Premier Medical

Case Study: Premier Medical

Premier Medical Group Leverages Flash-Optimized Storage to Answer the Demands of Storing and Protecting Electronic Health Data

Healthcare group realizes its regulatory compliance goals and achieves significant storage space savings with Nimble Storage.

Storage and backup was an increasing challenge for Premier Medical Group, a physician-owned and directed multi-specialty group with six locations and 240 employees in Clarksville, TN. Largely due to the growing demands of Electronic Health Records (EHR), the group had outgrown its existing backup solution. That solution struggled to do a full traditional backup across the network within the weekend time window. This was despite the fact that the backup was not corporate-wide but selective. It included irreplaceable items such as electronic health records (EHR), databases and files, as well as application data, but did not include server images. Each weeknight, IT staff used external data drives to backup critical data (its tape library had failed) and rotated the data offsite via removable media. This manual off-site media rotation process left data vulnerable between backups. A growing concern was the time required to recover this data in the event that it was needed.

Premier Medical not only needed a better solution for its storage and backup needs, it also needed a better disaster recovery solution that good business practices and compliance with Health Insurance Portability and Accountability Act (HIPAA) demanded.

Costly, Complex SAN Not Meeting Business Requirements

Premier Medical’s first priority was to improve its practices for storing data from critical enterprise systems. These include its practice management system, which handles scheduling, registration, billing, and patients’ EHR, and a lab information system that manages lab orders and results. Additionally, a picture archiving and communications system (PACS) stores a large and increasing number of medical images, which although compressed, take up a great deal of storage space, and a document management system used to scan millions of pages of pre-EHR paper-based records for storage.

Premier Medical Group turned to nexusSTOR, an IT reseller based in Memphis, TN, for a storage, backup and disaster recovery solution. “I go through a lot of due diligence prior to bringing on a technology, and Nimble Storage has the best technology in the market, period, as well as outstanding support,” said Kyle T. King, owner of nexusSTOR. “With a Nimble Storage array, we were able to do the entire project with one technology, clean up multiple processes, and save the customer considerable budget compared to other solutions.”

Storage Environment Optimized with Thin Provisioning and Compression

Today, Premier Medical employs a local iSCSI Nimble Storage array for primary and backup storage of all of its critical enterprise data. A replica Nimble Storage array offsite serves as a disaster recovery replication target. The group has migrated about 80 percent of the storage environment to Nimble Storage’s solution and expects that migration will be complete by the end of summer 2011.

Nimble Storage’s unique approach to thin provisioning and compression has provided significant space savings that was not possible with its legacy SAN. “Thin provisioning has been fantastic,” said Russell Roberts, Chief IT Administrator of Premier Medical. “Previously, we reserved expensive space on our old SAN based on what we thought we would need.

Often times we underestimated the size of a volume and had to expand the space, which was complicated. Other times we’d over estimate and that waste was costly. Now with Nimble’s thin provisioning, I err on the high side when provisioning space, because I know the space will not be allocated until it is actually needed by the host server and, therefore, it’s not wasted.”

The Nimble Storage array also compresses the medical group’s general-purpose files and applications such as Microsoft SQL and Exchange. Premier Medical is enjoying a multi-terabyte reduction in storage space thanks to the combination of thin provisioning and compression. In fact, Roberts thinks the medical group’s data footprint is now about as minimal as it can be.

Nimble Storage Array Works Seamlessly with VMware vSphere

In parallel to its move to Nimble Storage, Premier Medical implemented VMware vSphere 4.1 for server virtualization, hosted by new Dell servers. Two LAN switches for the iSCSI VLAN provide redundant paths between the server hosts and the Nimble Storage array and were set up with Nimble Storage’s help. This redundant iSCSI VLAN access to shared storage provides protection against a LAN switch failure.

Premier Medical also enabled vSphere’s high-availability features that allow a virtual machine to be quickly restarted on another server host in the event of a physical server failure. “It wasn’t Nimble Storage’s responsibility to get to that level of setup with us, but they did,” said Roberts. “We’ve definitely improved the resilience of our environment for our critical applications with Nimble Storage and their support engineers well supported our effort.”

The Nimble Storage system also takes consistent snapshots of the virtual machines, storing them locally and also replicating them to a second, offsite Nimble Storage array. Recently, when a Windows virtual machine experienced a complex registry issue, Roberts simply used a previous snapshot of the virtual machine to restore it to the point before the problem occurred.

Roberts does have a small quibble with the Nimble Storage array, however: “This isn’t hard enough! I need thick manuals, onsite field engineers, a complicated support web site, a-la-carte licensing charges for using the product’s advertised features, complicated spreadsheets to document configurations, maybe even a storage specialist! Something is very wrong here.”

Backup Time Reduced from Days to Minutes with Extended, Efficient Snapshots

The Nimble Storage array’s snapshot capability also has been key to both dramatically reducing backup time—from an entire weekend to a few minutes—and to quick recovery. “Now if we have an issue, the snapshots let us recover quickly,” said Roberts. “I have different snapshot schedules for different types of data. For example, I snapshot my database volumes once an hour, while I snapshot my Windows virtual machine images once a day. And the snapshots are all local, so it gives me quick recovery.”

For disaster recovery, IT replicates snapshots to a second, offsite Nimble Storage array that is 50 miles away via an Internet-based VPN with a bandwidth of less than 10 MB. All changes are replicated, so there are always complete copies of all data, including the snapshot recovery points, offsite. On the rare occasions when a snapshot replication is delayed, alerts from the Nimble Storage array let IT take action.

“I rest more comfortably at night knowing that I have a good, current copy of our mission critical data located in another town so that we could fully recover from a local datacenter disaster,” said Roberts.

The Nimble Storage array is significantly less complex to manage than Premier Medical’s previous SAN, and so IT staff has not had to invest as much time in learning the environment. “A modestly skilled IT person who has read the administration guide and had some practice time on the Web interface can be very functional at managing the Nimble array,” said Roberts.

Overall, according to Roberts, Nimble Storage has provided “a very high bang for the buck” and has a great feature set compared to other storage offerings the group considered. “We made a good value investment with Nimble Storage; we’ve met all our goals for storing important data and managing primary storage, and performance has been fantastic. I haven’t even had to troubleshoot any storage I/O issues since it was installed.”


Storage Profile


  • Data backup was extremely slow, requiring an entire weekend
  • Regulatory compliance required mandatory storage and backup of personal health information
  • Large and rapidly growing dataset
  • Unaffordable disaster recovery solution


  • Deploy Nimble CS220 and CS240 flash-optimized storage arrays

Immediate Benefits

  • Full backup, which previously took an entire weekend, now happens almost instantaneously
  • Thin snapshots and compression have reduced storage requirements by many terabytes
  • Integrated disaster recovery capabilities without additional investment, management, or training

Customer Quote

“A single Nimble array was not only able to meet the higher IOPS requirements, but also to deliver the needed capacity increases, all at a lower cost to CMJTS. That move also meant that they could demote the legacy SAN to a data protection role.”

Premier Medical Group

Premier Medical Group is the largest physician-owned and directed, multi-specialty group in the Clarksville-Montgomery County, Tennessee, area. With five clinic locations and more than 30 physicians in six specialties, it provides comprehensive healthcare to families and businesses throughout the community. Its Mission: to be an independent multispecialty group with a primary care emphasis, created and owned by local physicians, to form a family of health care professionals who take pride in their work and provide quality healthcare services to its patients.

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