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Nuffield Health finds SD-WAN deployment worth the added cost

The additional SD-WAN cost brought more value to the LANs of 189 Nuffield hospitals and fitness centers in the United Kingdom.

Nuffield Health, the United Kingdom's largest nonprofit healthcare company, didn't spend less on networking when it switched its 31 hospitals and 158 fitness centers and medical clinics to SD-WAN. In fact, the overall cost increased by 20%.

"It wasn't a savings," said Dan Morgan, the IT operations director at Nuffield, based in Epsom, U.K. "We were spending slightly more than we were spending before, but we're getting far more for it."

The return from the SD-WAN deployment is not measured in reducing current costs. Instead, the technology is about the future.

In 2015, Nuffield decided to embrace cloud-based software to eliminate one of two data centers over time. Applications chosen by the company included Microsoft's Office 365, SharePoint, Skype for Business and Teams.

Other products included TrakCare, an electronic medical record system from InterSystems Corp., and GymManager, a system developed by Sharptec for running sports facilities. Nuffield operates more than two dozen gyms with medical centers that provide rehab for injuries, weight control and health assessments.

Dan Morgan, IT operations director, Nuffield HealthDan Morgan

Going online for software meant the single 30 Mbps MPLS link at each of Nuffield's facilities was no longer adequate. Instead, the company wanted two 100 Mbps internet broadband links at each site -- a more than sixfold increase in bandwidth.

"As soon as you start looking at that in an MPLS world, you're then looking at double the cost, and probably triple the cost," Morgan said.

Deploying SD-WAN

The network overhaul demanded new technology for routing traffic, so Nuffield chose Silver Peak's SD-WAN. In general, the product creates a virtual overlay that abstracts the underlying private or public WAN connections, such as MPLS, broadband, fiber, wireless or Long Term Evolution. Network operators manage the traffic through the software console that comes with the system's central controller.

Installing the SD-WAN appliance was easy enough for Nuffield to have one running on the LANs of each of the 189 sites within four months, Morgan said. Speed was essential because Nuffield wanted to switch facilities to broadband before its MPLS contracts expired.

The most significant problem was the installation of the optical fiber that would carry the broadband. If the cable wasn't available at a facility, then Nuffield had to get approval from government regulators and landowners to have it installed. At the health facility in Cardiff, Wales, for example, Nuffield had to get permission from four farmers to dig up their fields to lay fiber to the center.

At another site, Nuffield lost the MPLS service before the broadband connection was up. So, a non-technical project manager stuffed the SD-WAN appliance and two 4G dongles in a knapsack and flew to the rural location.

Once connected to the LAN, the appliance re-established the internet connection after downloading the preset configurations from the controller. Nuffield's LANs use mostly Cisco Catalyst switches.

"The site was up and running over a pair of 4G dongles and ran like that quite happily for a good couple of weeks until the new link was ready to get plugged in," Morgan said.

Lessons learned from the SD-WAN deployment

In hindsight, Morgan would have preferred six more months with the MPLS links. That way, he could have set up each SD-WAN appliance with those connections and change to the new ones when they were ready.

Another gotcha for Morgan was failing to have a full understanding of how each device communicates with the network, especially hardware that hospitals might use for years. Examples include magnetic resonance imaging (MRI) equipment and computed tomography (CT) scanners used to diagnose tumors.

"You end up having to retrospectively fix it, rather than accounting for it in the migration piece," Morgan said.

Now that the SD-WAN deployment is done, Nuffield is working on migrating all its hospitals and gym-based medical centers to the online TrakCare EMR system. Also, the nonprofit will gradually consolidate on-premises applications in one data center. Nuffield plans to finish both projects within four years.

Nuffield will run its business operations on the broadband connections. The SD-WAN appliances will also have a 1 Gbps link available for the multi-gigabit size files CT scanners, MRIs and X-ray machines create.

Nuffield will store and access those files through its private data center, which is a less expensive option than using a public cloud provider, such as Microsoft Azure, Morgan said.

"With cloud hosting platforms, such as Azure, you have to be careful of the data volumes that are going in and out to keep an eye on your costs," Morgan said. "At the moment, things like Azure are still quite expensive to host that sort of environment."

So, while SD-WAN didn't cut Nuffield's networking cost, it is providing a more substantial bang for the buck.

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