At Banfield Pet Hospital, PACS and Telemedicine Bridge the Distance across Its Hospital Network

We needed a way to consolidate this image data and make it universally available across our distributed network of hospitals.”
– Dan Baldock, Senior VP and CIO, Banfield Pet Hospital

Banfield Pet Hospital was challenged by all of its digital x-ray and ultrasound images stored locally at each of 500 disparate locations across the country. They had no way to share those images among all of the 780 Banfield pet hospitals. There was no backup or disaster recovery plan in place, so the medical data was at risk of loss if a hard drive failed. Telemedicine (getting a second opinion from a radiologist working remotely) was slow, expensive, and many veterinarians were not taking advantage of the service to improve patient care. “We needed a way to consolidate this image data and make it universally available across our distributed network of hospitals,” said Dan Baldock, Senior VP and CIO of Banfield Pet Hospital.

Banfield Pet Hospital is a network of 780 veterinary hospitals located throughout the United States. Banfield partners with PetSmart, the nation’s largest pet-related retailer, and operates pet hospitals inside PetSmart stores.

First Step: Centralize and Protect Digital Images

To solve these challenges, Banfield implemented a centralized PACS system (Picture Archiving and Communication System) at its headquarters in Portland, Oregon. They selected the open source software ClearCanvas as both the back-end archiving system and as the front-end viewer. Banfield had the support of the team at ClearCanvas and leveraged their existing in-house resources and expertise to develop and deploy the system. The only additional staff they needed to hire was a single PACS Administrator to aid in the setup and ongoing administration of the system.

Banfield set up the infrastructure for all 500 digital x-ray and ultrasound machines across the country to transmit images over a WAN to their centralized servers for long-term storage. They set up redundant, mirrored server and storage infrastructure with daily and monthly backup processes to protect the data. In addition, once that data was centralized, they implemented a disaster recovery plan for failover to a remote site in Arizona. Now the medical imaging data (x-ray and ultrasound images) is protected and readily accessible.

Data centralization also allowed Banfield to implement nationwide image sharing. Many clients are very mobile across the country. The hospital has countless stories of truckers that drive nationwide with their pets or snowbirds that go south with their pets for the winter. Having the ability for images taken at any Banfield hospital to be viewed with the click of a button at any other Banfield hospital has improved dramatically the continuity of care their veterinarians could provide.

Second Step: Telemedicine

With the foundational PACS system in place, Banfield then implemented a robust tele­medicine system. To do this, they custom-built a RIS system (Radiology Information System) to track the requests for telemedicine consults, allow the radiologist or other specialist to view the cases, and communicate the consultation results back to the requesting veterinarian and team. They partnered with various veterinarian telemedicine vendors, even designing a custom integration with one to send cases that could be read in their existing system.

By building this RIS system, they were able to improve the turnaround time of telemedicine consultation results getting back to the hospital to an average of 30 minutes for STAT cases (emergency cases) and 90 minutes for routine cases. Historically the turnaround time was hours to days. This made an enormous impact at the point of care for the veterinarians and their clients and patients to have a specialist give a second opinion as needed on a case to improve the treatment decision-making process.

In the end, Banfield was able to save millions of dollars in the first few years by selecting the ClearCanvas technology and leveraging their existing resources. Since the initial imple­mentation, they have also expanded the PACS system to include digital dental x-ray images after adding 60+ digital dental x-ray units to its hospitals. The system was built to be very scalable so they could add different types of imaging equipment and allow for the growth of new hospitals. Banfield has been opening about 50 new hospitals per year and will continue to do so. They are also in the process of implementing another feature, DICOM CD burn, using another ClearCanvas product. “The solution we chose has really allowed us to grow in many directions,” added Baldock.

Next Step: Integration with EMR

The future for PACS, RIS, telemedicine and all imaging systems at Banfield Pet Hospital holds even greater promise. The next step is to integrate the imaging systems with Banfield’s proprietary EMR (electronic medical record system) called PetWare. The goal will be to integrate images that reside in ClearCanvas PACS and radiology telemedicine consultation results directly into the EMR. The solution will also allow them to integrate images into their client/patient portal system, so clients can view their pets’ images.

