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Posted Monday, September 24, 2012 12:29 PM
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I work in healthcare and I am pretty fresh in my career and would like to ask some advise.

As some of you may already know, there has been a significant reduction in the amount the government and insurance companies payout for medical care. Where we used to be reimbursed $300 for procedure X we are now only receiving $275. As you can imagine this is starting to effect our bottom line. As such we have been asked how we can reduce our operating costs.

My concern is this...

Our current SQL Server license model is to build a server for each and every vendor application and only run that vendors database(s) on it. I believe we also do this 'True up' thing with Microsoft once per year on the SQL Server licenses.

What I am wondering is if there could be a significant savings and overhead by either ....
1. Building up a very beefy few servers and running multiple instances on those. (If vendor contracts allow)
or
2. Cloud based services

We are already utilizing VMware on smaller applications but that is still a license...

Thank you!
Post #1363676
Posted Monday, September 24, 2012 1:12 PM


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It depends on why you have a different machine per vendor. If it's for security isolation, separate instances (one license) should be adequate. If it's for DR/BC, it's probably not doing what someone thinks it is (I've seen this argument before, so I mention it). If it's to simplify support, or to comply with vendor licenses/contracts, then it may not do what you need.

If I'm not mistaken, Enterprise Edition of SQL Server can cover multiple virtual machines with a single license. If you want specifics, call Microsoft and get their official answer on this. You may have specific circumstances that modify how the licensing would work, and it's best to get the answers directly from the source.


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Post #1363694
Posted Monday, September 24, 2012 2:29 PM
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Just some quick thoughts as I've worked as a systems analyst in healthcare maintaining and installing new applications:

* I'll echo G-Squared here: know what your vendors require and what is allowed by them to keep your support contract valid is important. Some systems that are FDA certified have very little flexibility in their configuration, especially when they interface with equipment that comes in direct contact with the patient.

* There are some good things out there in terms of cloud storage for healthcare, but not on the database side that I've seen. For instance there are some really cool medical imaging storage schemes where you have a local "cache" on SAN with copies replicated to the cloud for redundancy. Eventually over several years old images would be evicted, and would exist only on the cloud. The cloud provider could buy storage at a fraction of the cost that we could and pay the electricity bill to keep them spinning.

* At a previous position we were very resource constrained in terms of both money and manpower and one of our cost savings projects was to virtualize as much as possible. The reason was that a lot of vendors tended to trail far behind the current state of the art in terms of SQL Server and Windows OS. I remember looking at RFPs where they were still recommending SQL 2000 SP4, and SQL 2005 had been out for more then two years, and the vendor wasn't supporting anything newer yet. Since some of the hardware was approaching and exceeding 5 years of age we poured money into some beefy VM servers instead of replacing individual application servers. Also, some of the small apps that didn't have a heavy I/O load we hosted on a single SQL Server instance if the vendor would allow us to.

* Don't forget about your SAN/Disks: You might find that as part of your consolidation that a lot of data that was stored on local disk arrays need to migrated to a SAN. Then you see the price of the disks....

Hope this helps....
Post #1363724
Posted Wednesday, September 26, 2012 6:20 AM


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Of course, another thing to keep in mind, that I didn't remember to mention in my first reply, is that some applications may be sensitive to the patch-level of either Windows or SQL Server, on the server they live on. If different applications require different patch levels, then they have to be on different servers (or different VMs), or you can end up violating support contracts.

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Post #1364613
Posted Wednesday, September 26, 2012 6:36 AM
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The cost of the hardware and DB licences is normally a small fraction of the price of keeping your systems running. Implementing good practices for automation: backups, sheduled jobs, MI reports and implementing SSRS and sharepoint can seriously reduce the overhead of cleaning data, preparing and distributing reports.

I have working in healthcare in the UK. MI used server running SQL2005 with a part time DBA. The total cost of this probably less than £30K a year. However they had 6 analysts and a manager pulling data from SQL into local Access dbs, creating datasets and then sending the results out via email on Excel. Cost to the organisation? probably £150K+. I'm not saying that you could get rid of all of that, but the low level ETL and distribution could have been done by SSRS which was already included in their cost base.

Post #1364620
Posted Wednesday, September 26, 2012 6:38 AM
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