Healthcare provider organizations like yours remain under pressure to maximize the benefits from substantial investments in industry-leading MEDITECH electronic health records (EHRs). For mission-critical applications, when customers design their data centers for MEDITECH solutions, they often identify the following goals for their data center architecture:

As MEDITECH users evolve their organizations to become accountable care organizations and adjust to tightened, bundled reimbursement models, the challenge becomes delivering the required MEDITECH infrastructure in a more efficient and agile IT delivery model.

Because of an overarching requirement to deliver predictable low-latency system performance and high availability, MEDITECH is prescriptive as to its customers’ hardware requirements.

FlexPod is a prevalidated, rigorously tested converged infrastructure from the strategic partnership of Cisco and NetApp. It is engineered and designed specifically to deliver predictable low-latency system performance and high availability. This approach results in MEDITECH compliance and ultimately optimal response time for users of the MEDITECH system.

The FlexPod solution from Cisco and NetApp meets MEDITECH system requirements with a high- performing, modular, prevalidated, converged, virtualized, efficient, scalable, and cost-effective platform. It provides:

FlexPod is a proven data center solution, offering a flexible, shared infrastructure that easily scales to support your growing workload demands without negatively affecting performance. By leveraging the FlexPod architecture, this solution delivers the full benefits of FlexPod, including:

In addition to these benefits, each component of the FlexPod Datacenter stack with MEDITECH solution delivers specific benefits for MEDITECH EHR workflows.

A self-integrating, self-aware system, Cisco Unified Computing System (Cisco UCS) consists of a single management domain that is interconnected with a unified I/O infrastructure. So that the infrastructure can deliver critical patient information with maximum availability, Cisco UCS for MEDITECH environments has been aligned with MEDITECH infrastructure recommendations and best practices.

The foundation of MEDITECH on Cisco UCS architecture is Cisco UCS technology, with its integrated systems management, Intel Xeon processors, and server virtualization. These integrated technologies solve data center challenges and help you meet your goals for data center design for MEDITECH. Cisco UCS unifies LAN, SAN, and systems management into one simplified link for rack servers, blade servers, and VMs. Cisco UCS is an end-to-end I/O architecture that incorporates Cisco Unified Fabric and Cisco Fabric Extender Technology (FEX Technology) to connect every component in Cisco UCS with a single network fabric and a single network layer.

The system can be deployed as a single or multiple logical units that incorporate and scale across multiple blade chassis, rack servers, racks, and data centers. The system implements a radically simplified architecture that eliminates the multiple redundant devices that populate traditional blade server chassis and rack servers. In traditional systems, redundant devices such as Ethernet and FC adapters and chassis management modules result in layers of complexity. Cisco UCS consists of a redundant pair of Cisco UCS Fabric Interconnects (FIs) that provide a single point of management, and a single point of control, for all I/O traffic.

Cisco UCS uses service profiles to help ensure that virtual servers in the Cisco UCS infrastructure are configured correctly. Service profiles are composed of network, storage, and compute policies that are created once by subject-matter experts in each discipline. Service profiles include critical server information about the server identity such as LAN and SAN addressing, I/O configurations, firmware versions, boot order, network virtual LAN (VLAN), physical port, and QoS policies. Service profiles can be dynamically created and associated with any physical server in the system in minutes, rather than in hours or days. The association of service profiles with physical servers is performed as a simple, single operation and enables migration of identities between servers in the environment without requiring any physical configuration changes. It facilitates rapid bare-metal provisioning of replacements for retired servers.

The use of service profiles helps ensure that servers are configured consistently throughout the enterprise. When multiple Cisco UCS management domains are employed, Cisco UCS Central can use global service profiles to synchronize configuration and policy information across domains. If maintenance needs to be performed in one domain, the virtual infrastructure can be migrated to another domain. This approach helps to ensure that even when a single domain is offline, applications continue to run with high availability.