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 Copyright © 2011 Apropos LLC. All rights reserved.

Credit Union Takes Unorthodox Approach to Developing IT System for Member Care

We stress the point that there is no such thing as an IT project. Every project starts with a vision for the member experience that we desire and then works backwards to the technology.”
– Butch Leonardson, Senior VP and CIO, BECU

The credit union BECU took an unorthodox approach to defining its next-generation IT system. BECU sent 10 people from its member solutions group whose primary job was engaging with credit union members to the Disney Institute in Florida for professional training and to develop an IT vision. These were non-technical and non-senior management personnel. “Their charter was to come back with a dream of a member care framework for how we can provide an exceptional experience to our members,” said Butch Leonardson, Senior VP and CIO of BECU.

BECU, headquartered in Tukwila, Washington, is a community charter credit union in the state of Washington. It has 50 branches, 1,000 employees and 730,000 members, the majority of which are clustered around the Interstate 5 corridor in Western Washington.

While it may be unusual to assign staff other than IT and senior management with the task of proposing a major new IT system, it was consistent with BECU’s “outside-in” IT philosophy. Leonardson elaborated, “We stress the point that there is no such thing as an IT project. Every project starts with a vision for the member experience that we desire and then works backwards to the technology.” From this perspective, it made sense to start the IT project with the personnel who were most directly engaged with credit union members.

More to the point, it worked. The group came back with a compelling vision for a member care framework consisting of three parts: Member View which presents a holistic view of each member’s accounts and transactions; Member Interaction Tracking which presents a current summary of all communications and interactions with the credit union; and Member Access which automatically ranks members based on financial metrics and determines their eligibility for products and rates.

Member Care Framework

To implement this framework, BECU needed a software platform that could bring together information from many disparate applications and present it in a unified manner. They selected Microsoft Dynamics CRM because it seemed lighter weight and more developer friendly and cost less than competitive alternatives. They also liked Microsoft’s roadmap for developing and evolving the product.

Member View was the first component they developed. Prior to Member View, when a credit union member walked into a branch or called on the phone, the member consultant or call center representative did not have an up-to-date, 360-degree view of that person’s transactional activity. They could get it, but it would take several minutes of cutting and pasting across multiple applications to assemble a complete picture because the transactions came from a variety of channels, such as online, phone, mobile and ATM. Like most medium-sized banks, BECU used commercially-available software and transactional data was spread across many applications supporting these channels. Member View brought all of that data together in a holistic view.

Member Interaction Tracking followed. It presented a similar holistic view of communications between members and the credit union. “If you have a conversation with us or you attempt to do something online or on the phone through our integrated voice response system, we know about the conversation and we also know where you dropped off attempting to do something. So when you reach a representative, that representative knows exactly where you abandoned the automated process,” said Leonardson. Therefore callers do not have to re-identify themselves or re-explain what they were attempting to do before switching to a live representative.

The third component, Member Access, made it easier to present each member with a customized set of products and rates. By leveraging business intelligence (BI) software to analyze financial metrics such as account balances, credit scores, and how long that person has been with the credit union, Member Access automatically determined a member’s eligibilities.

Proof Is in the Pudding

When the member care framework was complete, it presented a current summary of member transactions, interactions and relevant product eligibilities in a single view. Member consultants loved it because it made their jobs easier and streamlined interactions with members. BECU even won an IT award for the system. What about the credit union members themselves? While they do not interact directly with the system, they seem to like their experience with BECU. The credit union’s net promoter score, which measures how likely members are to recommend it to friends and family, is in the 75% range as compared to 25 to 35% for major banks, according to Leonardson. BECU also adds 7,000 to 8,000 new members per month. The proof is in the pudding, so to speak.

Toward One-Click Fulfillment

Yet BECU is not standing still. After using the system for 2 or 3 years, member consultants began to ask if they could also execute transactions directly within Member View. Now BECU is layering a portal on top its transactional applications and integrating them with Member View. “It solves the problem that most branches and call centers worldwide have, which is whatever you want me to do, Mr. Customer, I need to go into that application to get it done. Car loans, mortgages, Visa cards are all different systems. Now this portal will homogenize everything and make it all look like one environment,” said Leonardson.

