale telework for all our users."

DVCH also set up COVID-19 testing in four sites, and conducts around 100 to 125 tests a day. Nathaniel said the system can get results back within 24 hours, a performance that would not have been possible under his old three-tier architecture.

'Flippin' COVID-19 pushed boundaries

U.K. cloud provider AIMES first deployed hyper-convergence five years ago to segregate traffic between its highly regulated Health Cloud and the "wild west" of the internet.

"It's always a struggle finding the next best thing to give us more reliable, more efficient systems," AIMES business development director Glenn Roberts said.

Now the provider is working on expanding its Pivot3 HCI to roll out services quickly for researchers working remotely on COVID-19-related issues.

It's always a struggle finding the next best thing to give us more reliable, more efficient systems.

"In this moment of crisis, we want to be able to step up and offer them a service," Roberts said. "Our VDI will allow us to provide remote working solutions. We'd been looking at this for months, but when this flippin' COVID-19 arrived, it pushed the boundaries for everyone's capabilities."

Because AIMES' customers include members of the U.K.'s National Health Service (NHS) public healthcare providers, as well as other commercial data center customers who connect over the internet, it has two sets of requirements for regulations. As a result, it runs two distinct networks for compute and storage.

"On one side we have this dedicated health network, and the NHS has strict rules around connectivity into and out of their own networks," Roberts said. "Only approved users can get on there, so everyone who gets on is a known user. Then we have the internet, which is the wild west. Anyone can get on, and it's really messy. So the rules are different, and you can't have the same piece of equipment connected directly to the NHS and also to the internet."

To deal with that, Roberts' team developed the AIMES Health Cloud, a hybrid cloud offering access to the regulated and nonregulated networks using a different set of IT equipment. It gives outside researchers access to the NHS without connecting directly into its network. Clinicians can access data through the NHS interface.

"Each stay in their own little bubble of protectiveness," Roberts said.

The AIMES Health Cloud is built on Pivot3 HCI technology and is managed separate from the SAN that connects AIMES to the internet.

AIMES started using Pivot3 about five years ago and has five Acuity HCI Hybrid flash nodes now with dual 20-core processors and 768 GB of RAM. Two Accelerator nodes use NVMe flash for performance, and two include Nvidia GPUs to improve performance for medical imaging. AIMES uses VMware Horizon virtual desktop infrastructure (VDI) software.

The new VDI services will allow AIMES to add resources to customers as they need it. Customers include acute health providers, as well as university hospital researchers.

"As you can imagine, our market at the moment is a challenge, to say the least," Roberts said.

And as DVCH's Nathaniel said, that challenge is becoming the "new normal" for healthcare IT.