To demonstrate that it meets the server configuration requirements, Cisco UCS has been extensively tested with MEDITECH over a multiyear period. Cisco UCS is a supported server platform, as listed on the MEDITECH Product Resources System Support site.

Cisco Nexus switches and Cisco MDS multilayer directors provide enterprise-class connectivity and SAN consolidation. Cisco multiprotocol storage networking reduces business risk by providing flexibility and options: FC, Fibre Connection (FICON), FC over Ethernet (FCoE), SCSI over IP (iSCSI), and FC over IP (FCIP).

Cisco Nexus switches offer one of the most comprehensive data center network feature sets in a single platform. They deliver high performance and density for both data center and campus cores. They also offer a full feature set for data center aggregation, end-of-row, and data center interconnect deployments in a highly resilient modular platform.

Cisco UCS integrates computing resources with Cisco Nexus switches and a unified I/O fabric that identifies and handles different types of network traffic. This traffic includes storage I/O, streamed desktop traffic, management, and access to clinical and business applications. You get:

Together, Cisco UCS with Cisco Nexus switches and Cisco MDS multilayer directors provides an optimal compute, networking, and SAN connectivity solution for MEDITECH.

NetApp storage that runs ONTAP software reduces your overall storage costs while it delivers the low-latency read and write response times and IOPS that MEDITECH workloads need. ONTAP supports both all-flash and hybrid storage configurations to create an optimal storage platform that meets MEDITECH requirements. NetApp flash-accelerated systems have received MEDITECH’s validation and certification, giving you as a MEDITECH customer the performance and responsiveness that are key to latency-sensitive MEDITECH operations. By creating multiple fault domains in a single cluster, NetApp systems can also isolate production from nonproduction. NetApp systems also reduce performance issues with a guaranteed performance level minimum for workloads with ONTAP QoS.

The scale-out architecture of the ONTAP software can flexibly adapt to various I/O workloads. To deliver the necessary throughput and low latency that clinical applications need while also providing a modular scale-out architecture, all-flash configurations are typically used in ONTAP architectures. NetApp AFF nodes can be combined in the same scale-out cluster with hybrid (HDD and flash) storage nodes that are suitable for storing large datasets with high throughput. Along with a MEDITECH-approved backup solution, you can clone, replicate, and back up your MEDITECH environment from expensive solid-state drive (SSD) storage to more economical HDD storage on other nodes. This approach meets or exceeds MEDITECH guidelines for SAN-based cloning and backup of production pools.

Many of the ONTAP features are especially useful in MEDITECH environments: simplifying management, increasing availability and automation, and reducing the total amount of storage needed. With these features, you get:

The following figure illustrates the FlexPod architecture for MEDITECH workloads.

MEDITECH does not resell server, network, or storage hardware, hypervisors, or operating systems; however, it has specific requirements for each component of the infrastructure stack. Therefore, Cisco and NetApp worked together to test and to enable FlexPod Datacenter to be successfully configured, deployed, and supported to meet the MEDITECH production environment requirements of customers like you.

MEDITECH associates the deployment size with a category number that ranges from 1 to 6. Category 1 represents the smallest MEDITECH deployments, and category 6 represents the largest MEDITECH deployments.

For information about the I/O characteristics and performance requirements for a MEDITECH host in each category, see NetApp TR-4190: NetApp Sizing Guidelines for MEDITECH Environments.

The MEDITECH Expanse platform is the latest version of the company’s EHR software. Earlier MEDITECH platforms are Client/Server 5.x and MAGIC. This section describes the MEDITECH platform (applicable to Expanse, 6.x, C/S 5.x, and MAGIC), pertaining to the MEDITECH host and its storage requirements.

For all the preceding MEDITECH platforms, multiple servers run MEDITECH software, performing various tasks. The previous figure depicts a typical MEDITECH system, including MEDITECH hosts serving as application database servers and other MEDITECH servers. Examples of other MEDITECH servers include the Data Repository application, the Scanning and Archiving application, and Background Job Clients. For the complete list of other MEDITECH servers, see the “Hardware Configuration Proposal” (for new deployments) and “Hardware Evaluation Task” (for existing deployments) documents. You can obtain these documents from MEDITECH through the MEDITECH system integrator or from your MEDITECH Technical Account Manager (TAM).