Ultimately BECU’s wants to achieve what they call “one-click fulfillment.” This refers to an end-to-end digital enterprise that eliminates the need for written forms and signatures. The goal is to minimize process and maximize engage­ment with credit union members.Butch Leonardson

We think what we do as leaders is more than lead functions. We lead hearts and minds.”
– Butch Leonardson

Hearts and Minds

Leonardson considers the journey of developing this member care framework to be a tangible aspect of his greater concern as CIO for the IT organization’s shared values and morale: “Do I have seventy five people who wake up in the morning and say, ‘Wow, I have a great gig.’ I think a vast majority of people have a desire to be valued, to be in the middle of something important. And if you can provide that authentically, you are going to have a great organization. That is the center of my gravity as a leader.”

“Somebody called me a unicorn CIO because the stuff I think about is so different from most CIOs. If you looked at the org chart for our IT organization, it would look very normal. We have two VPs and seven managers. There is nothing unique about the way we are organized. We think what we do as leaders is more than lead functions. We lead hearts and minds,” he said.

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 Copyright © 2011 Apropos LLC. All rights reserved.

Virtual Machines, Virtual Desktops and Zero Clients Deliver Real Benefits for PAE Consulting Engineers

We had all this hardware running and were going to replace it every three to five years, but it wasn’t really getting used. We were never going to wear it out.
– Dustin Rowe, IT Manager and Technology Planner,
PAE Consulting Engineers

The Drive to Virtualize

For PAE Consulting Engineers, the drive to virtualize began with realizing that its distributed server architecture was only 10% utilized. The company was running 20 application workloads on eight physical servers. Since mission-critical applications were distributed among the servers, this architecture offered a reasonable degree of high availability. Restarting one application, such as Microsoft Exchange, did not require bringing down other critical applications, such as Microsoft SQL Server or Active Directory. The downside was that these servers were poorly utilized. As servers are normally replaced every few years, the company was locked into a cycle of overbuying hardware and recycling still-usable equipment. “Virtualization takes advantage of that downtime. That is what drove us forward,” said Dustin Rowe, IT Manager and Technology Planner for PAE Consulting Engineers. “We had all this hardware running and were going to replace it every three to five years, but it wasn’t really getting used. We were never going to wear it out.”

At the same time, the company had about 35 traditional desktop PCs with Intel Pentium 4 processors that had reached end-of-life and needed to be replaced. These PCs ran applications with moderate processing requirements, such as email, web browsing and project management. Here they saw an opportunity to also consider virtual desktop infrastructure (VDI) instead of a typical PC upgrade. “As we moved forward, we realized that by virtualizing our application servers, we would free up hardware that could be used to explore virtual desktop systems, which we thought might be able to meet the needs of these people with traditional desktops,” said Rowe.

PAE Consulting Engineers, Inc., is a mechanical and electrical engineering firm that specializes in sustainable, efficient, “green” building design. The company is based in Portland, Oregon, and has a satellite office in San Francisco, California.

Virtual Machines, Virtual Desktops and Zero Clients

Working with a local computer consulting company called Tech Heads, PAE Consulting Engineers looked closely at various options for server virtualization and VDI, including Microsoft Hyper-V, Citrix and VMware. At the time Hyper-V lacked some features they wanted. Citrix would have required eight servers to support the application workloads and desktop virtualization, while VMware could do it with half the number. They also found VMware to be very easy to use. Performing physical-to-virtual migrations and provisioning virtual machines were straightforward, simple tasks. For a small business with one IT manager handling the entire infrastructure, this was an important factor. Furthermore, pricing for virtualization software had dropped a point where it was realistic for the company’s IT budget.

The company chose VMware vSphere for server virtualization, VMware View for desktop virtualization and ClearCube I9422 Zero Clients at the desktop. VMware vSphere is the leading platform for server virtualization. VMware View is a desktop virtualization platform that runs Windows sessions centrally on a server and streams the display data over the network to client devices. In this case, the client devices were ClearCube Zero Clients that reside at each user’s desk and perform the role of a PC except for storage and processing. These devices communicate with the View server over the network using a streamlined PCoIP display protocol that facilitates a fluid screen presentation. They provide a single restart button and support dual monitors, keyboard, mouse and peripherals.

