Open Source in Hospital Operations: University Hospital Essen relies on Proxmox VE

In large-scale, mission-critical healthcare IT environments, reliability and stability are top priorities. As infrastructure grows, budgets are constrained and data backup is a critical requirement, organizations depend on platforms that deliver reliable performance in day-to-day operations. This was exactly the situation faced by the central IT department at University Hospital Essen: moving away from dependencies toward greater control and flexibility.

The University Hospital Essen sees digitalization as a unique opportunity to actively shape the hospital of the future. As a leading provider of advanced medical care in Europe’s largest industrial metropolitan region, the hospital consistently pursues the vision of a connected “smart hospital.” With over 8,000 employees, the University Hospital Essen was looking for a future-ready virtualization platform that could handle the demands of modern, mission-critical IT infrastructure. Three key goals were defined: a highly flexible system, a more cost-effective alternative to the previously used proprietary solution, and reliable, production-ready backup capabilities. Ultimately, this led to the adoption of Proxmox Virtual Environment (VE), which was complemented by Proxmox Backup Server.

Michael Nieporte, Head of Infrastructure and Data Center, describes the initial situation:
“Our goal was a future-ready setup with the highest possible level of flexibility. At the same time, we wanted to reduce costs and implement a truly reliable backup solution.”

For University Hospital Essen, it was clear that the platform needed to enable rapid provisioning of new virtual environments, support efficient operations, and remain predictable in the long term. This was not just about introducing a new tool, but about establishing a new standard in day-to-day IT operations: fewer dependencies, greater control, and increased transparency. The goal was to implement a solution that would not introduce licensing constraints with every expansion but would instead provide the flexibility to evolve the infrastructure as needed.

Eliminating Vendor Lock-In and Reducing Costs

Before switching, University Hospital Essen relied almost exclusively on VMware vSphere. Over time, two questions increasingly came to the forefront: How could the platform remain flexible in the long term, and how could costs be sustainably managed without compromising operational stability or backup reliability?

Ultimately, the open-source approach was the decisive factor. As a FLOSS solution, Proxmox Virtual Environment provides full system access. The team can adjust and optimize the platform at any time to meet operational requirements. Transparency and genuine control take center stage instead of a black box. Added to this is a strong ecosystem, including the large Proxmox community and the combined expertise of the Debian and Linux communities. For an infrastructure team, this is far more than a nice bonus. It provides both support and speed, as solutions, best practices, and real-world experience are quickly accessible.

The economic benefits are substantial: with cost savings of at least 85% compared to the previous provider, the new solution has become a strategic asset for University Hospital Essen. What began as a technical migration has proven to be a highly efficient budget decision.

From Test Deployment to a Production Cluster Environment

The rollout was not a step into unfamiliar territory. The team already had hands-on experience with Proxmox VE, and several members had previously used Proxmox solutions in other contexts. This existing expertise was deliberately leveraged to ensure a fast and well-structured implementation.

The process began with a test deployment designed to validate the configuration, evaluate edge cases, and establish operational procedures before taking on production workloads. After approximately three weeks, the next phase was initiated: three clusters were deployed with Proxmox VE and brought into service after completing a series of tests. The result is a platform that not only runs reliably but continues to improve over time. All clusters have been operating successfully in continuous production use for more than two years.

A System with Heterogeneous Hardware

The platform’s scalability is now clearly visible. One cluster runs approximately 110 virtual machines, while another runs about 280. Additionally, the team operates around 30 virtual machines on standalone hosts. The environment has been running reliably in continuous operation for nearly two years and has been continuously improved over that time.

Another advantage of Proxmox VE in a clinical setting is that not every hardware refresh requires a full replacement. Proxmox VE demonstrates its flexibility here as well. University Hospital Essen operates the platform across a diverse host base:

• 9 hosts with older Intel processors, totaling around 450 cores and 4.2 TiB of RAM
• 13 hosts with current AMD processors, totaling around 1,650 cores and 25 TiB of RAM
• 2 hosts supporting a smaller environment

This composition illustrates the practical importance of hardware flexibility. Rather than enforcing a perfectly homogeneous ideal state, the team makes efficient use of existing resources and gradually supplements them with new systems. This enables economically sensible expansion without technical compromises. "Proxmox runs on our existing hardware as well. We are not dependent on strictly adhering to detailed compatibility lists," explains Michael Nieporte.

Seamless Backup Solution

When it comes to data backup, Proxmox Backup Server completed the overall picture. Its tight integration with Proxmox Virtual Environment enables structured backup workflows and flexible backup destinations without the need for a patchwork of separate solutions.

VM backups are based on a dual-system setup: Two installations share the backup and replicate the data to each other for full redundancy. Regular verification processes ensure that data inconsistencies are consistently detected and avoided. However, in critical situations, recovery performance is crucial – and in this regard, the solution delivered completely smooth operations for the team. This reliability is especially important in the medical sector, where rapid recovery directly impacts hospital operations.

Operational Experience and Key Learnings

“What is often overlooked in marketing materials, but proves invaluable in day-to-day operations, is solid documentation.” emphasizes Michael Nieporte. At the same time, the team is transparent about its learning curve. Not everything was fully implemented in line with recommendations from the beginning. Over time, several aspects were systematically aligned with the documentation's best practices. The result was a more robust operation and a configuration better suited to the realities of daily operations in the data center.

A Future-Proof Platform

With Proxmox Virtual Environment, University Hospital Essen established a virtualization platform that combines flexibility, cost efficiency, and reliable day-to-day operations. This is evident through the efficient test deployment, the prompt cluster rollout, and the stable day-to-day operation.

The decision has proven highly effective both technically and organizationally. In combination with Proxmox Backup Server, the setup enables the rapid creation of new environments while firmly embedding recovery and operational reliability into daily workflows. With cost savings of at least 85% compared to the previous contract, it's clear that open source not only keeps pace in the hospital setting, but also provides tangible relief.

Michael Nieporte

Head of IT Infrastructure

About University Hospital Essen

As a maximum-care hospital, University Hospital Essen is today the largest university medical center concentrated at a single location in the Ruhr region, earning it the title of the “Hospital of the Ruhr Metropolis.” With 1,300 beds and over 8,000 employees, it treats approximately 55,000 inpatients and around 300,000 outpatients annually.

Evolving from a long-established clinic, the University Hospital Essen is now fully committed to the concept of a “Smart Hospital.” Since 2015, the hospital has pursued a digitalization strategy that positions the hospital as a connected, information-open backbone, putting both patients and staff at the center.