One medical imaging vendor's journey from 'it's not my problem' to a strategic load balancing partnership

Taking away customer and vendor pain with high availability for medical imaging applications.

Radiology vendors have historically been reluctant to get involved in conversations about high availability. After all, why would they? They spend millions on the Research and Development of cutting-edge products that they're keen to provide to hospitals worldwide. What's high availability got to do with them? The short answer is 'nothing'. Traditionally, therefore, the customer would be advised to come up with their own high availability strategy with their in-house IT team.

However, now vendors are increasingly taking responsibility for ensuring the high availability of their applications by integrating with third parties to provide this service to their customers. Here we outline the journey of one medical imaging vendor we've recently worked with.

The use case: the need to remove the threat of application downtime

The 'leave it to the customer' high availability approach

This medical imaging vendor had traditionally viewed high availability as the responsibility of its customers.

The pros of this approach were that:

• They were able to avoid getting into the nitty-gritty of technical conversations that would have taken time away from their core business. It was seen as a distraction to product managers, development teams, and implementation staff whose time could be better spent focusing on what they do best - their own medical imaging products.
• They didn't have the in-house skills to design and deliver application redundancy even if they'd wanted to. So the decision to leave high availability to the customer was a commercial one — with staff hired for their medical imaging expertise, not their load balancing knowledge.
• When server or network issues resulted in application downtime for the end user, it wasn't their fault! After all, they'd been upfront from the outset that high availability and scalability were the responsibility of the local IT team, right?

The cons of leaving it to the customer however were the following:

• When their medical imaging application went down (through no fault of their own) the healthcare vendor still got blamed. Most customers' first point of call when things went wrong was understandably to reach out to their medical imaging vendor. But the customer was then somewhat unimpressed when their inevitable response was along the lines of "err, we can't help, this isn't our responsibility, speak to your IT folk". This was not a good experience for the customer, especially when their critical application were failing and patient care was being disrupted...
• Another downside for the vendor was the complexity of integrating their application with their customer's networks. Customer networks typically include many other, untested, third-party solutions. Trying to integrate with third-party load balancers on-premise at the customer's site was often incredibly complex (both in terms of implementation and maintenance). Furthermore, customers didn't always have the in-house expertise to deal with these implementation challenges on their own. The customer, therefore, had to rely on paid-for services from their own load balancing provider, which wasn't only complicated but also expensive.
• The 'noisy neighbor' problem was also causing them issues. When a customer already had a large, expensive F5 or Citrix Netscaler load balancing solution in place, they were understandably reluctant to spend additional funds on a dedicated load balancing solution to support the vendor's own medical imaging application. This meant the customer often put multiple applications through the same load balancer, resulting in the compromised performance of all connected applications —  including this medical imaging vendor's own application. What's more, the medical imaging vendor had no control over the situation and was therefore unable to resolve this issue for the customer. So, in order to avoid this 'noisy neighbor' situation, this medical imaging vendor concluded that a per application approach was needed. In other words their application needed to be deployed with its own, dedicated load balancer — thus preventing other applications from slowing it down, or causing it to fail.
• Lastly, the customer's lack of in-house high availability expertise was becoming a roadblock to securing sales. With in-house IT teams already stretched dealing with multiple vendors and third-party software, the  'leave it to the customer' approach was starting to come up repeatedly during the procurement process. With other medical imaging vendors taking on this responsibility for their customers, hospitals were understandably reluctant to add yet another maintenance responsibility to their already complex application stack.

Realization: It impacts our customer's so we need to address it

Having reached the point where this medical imaging vendor had determined once and for all that they needed to tackle the 'who is responsible for high availability' conundrum, they then needed to determine what to do about it.

They explored two possible avenues...

Option 1: Recommend a specific load balancing solution to their customers

The advantages of taking this approach would have been as follows:

• A mutually validated solution — For a vendor to be able to confidently recommend a solution that works with their application, a certain level of technical validation has to be completed. This usually takes the form of setting up a Proof of Concept (POC), confirming working configuration methods, documenting the config, and producing co-branded deployment guides. The value of this is ultimately being able to share validated deployment guidance with the customer. This greatly reduces the complexity of implementation for both the vendor and the customer. It also helps diagnose issues when maintaining the solution as known bugs, common issues, and troubleshooting practices are documented.
• Clear delineation of responsibilities — Having a validated solution also means you can clearly delineate responsibilities when an application fails. As above, once a working configuration has been agreed upon, and a test lab is in place, troubleshooting issues then becomes a lot simpler. Whereas before the customer may have been 'passed around', in this scenario the respective parties can more easily diagnose the problem and determine who is responsible for fixing it.
• Someone else provides high availability support — Finally, having a validated recommendation on the books means that the third-party load balancing vendor can be relied upon to provide in-depth technical knowledge and support to the customer. This not only ensures that implementation and maintenance happen smoothly, but also that end users and vendors can avoid getting caught up in complex implementations and troubleshooting — allowing them to focus on providing care for their patients, and the development of their applications!

