Integrated Dermatology migrates to Azure, upgrades SQL versions, and increases SQL Server performance

Integrated Dermatology


  • SQL Server unreliable
  • Slow SQL
  • Lack of senior SQL experience internally



  • Stabilized SQL Server
  • Significant SQL speed increase
  • Expanded SQL Server capacity
  • More SQL Server capacity
  • Savings in hardware upgrade
  • Successful SQL Server migration and upgrade
  • Minimum downtime


Integrated Dermatology is the largest independent dermatology practice in the country with over 1,800 facilities in 25 states. All of Integrated Dermatology’s practices are tied into a single centralized server.  When Integrated Dermatology began experiencing stability and performance issues the impact was felt across all of their locations and none of the internal fixes they deployed addressed the issues.  Integrated Dermatology engaged Red9 and we were able to successfully stabilize the environment and maximize performance. 

When Integrated Dermatology decided they needed to upgrade and migrate to a new server and data center they knew that Red9 had the Sr. DBA’s on staff and expertise to handle a project with this level of complexity. There was a lot of internal concern around how potential downtime might impact office locations and patients given their size and scope. 

Red9 had a thorough, well-thought-out plan for each and every step of the migration.  As a result, the process was seamless, Integrated Dermatology avoided downtime during critical business hours and the project was completed without any major interruptions or rollbacks.


There were many.

Client wanted to address as many SQL Server problems as possible, while also migrating SQL Server from on premises to to Microsoft Azure, implementing AlwaysOn, disaster recovery, migrating hundreds of SSRS reports, and SSIS packages. Requirements also included implementing the best Win OS practices, setting up SQL Server with best practices for speed and reliability, implementing SQL monitoring and alerting and addressing lots of slow SQL queries.


At Red9 we often start with our proprietary 145 point comprehensive SQL Server Health Check <link> which we used to uncover a variety of technical issues.

  1. Setup SQL Server with best practices for stability and performance..
  2. Performance tuned worst performing slowest queries.
  3. Deployed custom SQL monitoring and alerting.
  4. Performed SQL Server migration to Azure with just few minutes of downtime. 

In preparation for SQL migration, Red9 created in-depth SQL migration project plan. Each plan step was tested, duration measured, owner for execution assigned. Each step contained pre-written TSQL scripts to be run. Red9 also led coordination with multiple technical client teams to ensure everyone was in synch, knew when to execute assigned sections. 

Red9 also did comprehensive testing. This was done by capturing 8 hours worth of SQL Server workload from client’s production SQL Server and then rerun that workload on the new SQL Server. This allowed us to clearly see how SQL Server performance compares between old and new SQL Servers.


All client’s goals were achieved successfully with only a few minutes of downtime.


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