Easier to Manage and Less Costly to Operate

With the new virtual environment, PAE Consulting Engineers consolidated its original eight application servers down to two VMware servers running the same 20 application workloads in virtual machines. This was a major improvement in hardware utilization and delivered cost savings that would carry forward into the future as they only needed to replace two servers instead of eight when they reached end-of-life. Three additional servers ran VMware View to support nearly 30 virtual desktops. Two of the servers were required to support the workload and the third was for redundancy and failover purposes. Rather than purchase new hardware, they added processors, memory and network cards to the existing servers and redeployed them, thus minimizing costs for the transition to the virtual infrastructure.

They also added two IBM DS3500 Express storage systems, dedicating one for the application servers and the other for the virtual desktop system. Beyond storage consolidation and high availability, SAN storage allowed them to derive more benefits from server virtualization. For instance, the VMware vMotion feature in a SAN environment can migrate applications live between servers without disrupting user access. “We moved Microsoft Exchange in the middle of the work day with seventy people running email through it, and no one could even tell it moved to a different server,” he said.

At the relatively small scale of the company’s virtual desktop environment, hardware costs as compared to traditional PCs were break-even. While Zero Clients cost less than PCs and have a longer expected life of 7 to 10 years since they lack moving parts, the VMware View servers and SAN storage also factored in to the total cost.

The greatest benefit PAE Consulting Engineers experienced from VDI was simplified management and reduced IT supports costs. Rowe continued, “Now IT has one place to go take care of hardware. Aside from training and educating users on the end point, we nearly never have to go to the desk. That foot traffic is an incredible amount of time for the IT staff. You’re up and constantly going to a different machine to do something physically that is unnecessary with the technology we are using these days. We can do everything from our remote session. And as you scale the business, it becomes more and more valuable – by an order of magnitude.”

Windows functionality for virtual desktop users was identical to traditional PCs, though it took time for users to adjust to some differences in the interface. For instance, when restarting a computer, users only saw a welcome screen instead of one proclaiming that Windows is restarting, so they wondered if the computer was working correctly. While issues like this did not affect productivity, they required some changes in how users interacted with the system. Most workers used ClearCube Zero Clients as client devices. A handful of people used an Apple laptop or mobile device as their main computer and ran a View software client for occasional Windows access.

A surprising benefit of virtualization was the ability to extend the useful life of server hardware. Normally servers are replaced when the warranty expires after 3 to 5 years because warranty costs becomes prohibitive as the hardware ages. But with redundant servers and components and the ease of moving workloads around in a virtual environment, it becomes possible to continue using servers outside of warranty until they fail, then replace them. “We can be more flexible and let the hardware push us to replace, not the warranty,” said Rowe. However, a thoughtful recovery plan should be in place to do this. The company knows which of its applications are mission-critical and which can afford a little downtime in case of a hardware failure and recovery scenario.

Virtualization is a big deal. It is literally everything that it proposed itself to be.”
– Dustin Rowe

Another benefit they experienced was energy efficiency and lower electricity costs. The ClearCube Zero Clients consume only 15 W of power compared to 100 W for the PCs they replaced, which reduced power and heat dissipation at the desktop by 85% and eliminated noise from fans and hard drives. The tasks of computer processing and storage were transferred to three 300 W servers and a SAN storage array. Even including this hardware in the calculation, the power consumption per desktop was still reduced by approximately 50%.

Potentially More to Come

to the future, Rowe noted that the industry is developing server offload cards for graphics processing that could open the door to run CAD and sophisticated graphic design applications in the virtual desktop environment. Currently the workers using these applications have workstations with 3D graphics cards that perform the heavy-duty processing because it would be too slow and choppy to run these applications on a central server. But if high-performance graphics processing were available for the View servers, the company could consolidate the remainder of its desktops and further streamline the IT infrastructure.

“Personally it is very exciting to see legitimate advancements in technology,” he added. “For a long time, there hasn’t been anything to really change the way we think about how hardware should operate and when we’re going to replace it. But virtualization is a big deal. It is literally everything that it proposed itself to be. It just takes using it a while to really see.”

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 Copyright © 2011 Apropos LLC. All rights reserved.