They did however determine that there was one major disadvantage of this approach:

• The limitations of off-the-shelf offerings - Whilst the vendor and a named load balancing provider would have been able to provide a solid solution to the customer, the vendor was mindful that off-the-shelf models couldn't be tailored to their customer's exact requirements. Licensing model not ideal? Product contains some functionality you'll never need or use? Branding conflicts? Software updates at inconvenient times? Tough. This inflexibility would result in various barriers and for this reason this medical imaging vendor came to the conclusion that a strategic partnership was their preferred route.

Option 2. Explore a strategic partnership

A strategic partnership is essentially a tailored load balancing solution that meets the vendor's unique requirements, unlike an off-the-shelf product. At Loadbalancer.org we offer numerous tailoring possibilities - the vendor just has to come to us with their wish list.

Here are a few examples of what we did for this medical imaging vendor:

Technical

A common technical ask we often get is for changes to be made to the WebUI. This particular strategic partner had let us know that they didn't want their engineers, or end users updating the load balancer to a version they had not tested their application with. In other to achieve this, we therefore removed the ability to perform online updates from the WebUI and removed the customer pop-up that prompts them when an update is available. We were also asked to hide any functionality that didn't relate to the specifics of their deployment, removing unnecessary complexity and avoiding implementation errors.

Commercial

Another aspect of our tailored offering was the commercial agreement. For this vendor we introduced a tailored subscription model that matched their own customer billing and project management processes. This meant the vendor's projects team had a clear understanding of how to size and quote their opportunities, without having to interact with our team each time they quoted for a project.    

Training

Training is always essential to any of our strategic partnerships and it was a core component of this one as well. With this vendor we worked closely with their management teams to create a training schedule that was application and audience-specific. This took the form of application-specific implementation, support, and sales training. We take this path because when we enter into a strategic partnership we view ourselves as the high availability arm of their business, sharing our expertise with our partners thereby establishing a strong knowledge base.

Branding

For this medical imaging vendor we also tailored the branding of our solution, incorporating their own logo on the user interface. This enabled the vendor to position the solution as an extension of their own offering, building on their brand recognition by matching the branding of the load balancer to their solution. We also collaborated on marketing materials by tailoring our messaging to align with this strategic partner's own initiatives.

Roadmap

We also tailored our product roadmap to theirs. To achieve this we worked closely with the vendor's R&D team to understand how development was shaping the future of their solutions and in what timeframes. By doing this we were then able to align release schedules and feature additions. It was through conversations such as these that our new centralized management portal was conceived, designed to allow our strategic partners to update their entire estate of Loadbalancer.org and third-party load balancers in manageable batches remotely and from a single interface.

The final outcome: a strategic partnership that optimized this vendor's medical imaging application

At the beginning of their journey, this medical imaging vendor was understandably reluctant to take on the responsibility of providing high availability as part of their package to their customers. However, due to some of the reasons detailed above, they concluded that this approach was no longer viable as it was causing their valued customers to experience pain. They therefore conducted due diligence on the top load balancing providers in the market and, once they had validated our solution, determined that by working with us they could greatly reduce some of the complexity, cost, and risk involved when a customer deployed their application.

The result is an optimized medical imaging solution, a team of high availability experts on hand 24/7, and a seamlessly integrated solution that simply works. By adding us to their product catalog they have also been able to benefit from new revenue streams, with the load balancer accounting for a very small % of the overall deal value but attracting customers to the project, driving more revenue and margin for the sales team.

Why they chose us: market leaders in load balancing medical imaging applications

Our medical imaging expertise...

Tech vendors and healthcare organizations work with us because we are the market leaders in load balancing PACS systems and medical imaging equipment globally and the only vendor with a dedicated medical imaging team. For more than 20 years, we have worked with a range of ‘blue chip’ customers and partners such as Fujifilm, Philips, GE Healthcare, Change Healthcare, Carestream, and Hologic, and developed validated solutions for many others.

Our extensive experience engineering healthcare applications (from Enterprise Imaging to Clinical Workflows, EHR to Interoperability solutions) allows us to work closely with existing and prospective customers to develop solutions that facilitate high availability, scalability, and zero downtime for critical healthcare applications.

For a full list of our credentials or to discuss this use case in more detail, contact sales@loadbalancer.org for more info.