Linux-based email helps healthcare cut costs

Three US health centres expand email with open source

For three US healthcare centres, the challenge was clear: find a way to improve internal communications by expanding email accounts to all employees, including doctors, nurses, security staffers, dietary workers and others, without breaking their IT budgets.

To do it, the hospitals needed to look at alternatives to traditional ways of creating and administering email accounts.

In the end, all three health centres chose an application that could do the work of Microsoft Corp's Exchange email administration package while maintaining calendaring and other group features.

Wade Grimes, the IT operations manager for the three-hospital Appalachian Regional Healthcare System in North Carolina, had to update an email system that served only about 400 of 2,000 staff members, with a mandate to find an economical way to get service for the rest of staff. The infrastructure was a hodgepodge, with Microsoft Exchange 2000 running in one facility while two different brands of email appliances were used in other areas. The three hospitals in the systems are Watauga Medical Centre in Boone, N.C., Charles A. Cannon Jr. Memorial Hospital in Linville and Blowing Rock Hospital in Blowing Rock.

When Grimes checked into replacing it all with new Exchange infrastructure about a year ago, the estimated US$250,000 to $300,000 (NZ$328,000 to NZ$394,000) cost quickly put an end to the search. That's when the IT staff brought in a server using the free, open source Postfix email application running on Ubuntu Linux to operate alongside the Exchange server so that more users could be added at little cost.

"It was nuts," Grimes recalls. "It worked, but there were several challenges. User management was an impossibility" because it lacked central management for the entire system.

A bigger problem was that as the IT staff provided the additional workers with email accounts in the Postfix environment, they quickly heard requests for such features as shared calendaring and other collaboration tools that the Exchange users had. Users on the Exchange system couldn't share these features with users on the Postfix system, which sent Grimes again searching for an answer.

Grimes looked at other big email/collaboration applications, including Novell's GroupWise and IBM's Lotus Notes, but those were also too expensive for the hospitals, he said. "Email is incredibly important, but budgets are important, too."

That's when one of his IT staff members found PostPath's PostPath Server application, which runs on Linux and allowed the hospitals to save money while still connecting new users with the Exchange users, all while allowing collaboration features to work for everyone. It was sufficiently inexpensive that Grimes "didn't need to go to the capital budget committee to get it passed".

He also looked at the open source alternative Open-Xchange, but tests didn't show the needed results, he says. "Some calendars didn't sync up quite right," he says. "We've got some decent Linux talent in-house and looked at these things on virtual machines to see if they could get them to work. We could get it 80% of the way there, but the [missing] 20% were the features I wanted."

"We really tried not to use PostPath, we really did," Grimes says. But in the end, "it was the obvious choice for all the things we tried to do." Another benefit of PostPath Server, he says, is being able to add more web servers at no charge, unlike Exchange. With PostPath, customers pay for mailboxes and can add servers at no charge.

The PostPath deployment cost the hospitals about US$40,000, compared with US$300,000 for Exchange licensing. Grimes also said they were able to use some existing hardware they had on hand.

Clyde Williams, the infrastructure systems manager at Southeast Alabama Medical Centre, in Alabama, also moved to PostPath Server after looking for ways to expand email service to an additional 1,500 employees beyond the 1,000 who already had email accounts.

Faced with the high costs of Exchange deployment, Williams looked at Exchange alternatives but came upon several that required plug-ins or client add-ons to make them work with Exchange systems. "I didn't want to have to worry about extra deployments and going out and touching 1,500 PCs," he says.

For Williams, a major benefit of PostPath Server has been that users don't even know they're running on anything else, he says. He began by setting up 50 users to the PostPath system and will add users over time, having purchased 2,000 user licenses. The deployment will continue through to the end of the year and will be connected to the hospital's single sign-on project that will enable users to have single sign-on to use all of their applications.

The system saved the hospital 80% of what an Exchange upgrade would have cost, he says.

At Moses Taylor Hospital ,in Pennsylvania, Frank Fallo, who is in charge of network systems workflow development, was looking for a replacement for the hospital's older Exchange 5.5 server, which had a 16GB data limit that was constantly being reached by hospital users, rendering the mail system inoperable. After reviewing five competing products, Fallo chose PostPath because it didn't require plug-ins and would work with the existing Microsoft Outlook client software, which users already liked and were accustomed to using.

"We were happy with Exchange," other than its high costs, Fallo says. "It was really a cost-driven search" for alternatives.

A key, he says, was choosing a product that he could install on a Friday and have users come in on Monday with the system fully operational and "not know that anything was done."

With PostPath Server, that's what he got, he says. About 1,000 users are on the system now, and the hospital saved about 50% on the software costs, he says. "It was nearly a drop-in," other than a few small problems which weren't caused by PostPath. "They were mostly due to incompatible older Outlook clients. Once we got rid of them, we had no problems."

Analysts say such products fill niches when users want to spend less money but want to keep the features they like with Exchange and other large enterprise email server applications.

Vince Londini, an analyst with Info-Tech Research Group in Ontario, Canada, says Exchange dominates 60% to 80% of the market, with Lotus Domino and Notes and Novell Groupwise filling in the gaps, but those systems don't fit all users because of their size and complexity.

"There is definitely a trend in the datacentre toward Linux" alternatives, Londini says. In addition to PostPath, vendors Scalix, a wholly owned subsidiary of Xandros, and Zimbra, which is owned by Yahoo, also offer Exchange replacement software that runs on Linux.

Michael Osterman, principal of Osterman Research, in Washington, says all three vendors — PostPath, Zimbra and Scalix, as well as others like Open-Xchange — offer good Exchange alternatives for users.

With PostPath, the lack of any plug-ins can be a benefit, Osterman says, because it can simplify your deployment and system. But it's not the only thing to look for, he says.

"The thing with plug-ins is it's just another step," he says. "It's not a deal breaker probably for a lot of customers, because you can do automated installs remotely" to ease their installation and configuration. "But if you can get away without a plug-in ... then it's probably a better choice for administrators. It removes one layer of complication."

For users, Osterman says many more are willing to replace their backend email infrastructure if they can leave their client software alone so users can continue to use what they know. That's why these Exchange alternatives are gaining in popularity, he says.

"We find that a dramatically larger percentage of companies would consider the new messaging systems if they didn't have to do anything to the desktop," he says. "If you consider the logistics of dealing with an upgrade like this, if you can go with PostPath [or one of its competitors] and just replace the backend ... then essentially to the users, there's no difference."