Headquartered in Atlanta, Georgia, ExamWorks is a fast-growing independent medical examination (IME) and review company. The company’s service portfolio includes medical assessment programs that meet the needs of first-party insurers, attorneys, municipalities, and third-party administrators handling automobile, short- and long-term disability, group health, liability, no-fault, and workers’ compensation claims. (Source: www.examworks.com)

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Support hypergrowth, helps ensure availability/flexibility, slash IT costs

ExamWorks is a hypergrowth company focused on building a national network of services through a combination of expansion, mergers, and acquisitions. Supporting this strategy for aggressive growth demands a flexible and dynamic IT infrastructure. Brian Denton, ExamWorks CTO, envisioned an architecture that would allow the IT organization to pull differentiating technology from acquisitions, quickly virtualize key applications, and then make them all accessible to the entire family of ExamWorks companies via an internal cloud infrastructure. “We wanted to implement a highly adaptable infrastructure that would allow us to rapidly integrate best-in-class technologies and processes and then offer them as services to the rest of the organization.”

At the same time, the infrastructure had to support ongoing business operations with five-nines availability, seamless recoverability of critical processes, and efficiency. Denton emphasizes, “Cost control is paramount for maximizing our use of seed funding and to subsidize new acquisitions. Data center real-estate efficiencies are also critical in allowing us to achieve our ‘green’ space- and power-conservation objectives.”

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Deploy VMware on Cisco UCS with NetApp storage

To build out its virtualized infrastructure, ExamWorks evaluated server solutions from Cisco, Dell, HP, and IBM, and storage from EMC, Hitachi, and NetApp. Determining factors for selection included corporate vision, solution functionality, deployability, ease of use, and flexibility. “After careful consideration,” says Denton, “we found the best match to be a Cisco®, NetApp®, and VMware® solution. By integrating best-in-class, complementary technologies, this platform compounds the benefits of the individual components to deliver unprecedented agility, efficiency, and cost savings.”

Combining compute, networking, and virtualization in a single platform, the Cisco Unified Computing System™ (UCS™) delivers deployment and space efficiencies. NetApp provides equivalent efficiencies on the storage side, including simplified scale-out that complements UCS scale-out computing.

Denton points out that a commitment to Ethernet connectivity is another benefit that both Cisco and NetApp bring to the solution. “Cisco UCS utilizes 10-Gigabit Ethernet as the unified wire to network and storage, and NetApp has shown clear leadership in Ethernet storage, particularly in achieving 10GbE certification from VMware. Furthermore, while other storage vendors offer point solutions, NetApp supports 10GbE connectivity across its entire product line,” says Denton. “Having native support for all protocols within the same box gives us flexibility other solutions didn’t offer.”

NetApp’s GUI, management toolset, and tight integration with VMware—including plug-ins for VMware vCenter™ that help manage storage in VMware vSphere® 4 and View™ environments—also contribute to long-term administrative savings. “NetApp simplicity—of interface, provisioning, cloning, backup/recovery—factored strongly in our decision,” asserts Denton. “ExamWorks administrators may be required to be Windows® admins one day, Exchange or storage the next, so they have to be able to easily and intuitively navigate systems even though they aren’t accessing the same screens every day.”

ExamWorks partnered with Coleman Technologies—a Cisco Gold Certified Partner, NetApp Gold Partner, and VMware VIP Partner—to implement a highly dynamic data center. A high-availability NetApp FAS3140 system, populated with FC disk drives, provides storage resources via NFS to the VMware environment running on a Cisco UCS configured with B-Series blade servers (eight 2.5GHz CPUs) and a Cisco Nexus® 5000 Series Ethernet switch.

The ExamWorks virtualized environment is built on the VMware vSphere 4 cloud operating system and the View 4 desktop virtualization solution that currently support approximately 24 virtual servers and some 190 virtual desktops. “We run our entire business in the virtual environment, and everyone, including the chairman of the board, uses a virtual desktop,” adds Denton. “We maintain no physical servers [that is, non-ESX® based], and all of the company’s data resides within the data center.”

The infrastructure now supports some 450 ExamWorks employees in 13 family companies at 17 sites and provides web-based information access to customers as well as the company’s network of 6,000 board-certified physicians. The solution helps ExamWorks achieve five-nines availability of widely accessed, business-critical applications, including IME software, Microsoft® SQL Server® 2005 systems, Exchange Server 2007, and Proofpoint e-mail security. NetApp provides storage for hundreds of thousands of PDF files related to the more than 95,000 IMEs conducted annually by ExamWorks. Other systems running in the virtual environment include Cisco Unity unified messaging and the RConsole attendant console, the View Broker, BlackBerry and file servers, domain controllers, and web servers.


NetApp Products

NetApp HA FAS3140 system
NetApp deduplication, SnapRestore® technologies
NetApp NearStore® software




VMware vSphere , VMware vCenter, VMware View
Cisco UCS, Nexus 5000, B-Series blade servers

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  • Avoid >$1M in IT staffing costs
  • Achieve nearly $500K capex/opex savings
  • Deploy 3-rack data center to support >2,000-employee business
  • Scale seamlessly for tripling revenue growth
  • Eliminate high-cost PC refreshes
  • Eliminate help desk

By deploying NetApp unified storage, the Cisco Unified Computing System, and the VMware virtualization platform together, ExamWorks streamlined deployment of data center resources, eliminated complexity, and achieved operational efficiencies.