A MEDITECH host is a database server. This host is also referred to as a MEDITECH file server (for the Expanse, 6.x, or C/S 5.x platform) or as a MAGIC machine (for the MAGIC platform). This document uses the term MEDITECH host to refer to a MEDITECH file server or a MAGIC machine.

MEDITECH hosts can be physical servers or VMs that run on the Microsoft Windows Server operating system. Most commonly in the field, MEDITECH hosts are deployed as Windows VMs that run on a VMware ESXi server. As of this writing, VMware is the only hypervisor that MEDITECH supports. A MEDITECH host stores its program, dictionary, and data files on a Microsoft Windows drive (for example, drive E) on the Windows system.

In a virtual environment, a Windows E drive resides on a LUN that is attached to the VM by way of a raw device mapping (RDM) in physical compatibility mode. The use of Virtual Machine Disk (VMDK) files as a Windows E drive in this scenario is not supported by MEDITECH.

The I/O characteristic of each MEDITECH host and the system as a whole depends on the MEDITECH platform that you deploy. All MEDITECH platforms (Expanse, 6.x, C/S 5.x, and MAGIC) generate workloads that are 100% random.

The MEDITECH Expanse platform generates the most demanding workload because it has the highest percentage of write operations and overall IOPS per host, followed by 6.x, C/S 5.x, and the MAGIC platforms.

For more details about the MEDITECH workload descriptions, see TR-4190: NetApp Sizing Guidelines for MEDITECH Environments.

MEDITECH requires that the FC Protocol be used for data traffic between the NetApp FAS or AFF system and the MEDITECH hosts of all categories.

Each MEDITECH host uses two Windows drives:

MEDITECH requires that a specific naming convention be used for all LUNs.

Before any storage deployment, verify the MEDITECH Hardware Configuration Proposal to confirm the naming convention for the LUNs. The MEDITECH backup process relies on the volume and LUN naming convention to properly identify the specific LUNs to back up.

Cisco focuses on three key elements to deliver a superior data center infrastructure: simplification, security, and scalability. The Cisco UCS Manager software combined with platform modularity provides a simplified, secure, and scalable desktop virtualization platform:

VMware vCenter Server provides a centralized platform for managing MEDITECH environments so that your healthcare organization can automate and deliver a virtual infrastructure with confidence:

Virtual Storage Console (VSC), vSphere API for Storage Awareness (VASA) Provider, and VMware Storage Replication Adapter (SRA) for VMware vSphere from NetApp make up a single virtual appliance. The product suite includes SRA and VASA Provider as plug-ins to vCenter Server, which provides end-to-end lifecycle management for VMs in VMware environments that use NetApp storage systems.

The virtual appliance for VSC, VASA Provider, and SRA integrates smoothly with the VMware vSphere Web Client and enables you to use SSO services. In an environment with multiple VMware vCenter Server instances, each vCenter Server instance that you want to manage must have its own registered instance of VSC. The VSC dashboard page enables you to quickly check the overall status of your datastores and VMs.

By deploying the virtual appliance for VSC, VASA Provider, and SRA, you can perform the following tasks:

NetApp OnCommand Insight integrates infrastructure management into the MEDITECH service delivery chain. This approach gives your healthcare organization better control, automation, and analysis of your storage, network, and compute infrastructure. IT can optimize your current infrastructure for maximum benefit while simplifying the process of determining what and when to buy. It also mitigates the risks that are associated with complex technology migrations. Because it requires no agents, installation is straightforward and nondisruptive. Installed storage and SAN devices are continually discovered, and detailed information is collected for full visibility of your entire storage environment. You can quickly identify misused, misaligned, underused, or orphaned assets and reclaim them to fuel future expansion. OnCommand Insight helps you: