What Healthcare Companies Need from Application Availability and Load Balancing – Three Case Studies Say Everything You Need to Know

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Disaster recovery and uptime are two key concerns. 

Healthcare companies and their eHealth applications are very demanding of IT’s resources, priorities and solutions. And it goes far beyond HIPAA, though that is a big load in itself.

E-Healthcare includes applications supporting healthcare and streamlining patient and doctor interaction processes. These applications:

  • Compile and store digital patient records
  • Schedule patients, physicians, technicians and facilities
  • Store, manage and retrieve digital images
  • Bill for services
  • Perform accounting
  • Offer telemedicine as well
These critical applications cut operational costs while boosting healthcare IT efficiency.

To make the applications themselves efficient and available, the network infrastructure supporting them must be equipped for the challenges. Key applications attributes include:

  • High Availability – always running and able to handle image needs, patient billing info, etc.
  • Highly Scalable – accommodate increased loads without bogging down
  • High Performance – snappy not sluggish with no delays
  • Cost Effectiveness – maintain a right-sized network that is available and scalable, and achieve right-sized performance at the right price.
Core to this underlying infrastructure is application delivery controllers (ADCs), also known as load balancing solutions, which have emerged as a vital technology in solving the problem of performance and accessibility for mission-critical healthcare applications. 

In its simplest form, a load balancer directs users to the best-performing, accessible server. When a server (or software on that server) is unavailable, the load balancer takes that server offline and seamlessly and automatically re-routes users to other available servers. Using load balancing algorithms, an intelligent load balancer distributes users to servers with the best performance by dynamically interrogating key server elements such as the number of concurrent connections and CPU/memory utilization. 

Further enhancing user experience, advanced load balancers offer Secure Sockets Layer (SSL) acceleration by offloading security encryption/decryption processes from application servers, dramatically boosting performance while shrinking the time and costs associated with certificate management.

Now let’s see how three organizations put load balancers to work.

Three Healthcare Cases in Point

Macmillan Cancer Support

Macmillan Cancer Support offers practical, medical, financial and emotional support across the UK – from nurses and therapists to medical experts and legal advisers. The organization has over 1,500 office staff and remote volunteers helping thousands of people affected by cancer. Macmillan has over 400 servers; most are virtual, running VMware ESXi.

Fast and reliable, around-the-clock communication is critical for Macmillan, and it was this need that led James Byrne, systems support manager at Macmillan Cancer Support, to look for a load-balancing solution for its Microsoft Exchange servers. To increase the performance and ensure high availability of its vital Microsoft Exchange email servers. Macmillan installed Kemp LM-2600 LoadMaster appliances.

The Kemp LoadMasters ensure a fast response and maximum network uptime for Macmillan's Exchange email users while removing congestion problems during peak times of the day. Users are automatically connected to the best-performing Exchange server, and if one becomes inaccessible, the load balancer will automatically re-route traffic to other functioning servers.

“A key factor was that the Kemp LoadMaster solutions are specifically for load balancing MS Exchange; but they also offer an all-in-one solution with excellent price/performance and features, such as SSL acceleration that allows us to offload encryption processing from our servers,” Byrne explained.

Learn more by reading the full Macmillan Cancer Support case study.

L'Azienda Sanitaria Locale n.1

Ecobyte, an authorized LoadMaster partner, carried out a critical project for the healthcare authority in the earthquake-sensitive area of Abruzzo in Southern Italy.

The local healthcare authority (L'Azienda Sanitaria Locale n.1) in the province of L’Aquila in Italy chose a LoadMaster load balancing solution to secure a disaster recovery infrastructure to ensure business continuity across its sites in the event of a natural disaster, manmade disaster, data center crash or power outage.

The local healthcare authority, ASL n.1, is in the Province of L'Aquila, the largest province of the Abruzzo region in Southern Italy, and an area sensitive to earthquakes. In 2009 the area suffered the deadliest earthquake to hit Italy since 1980, measuring 5.9 on the Richter scale and tragically causing 308 fatalities along with widespread damage.

ASL n.1 manages the healthcare system for the province’s 310.000 inhabitants and runs four hospitals, two local healthcare support centers and ten primary care general practices distributed over 60 sites.

Ecobtye deployed a cluster of Kemp LoadMaster devices in its main data center, with an additional LoadMaster in the backup site. This solution manages a heavy volume of email and other business-critical application traffic.

The goal was to create a disaster recovery infrastructure between the L’Aquila and Avezzano sites, to guarantee business continuity, even in the case of natural disaster, and maintain high availability for the authority’s business-critical services such as email and server applications. The solution to ensure zero interruption to access to crucial data such as patient records, surgery schedules, prescriptions and test results. 

“Unfortunately, earthquakes mark the history of our province here so having highly-available applications is critical. Server load balancing is essential for healthcare entities like ours so that service delivery can be controlled and managed – and if need be, reallocated — in the event of a disaster or downtime. With the Kemp LoadMaster Application Delivery Controller, server load balancing – in a disaster or during a regular business day — is completely seamless.”

Get the full story from our case study, LoadMaster Provides Disaster Recovery for Local Healthcare.


ImageTrend provides electronic Patient Care Reporting (ePCR) applications, data analytics and IT services, enabling fully integrated, patient-centric healthcare to customers such as fire departments, emergency medical services (EMS), hospitals and critical care facilities. In more than two-thirds of American states, ImageTrend is the sole provider to EMS and fire departments. 

ImageTrend’s main product, Elite, is used by paramedics and firefighters in the field to collect on-scene data about patients, incidents, drugs administered and patients’ medical conditions.

"We have three hosting facilities here in the Minneapolis-Saint Paul area of Minnesota," says Pete Larsen, an IT Services Engineer at ImageTrend, “plus a geographically separated hosting facility in Dallas, Texas. We believe in running almost entirely in-house with on-premises hosting because many of our customers don’t trust the cloud for their data and operations. Most of our applications run on virtual machines, and our stack is built on Microsoft products like Hyper-V, Virtual Machine Manager (VMM) and Storage for Windows Server.”

ImageTrend was using Microsoft Application Request Routing (ARR), which acts as an extension to Internet Information Server, enabling an IIS server to function as a load balancer. The company sought a more secure solution for load balancing and web termination. But it also wanted flexibility in moving around workloads, which few physical appliances offer. 

“The clincher for us was that LoadMaster was a solid virtual offering, “said Christoph Riesterer, IT Systems Engineer at ImageTrend

ImageTrend separates all its clients into tenants, which are logical groupings. There is no overlap among tenants, such that customers are never co-located on a particular app server. Running hundreds of separate tenants across the company’s half-dozen main applications means that ImageTrend continually runs 500 to 600 client-specific web applications.

"We run between 30 and 50 pairs of LoadMaster load balancers, some with multiple virtual services. We use load balancing for about 80 percent of our applications. We're constantly getting new clients, so we're constantly spinning up new tenants. That means new Kemp Virtual LoadMasters,” said Pete Larsen.

Dig into the details with our ImageTrend IT Healthcare Service case study.

Learn More

Thousands of customers across all industries use Kemp LoadMaster. Learn more about the use of load balancers in healthcare, as well as what templates and additional resources we offer.


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Doug Barney

Doug Barney was the founding editor of Redmond Magazine, Redmond Channel Partner, Redmond Developer News and Virtualization Review. Doug has also served as Executive Editor of Network World, Editor in Chief of AmigaWorld and Editor in Chief of Network Computing.