Horribly conceptual

Virtualisation is a hot topic among NHS IT managers and is being promoted by NHS Connecting for Health, the agency in charge of NHS IT. However, it can be a very hard concept to grasp. If you’re a board member, clinician or other non-expert baffled by the pros and cons, start here. By Daloni Carlisle.

Talk to an NHS IT professional today and sooner or later the discussion will come round to virtualisation. NHS Connecting for Health has made it clear that this is the direction of travel for the NHS -- and has this year’s Operating Framework for the NHS in England to back it up.

The Informatics Planning guidance issued to support the framework promotes virtualisation within the NHS Infrastructure Maturity Model (NIMM). Mark Ferrar, CfH’s director of technical infrastructure says: “The guidance is as close as you get these days to an instruction to do it.”

What is virtualisation?

The trouble with the term virtualisation is it covers a variety of meanings, all of which overlap and all of which are quite hard to imagine. As an article on the Microsoft NHS Resource Centre put it recently: “It’s all horribly... conceptual.”

“It means a lot of things to a lot of people,” says Nick Umney, Microsoft’s lead technical specialist for health in the UK. “A lot of people see it in one specific light, but there is much more to it than that.”

Perhaps the best place to start is a trust server room. It is probably hot and overcrowded and may be drawing so much electricity that it is threatening local power supplies. This is all down to the way computing has evolved over the years.

Ten years ago, you bought a computer and some software to do a job. Then along came servers -- more powerful computers -- which networked whole offices to a central point so they could all access the same data.

Unfortunately, these servers were tied to a single operating system and a single task, and they often ran in isolation from each other. That made for waste. It also made for silos of information; a situation no longer tenable in the NHS.

Then along came virtualisation. It’s a way of pooling computing assets -- the processing power and data storage -- so that they can be used more efficiently and effectively, but without interfering with each other. It occurs on a physical level and at a software level -- keywords here being blade technology and hypervisors.

The idea is that in a virtualised system you need fewer servers because you can use them to maximum effect. So, the pay roll system runs once a month. Instead of having a server dedicated t the task, a virtualised system will switch computing power to it while it is needed.

Umney spells out the benefits. “It allows you to potentially get rid of physical machines,” he says. “At Microsoft, we achieved an eight to one ratio in a production environment.” It also saves electricity and carbon and reduces the amount of management time the IT department has to devote to maintaining the servers.

Not just servers

A second area is application virtualisation. “This means you can run multiple versions of an application on the same machine at the same time. Because they run in their own bubbles, they talk to the operating system but cannot interfere with other applications,” says Umney.

And why would you want to do that? Well, suppose you have an old clinical application that will only write letters to patients in Word 2000 but the trust has now moved to Office 2007. Application virtualisation allows the user to run both on the same machine. This is a key driver in industry, says Umney.

“The NHS already has this technology through [Microsoft’s] Enterprise Agreement [with the NHS] and it has guidance through the Common User Interface programme, but not everybody knows about it yet,” he adds.

The byproducts of virtualising your infrastructure are some serious benefits in terms of security and data recovery. Data is not spread around the place, tied to different machines, but in one place where it can be secured more easily. And that means it can be replicated into a virtual back up facility -- a mirror of the original system (see case studies).

Next comes the virtual PC. This is mostly of interest to IT specialists, who can use it to test out applications as though they were running on a hospital system, but in fact testing them in isolation. It allows testing time to come down from weeks to days -- another huge saving.

And then there are terminal services and virtualised desktops that allow clinicians to sit down at any PC in a trust and pull up their own desk top. The application sits on the server, meaning that the IT manager has control of it – which stops people downloading odds and sods of software that might lead to security problems or application conflicts.

The direction of travel for the NHS

There is now considerable weight behind the NHS using this technology. In particular, it should be driven by NIMM. This has been developed over the past two years by CfH and describes five levels of infrastructure, from one to five.

Ferrar says: “It describes the difference between a fairly standard IT infrastructure at level one to exceptional practice at level five.” A company like Amazon, in which IT is embedded in the business, would be at level five.

“Typically the NHS is operating at level one or two. The guidance to the Operating Framework wants to see trusts move to level three, pushing level four.” A trust at level three would be starting to implement virtualisation as part of a package of measures to rationalise and take control of its infrastructure and related devices.

If you are in a trust that has yet to start thinking about virtualisation, now is a good time, says Ferrar. The guidance and good practice is available through NIMM (on the NHS only pages of CfH’s website). The technology and software is advancing, with new offerings not just from Microsoft but also XenSource openware.

“There is now some competition in market place so we will see prices coming down and see more of it happening,” says Ferrar. “We know that many server rooms are stuffed full of equipment that is overloading the air conditioning at local power supplies.

“We have run up against the physical limits ourselves we have plans in place to take some of our own services as virtual services. We are applying virtualisation solutions ourselves to some of the national offerings and now we can also offer best practice guidance to apply it in their environments too.”

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