Like any budget-minded nonprofit organization, the American College of Radiology would rather not spend a lot of money on computer hardware and software. Nonetheless, the Reston, Va., group cannot afford to skimp.
A professional association of more than 33,000 doctors that conducts clinical trials and lobbies for better insurance coverage of scans for diagnosing cancer and other diseases, ACR has millions of high-resolution images in its archives. All these images need to be stored in a way that keeps them secure but also makes them easily accessible to doctors and researchers.
ACRs approach to technology had always been one of adding as it went along and putting out fires when they appeared. But Steve Giddens said that when he took over as CIO two years ago, he discovered that years of neglect had taken a toll.
Between two advocacy and research locations in Reston and Philadelphia, Giddens found that ACRs large image collection was supported by 100 servers made by at least four different manufacturers running at least five operating systems. None was working at anywhere near optimal levels.
“There was no commonality,” Giddens recalled. “Technology had never been a focus. It was really a hodgepodge of equipment.”
ACR, of course, had always been more interested in helping doctors diagnose cancer than shopping for servers. The group is continually studying the impact of radiology scans in diagnosing and treating cancers, while setting guidelines for what sorts of patients need scans and when they should receive them. ACRs past research into the detection of breast cancer led to its now-widely-followed recommendation that all women receive yearly mammograms beginning at age 40.
Giddens said he quickly realized that many of ACRs problems stemmed from its data center, where each server ran just one software application, resulting in massive waste for the organization.
Giddens said he knew that new technologies were being developed to help enterprises condense more applications on each server and improve efficiency. So he drew up a wish list.
First and foremost, Giddens recalled, he wanted to improve server utilization rates. Twenty percent was simply not acceptable.
Next, Giddens said he wanted to achieve more fluidity among servers so they could pick up and pass off loads in response to shifting demands for computing power in different areas of the organization. Ideally, he said, if one server crashed, another should be able to automatically take over without human intervention.
That led to the third item on his wish list: reducing the need for human intervention in the IT department.
Finally, Giddens said he believed strongly that any new technology ACR adopted should not only address its current needs but also anticipate the future.
Fortunately, Giddens found that one of the first vendors he met with offered a technology that fulfilled all the requirements on his wish list. Egenera, of Marlboro, Mass., is a startup specializing in the burgeoning area of server virtualization, a practice that effectively tricks applications into thinking they are supported by a dedicated piece of hardware while loading groups of applications on the same server.
Founded in 2000 by former Goldman Sachs Chief Technology Officer Vern Brownell, Egenera was built with the massive and exacting computing demands of the financial services business in mind, said Susan Davis, the companys vice president of marketing.
“His feeling was that the complexity had gotten chaotic,” Davis said of Brownell. “Most companies were using servers that really hadnt changed since the mainframe days.”
Without virtualization, server functions are pretty much fixed. Applications running on different operating systems, such as Windows or Linux, cant run together on the same server. Egenera developed a way to break that link between what Davis called “a particular piece of hardware and its logical identity.”
Because the virtualized server treats each application separately, these problems are avoided. “It allows you to move the capacity around as you need it,” said Davis, adding that this fluidity also helps with storage, since one operating system can now automatically take over for another in the event of a crash.
In January 2005, ACR deployed Egeneras BladeFrame virtualization system to power a key database: its National Oncologic PET (Position Emission Topography) Registry of images.
PET data is a diagnostic imaging procedure that can differentiate cancer from normal tissue while also estimating the stage of the cancer and tracking its progression. The collection of this data was vital in ACRs efforts to lobby for better Medicare coverage of PET scans for cancer patients.
Egeneras BladeFrame systems are collections of thin servers, or blades, that are stored as a single unit and can be moved around like books in a bookcase. ACR was able to migrate the work of some 50 Dell servers to just two BladeFrame systems.
Giddens said that because the Egenera servers are built to share and transfer work, they can be reconfigured for new jobs in approximately 30 seconds, compared with four days under the old system. As a result, ACR now has a hot fail system in place that will automatically put another server to work when one fails.
ACR would not disclose the amount it invested in Egeneras technology. However, Giddens said the organization has already saved more than $500,000 in software administration and licensing costs, which have dropped between 40 and 50 percent.
Since adopting Egeneras technology, Giddens said downtime in the ACR data center has been reduced by 65 percent. That translates into more time for ACRs member doctors to examine images; study the impact of drugs and other treatments in slowing or reversing the progression of cancers; and, ultimately, make a better argument for why these imaging procedures should be covered by insurance.
In May, ACR launched a new registry of PET scans that will enable Medicare doctors to offer scans to patients with all kinds of cancers. The program will provide reimbursement of the procedures, provided that doctors add the data collected to the registry for further research. ACR expects the program to provide free PET scans to hundreds of thousands of Medicare patients who previously did not have insurance coverage for those procedures.
Andrea Pettis is a freelance writer in San Francisco.
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Case File: American College of Radiology, Reston, Va.
- Organizational snapshot: A nonprofit professional organization that lobbies for better insurance coverage of scans for diagnosing cancer and tracking its progress
- Business need: ACR had long added servers as they were needed but found that many machines were running at utilization below 20 percent
- Recommended solution: BladeFrame computing systems from Egenera, which let individual servers power multiple software applications
- Project ROI: ACR was able to reduce licensing and software administration costs by 40 to 60 percent and downtime by 65 percent