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Hospital Network Gives Doctors Reliable Access to Clinical Applications with F5 Solution

West Virginia University Hospitals (WVUH) is a seven-hospital network that serves the healthcare needs of thousands of West Virginia residents every day. The organization wanted to increase the availability of its Epic clinical applications and Microsoft Exchange Server 2010 mailboxes, while easing the user authentication process. WVUH recently implemented three F5 Big-IP Local Traffic Manager devices in its primary data center. Now, the organization can provide higher uptime for its Epic and Exchange environments, and can give doctors and nurses more reliable access to these critical applications. Additionally, the WVUH IT team can more efficiently manage the network.

Business Challenges


West Virginia University Hospitals (WVUH), located in Morgantown, West Virginia, is a 531-bed tertiary care center offering advanced medical treatment to patients throughout the state. WVUH operates seven local hospitals and clinics, including four hospitals in Morgantown, and is nationally recognized as a Level I Trauma Center.

WVUH is a member of the West Virginia United Health System, a regional network of hospitals and clinics that treats more than 3,600 people every day. Each year, these facilities perform 41,000 surgical procedures, more than 450,000 diagnostic imaging procedures, and over 3 million laboratory tests.

Since early 2010, WVUH has been implementing Epic Systems software to integrate its electronic records with appointments, registration, and billing. As of early 2012, more than 1,700 authorized doctors, nurses, and administrative staff at WVUH use Epic applications to access to clinical information. Eventually, more than 9,000 WVUH employees will rely on Epic applications to do their jobs. Additionally, WVUH maintains a growing Microsoft Exchange Server 2010 infrastructure with more than 6,000 mailboxes.

Because of the critical nature of the patient information accessed in the Epic applications and through email, the WVUH IT team must ensure high uptime around the clock. “In the healthcare environment, downtime is completely unacceptable,” says Farhan Ahmed, Senior Network and Security Engineer for WVUH. “We don’t even want the doctors and nurses we serve to know what uptime is. They shouldn’t even have to think about it.”

However, WVUH’s IT infrastructure had no way to direct traffic between web servers to control bandwidth. As a result, doctors, nurses, and other users often spent too much time logging into the system. “We had five domain controllers, but if one was down, four users would be able to log into the system and one would not,” says Ahmed. “That user would get an application timeout trying to log in, but it might take five or more seconds for login to work.”

Even five seconds of wait time could have a significant effect. “For doctors trying to access the application from his or her phone at home, five seconds is too long,” Ahmed says. “They might need to access important patient information for the hospital, and the patient is waiting on the other end of a call. And if the doctors can’t log in, they may think they typed their password incorrectly. In that case, they’re locked out after three password attempts, and that leads to an even bigger delay. Meanwhile, the hospital can’t get the critical information to the patient on time.”

Because WVUH needed to address this issue as it continued its Epic software implementation, the organization was determined to find a network optimization solution.

“BIG-IP LTM is not only a load balancer for us. It’s actually the core of our entire network, and it gives us the protection we were looking for from a technology solution.” Farhan Ahmed, Senior Network and Security Engineer for West Virginia University Hospitals



WVUH considered technology solutions from different vendors before deciding on F5 Networks. “I had used F5 technology at a previous job,” says Ahmed. “I knew their products were easy to deploy and manage. “

WVUH chose to implement three BIG-IP Local Traffic Manager (LTM) devices in its Morgantown data center. BIG-IP LTM provides intelligent network  traffic management and application delivery, and works as a reverse proxy, offering SSL acceleration and termination  as well as re-encryption to web servers. BIG-IP LTM also offers failover handling and health monitoring capabilities.

Working with Illinois-based network specialist CDW Healthcare, WVUH deployed the BIG-IP LTM devices in June 2011. Two of the devices were placed within the organization’s internal network to optimize the Active Directory and Exchange systems. The third device was placed inside the DMZ network to provide reverse proxy functionality for all of the company’s external websites.