Agility—rapid integration of new sites, businesses, and functionality

The new infrastructure facilitates rapid integration of new sites, businesses, and functionality. To bring a new company online, for example, ExamWorks IT virtualizes existing physical servers—typically four or five systems—onto a local server that is then shipped to the Atlanta data center where the virtual servers are migrated onto the UCS, NetApp, and VMware solution. Next, headquarters IT staff members develop a base image for the new office’s desktop systems and replace those PCs with virtual desktops that can be accessed remotely from any Windows XP device.

Once the new organization is integrated, the ExamWorks IT staff consolidates common systems—Exchange e-mail servers, for example—to achieve further efficiencies. A new office may initially require creation of five virtual servers, but consolidation typically shrinks that to just one or even zero net server additions. Because the number of virtual servers constantly expands and contracts, the ability to rapidly provision server and storage resources is essential to maximizing utilization of both system and staffing resources.

“The Cisco, NetApp, and VMware solution allows us to maintain the decentralized business processes that make us competitive while centralizing IT functions to reduce costs,” notes Denton. “In less than a week, we can transform an acquisition’s complex IT environment into this highly efficient infrastructure with platform, data, and policy consistencies. The cloud infrastructure makes it simple to cross-pollinate—that is, integrate high-value-add processes and applications from our new businesses—and push them back out to other ExamWorks companies.”

The infrastructure also helps ExamWorks meet the backup/recovery, retention, and security requirements associated with HIPAA compliance and URAC accreditation that the company sees as another market differentiator.

Scalability for three-times growth

Expectations for significant growth made solution scalability a must-have. Denton elaborates, “We’re currently supporting a 15% annual organic growth rate. Combining that with our growth from mergers and acquisitions, we expect to double or triple the number of sites we support and to triple the company’s revenues within the next three years.”

The Cisco, NetApp, and VMware infrastructure gives ExamWorks multidimensional scalability within an extremely condensed form factor, as well as investment protection. Building on 10-Gigabit Ethernet not only delivers high bandwidth and low cost of ownership, but it offers a scalability road map that enables ExamWorks to meet future traffic demands. “It’s also much, much simpler to use than if we had to manage HBAs, LUNs, etc.,” observes Denton. “But I should add that by choosing NetApp unified storage, we did hedge our bets, knowing that we can leverage whatever protocol we need, whether it’s FCoE, FC, iSCSI, NAS. It’s all supported within the NetApp architecture.”

Simplicity and efficiency: four-person, three-rack data center and $1.5M savings

The ExamWorks team offers compelling evidence that by leveraging NetApp storage in conjunction with VMware and emerging technologies such as Cisco UCS, businesses can significantly drive down IT costs through consolidation, centralization of application services and data, and reduced complexity.

The Cisco UCS and NetApp platforms have dramatically simplified infrastructure management. ExamWorks does not segregate administration—that is, any IT staff member can administer any element of the data center, including the phone system (nothing is outsourced). “Right now we’re supporting a 450-employee organization with just 2 IT staff and 2 racks of equipment,” Denton states. “We’re confident that the Cisco, NetApp, and VMware infrastructure will allow us to eventually support a 2,000-employee company from a 3-rack data center with an IT staff of 4. That represents more than a $1M in IT staffing cost avoidance—historically, we’d have needed 25 IT staff and 15 racks for a company of that size.”

Denton cites other key contributors to savings and efficiency:

  • Use of capacity-saving technologies like VMware Linked Clones and NetApp deduplication.
  • Server consolidation equivalent to a $300K capex reduction (3 Cisco servers fully serve 17 ExamWorks locations).
  • The virtual desktop infrastructure—overnight, ExamWorks can push out new systems—for example, Windows 7—to all of the company’s employees and contractors. Without this infrastructure, Denton estimates the same project would require touching some 50 remote locations and take up to a year to complete.
  • Elimination of PC hardware refreshes for an estimated $150K annual savings. Denton states, “We no longer are on a rotation cycle of capitalizing desktops, because we don’t buy them. We use them until they don’t work anymore, then call around to other companies for their old computers. It saves them the disposal costs, and we– just add a flat-panel display, keyboard, and mouse. Because we can maintain user settings, the screen looks identical, right down to the background with their kids’ photographs.”
  • No help desk. “I was recently on an airplane using Gogo Wi-Fi and got an e-mail about a server problem. I got onto vSphere, rebooted the server from 30,000 feet, and had it back up and running before we touched down,” Denton relays.
  • Reduced security costs. Because all data resides at the data center, the solution minimizes the risk of virus/intrusion and eliminates the costs of firewalls and hardened remote sites.

Game-changing technology

Denton describes the benefits of choosing a solution developed as a result of strategic partnerships among three industry leaders: “The Cisco, NetApp, and VMware infrastructure is a game-changer. We can run our entire business on an integrated and verified platform that we deployed in our data center in just a matter of hours.

“It’s a solution with benefits for everyone—clients realize faster turnaround because of improved information workflow in the independent medical review process, users benefit from efficiency and improved data/application services access, ExamWorks gains competitive advantage through agility and enhanced functionality, and shareholders reap the rewards of investing in a company that is simultaneously achieving hypergrowth and shrinking IT costs.”

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