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The OSS Cure for What Ails Hospital IT

The OSS Cure for What Ails Hospital IT

Years ago, Florida Hospital in Orlando faced problems with its IT system, much of which relied on proprietary software. Innovative projects were abandoned due to high costs, and disaster recovery time was unacceptably long. So the hospital turned to open source. It was difficult at first, but officials say things are becoming easier as OSS goes more mainstream.

By Jack M. Germain
04/11/08 4:00 AM PT

What does a systems engineer in charge of a computer network for a major medical facility do to trim expenses and administer much-needed performance medicine to mission-critical applications? In the case of Orlando's Florida Hospital, network administrators surgically removed failing proprietary software and hardware and implanted open source technology.

That procedure took five years to flush out all of the costly proprietary apparatuses and phase in the replacement open source operating system and integration management software. Today, Florida Hospital is on the leading edge of network server and disaster data recovery technology and is fostering similar changes throughout its parent management network of seven hospital campuses run by the Adventist Health System (AHS) [*correction].

"Our central IT department is too small, so we did this transition on our own. Now we are seeing signs of the Linux operating system spreading elsewhere in the system. The central office has a large proprietary staff but no technicians to handle Linux. They view us as progressive technologists," Ron Skantz, Linux administrator for Florida Hospital, told LinuxInsider. "They are going to have to do the same thing we did."

Florida Hospital turned to Red Hat Linux and now operates 70 HP and IBM servers running Red Hat Enterprise Linux. These servers run several databases, including the hospital's two-terabyte Oracle data warehouse. Red Hat Enterprise Linux also runs JBoss Application Server and the hospital's proprietary applications, which include patient care, financial and data management solutions. A group of servers is also dedicated to communication and system protection applications, such as authentication, user ID management, mail and virus scanning.

Medical Trend

The healthcare industry in general and hospitals in particular are very conservative about trying anything new. Healthcare officials are often reluctant to risk the reliability and security they perceive in their existing computer networks, according to Red Hat officials specializing in healthcare technology. Over the last two years, however, healthcare and hospital network administrators are discovering open source as more affordable than proprietary installations.

"Red Hat Linux and JBoss have become leading platforms for hospitals," Richard Li, product marketing director for healthcare at Red Hat, told LinuxInsider.

This trend is driven by several factors. One is the forward-thinking, progressive hospitals that are setting the pace.

"This is being orchestrated by mostly a handful. The rest are followers," said Li.

Another driving point is the growing availability of network administrators turning to Internet service providers for business software solutions applications and services. Six major service providers now cater to hospitals and offer various modules for healthcare management needs.

Also contributing to this trend, according to Li, is the Health Level 7 United States Standards for electronic interchange of clinical, financial and administrative information among healthcare-oriented computer systems. Red Hat is working with several health groups to align open source standards with HL7 requirements.

The Illness

The decision to move from proprietary to open source technology often starts with cost. The need for better performance and more flexibility adds to the urgency.

"Florida Hospital is a not-for-profit facility with a limited budget for computer network infrastructure. We are more of a cost to the hospital. We don't bring in revenue," Jack Velazquez, senior systems engineer for open source systems at Florida Hospital, told LinuxInsider.

The hospital decided in the mid-1990s to develop a new Web initiative to publish its internal applications on the Internet. That effort failed due to high costs. The expensive proprietary operating systems became too much of a liability, according to Velazquez.

At the same time, the hospital began to re-evaluate its disaster recovery system. The existing system needed as much as two days to restore file systems and data if disaster struck. So the quest began for a smarter system that would provide seamless business continuity for the hospital, he said.

The Cure

Systems engineers at the hospital working with Red Hat designed a unique system that offloaded all applications and data to the Red Hat Global File System (GFS) running on the storage area network (SAN). Next was the creation of a six node cluster with each cluster sharing two volumes on the GFS, one for the applications and the other for data.

That eliminated having to replicate data or applications if a server failed. Because the servers only provide central processing units and power, everything else runs from GFS, Velazquez explained. Upgrading or restoring a machine in the cluster requires the team to install Red Hat Enterprise Linux and attach the computer to the SAN. That process takes minutes rather than days.

The Results

Transitioning to Linux helped the hospital reduce its equipment load exponentially. What the hospital has now is much better than what open source replaced, Skantz said.

However, doing the transition to open source in a vertical market such as healthcare did pose some problems, some of which have disappeared in the meantime. For instance, software availability is astronomically better now than before, admitted Skantz.

"We did have some trouble making the transition. There were only a few large companies when we started this. Now we have the same performance if not better for one-quarter less cost," he said.

Velazquez and Skantz had to rely on open source community support on the Internet to solve some of their problems. The market was new, and vendors were not sure about it, so it was a struggle starting out, they said.

Leadership Role

Using open source in the healthcare field is a growing trend, according to Li. A lot of proprietary Unix exists, but that solution is not meeting the needs of customers, he said.

"We see competition but not at the strategic healthcare level. Microsoft is also moving into this space," said Li.

When the proprietary vendors that Florida Hospital was using doubted their ability to switch to open source, Velazquez and Skantz took the challenge. They knew they were pushing ahead of the curve but did so anyway.

"We are saying 'follow us' in many aspects. Now we are seeing a trend developing. Even our competing hospital at the other end of town is considering a migration to open source," added Velazquez.

More to Come

The Linux Foundation is not surprised at the experience Florida Hospital has had in making the move.

"Using open source software in a hospital environment makes sense. Why pay lots of money to own a product with restricted use?" Amanda McPherson, marketing director of Linux Foundation, told LinuxInsider.

Many developers out there are available to integrate software for these purposes. Especially with the strides being made with mobile Linux, health field applications are moving up the stack, she said.


*ECT News Network editor's note: The original publication of this article incorrectly identified Florida Hospital's owner and operator as Atlanta Health System. Florida Hospital is owned and operated by Adventist Health System. We regret the error.


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