WVUH is also taking advantage of advanced client authentication features in BIG-IP LTM, which helps increase server and application capacity by offloading authentication processing.

WVUH was assisted by F5 Professional Services during the implementation. “That was the best experience I’ve ever had in terms of professional services,” remarks Ahmed. “The consultants really knew the technology, but they also had very good network knowledge. That helped confirm that we’d made the right decision.”

WVUH is rolling out Epic software to WVUH- East Hospitals. “We will implement Epic to thousands more users over the next several years, and the F5 solution will provide domain authentication and load balancing for the entire infrastructure,” says Ahmed.  “At that point, we will likely implement an additional BIG-IP LTM device in our DMZ.”

WVUH is also interested in adding BIG-IP Application Security Manager (ASM), a web application firewall (WAF) that secures websites and applications and would help the organization meet HIPAA requirements, as well as the BIG-IP Access Policy Manager  (APM) module, which would provide  single sign-on and secure remote access capabilities.

“With BIG-IP LTM, we have the right technology in front of our clinical applications and Microsoft Exchange Server mailboxes. We can guarantee 100 percent uptime for our Epic and Exchange users, and they can get reliable access to the patient information they need.” Farhan Ahmed, Senior Network and Security Engineer for West Virginia University Hospitals



Using BIG-IP LTM, WVUH can now guarantee higher uptime for its critical Epic and Exchange implementations. As a result, doctors, nurses, and other clinical users can focus on serving patients rather than accessing the system. The organization’s IT team, meanwhile, is more efficient overall.

High uptime for critical Epic applications

With F5, WVUH can now reliably authenticate users, because its authentication servers have the redundancy and traffic optimization they need. With BIG-IP LTM, IT administrators can intelligently direct traffic between servers, ensuring higher availability for the organization’s critical clinical software implementation. “With BIG-IP LTM, we have the right technology in front of our clinical applications and Exchange mailboxes,” says Bill White, Systems Administrator for WVUH.  “We can guarantee 100 percent uptime for our Epic and Exchange users, and they can get reliable access to the patient information they need.”

WVUH also has more confidence in its infrastructure as a whole. “BIG-IP LTM is not only a load balancer for us,” says Ahmed.  “It’s actually the core of our entire network, and it gives us the protection we were looking for from a technology solution.  If the devices go down, all of our critical applications are down. This product gives us a lot more confidence in the network.”

Doctors and nurses can focus on patient care

Doctors, nurses, and other WVUH employees now have much more reliable access to Epic applications. With the server redundancy and traffic optimization functionality in BIG-IP LTM, as well as the reliability of authentication, these users can focus their attention on patient care and not the network. “Our Epic users have much less frustration now in terms of accessing the system and getting the important patient records they need to do their jobs,” says Ahmed. “For doctors and nurses, wasting even a few seconds trying to get into the system while patients wait for important information is not acceptable. They should be focused on providing the best patient care, not worrying about technical problems.  With the F5 solution in front of our clinical applications, caregivers can easily access the system from their phones, mobile devices, or computers, whenever they need to.”

IT efficiency increases

The WVUH IT team is more efficient with its new F5 solution, because it can centrally control application delivery and easily manage the organization’s web servers.  “The F5 solution definitely increases our efficiency, because we have fewer things to be concerned with, so we can put our time and effort into delivering services to our users,” Ahmed says. “We have not had any troubleshooting issues at all to date, and we do not have to worry about failover and health monitoring now.” With an improved ability to distribute the network load, WVUH IT employees can more efficiently perform maintenance. “We recently had to do maintenance on the Exchange servers, and because of the BIG-IP LTM traffic management capabilities, we didn’t have to schedule server downtime, so there was no user impact,” says Ahmed.

And because BIG-IP LTM gives WVUH the redundancy and high availability it needs, Ahmed and his team feel less pressure.  “With F5, I don’t worry as much about our data center,” he says. “I can sleep better at night with this technology in place, knowing that it’s giving us high uptime and reliable authentication.”