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Tuesday, January 02, 2007

Going Solo? Back up your digital records

Going solo today almost requires you to be somewhat tech, if not saavy, comfortable. This means that you will most likely have a EMR or practice managment billing software or both. If you do, you'll need to back up your information in case of disasterous data loss. Back-up can be cheap or expensive, simple or complex, manual or automatic, on-site or off-site and everything in between. I think that a back up system needs the following elements:
  • Easy to do: if the system requires more than the press of a button or 1-2 key strokes, you won't back up enough
  • Quick: if the system takes, for example, 235 minutes to copy the data, you won't back up enough
  • Cheap
  • Reliable
  • Spoliation proof: Spoliation of evidence is a legal term that means the deliberate or inadvertant alteration, destruction, or loss of a record (medical chart) before or after the initiation of a legal proceding (lawsuit). Basically, if you change a note in your chart or toss out a key x-ray in the hope of making "your case better," or if you lose a chart after a hurricane and then get sued, you may be accused of spoliation of evidence. Spoliation of evidence is not just ilegal, but it can completely torpedo an otherwise defensible case. Your back up system must be spoliation proof.
  • Under your ownership: you must always own your records and have access to them at all times without having to go through a "middleman", in my opinion.

I believe that my system meets these requirements.

Here's how mine works:

  • I back up several times per week, or daily on days that I see more than a certain number of patients, onto a 250GB external hard drive ($200)
  • I never over-write backed up files. Instead, each back up file gets its own folder, for example Dr Schoor's office 5-3-06, and Dr Schoor's office 5-5-06, and Dr Schoor's office 5-7-06 and etc. By this way, if a virus or, something else that bad, was to corrupt my files, it would not corrupt all my back-ups as well, but would only effect the back-ups after the date that the virus was introduced. In addition, since there are now literally hundreds of copies of the charts, deliberate alteration of one would require deliberate alteration of every chart, which is impossible and not even tempting.
  • 1-2 times per month, I back up everything onto DVD-R's, not RW's, R's. Once the data goes onto a recordable only DVD, it is unalterable and thus spoliation proof.
  • The DVD's are kept off-site, in a flood proof room, locked up in a fire-proof safe. Each DVD is labeled, Dr Schoor's back-up and the date, for example Dr Schoor's back-up 6-21-06.
  • I have sole access and ownership of both the in-office and off-site back-ups.

Using my system, daily back ups take 5-10 minutes to complete and I start them at the end of the day before I leave or after I get home, via VPN/remote access commands. The DVD back ups take ~10 minutes as well. My first 9 months of back ups used 9 DVDs and 40GB of hard drive storage and it cost< $250. In addition, if Al Gore is correct and global warming produces a category 5 hurricane in Long Island, I can simply Fed-Ex a back up disk to my friend Bob in Indiana, and he can Fed-Ex it back to me after the waters have receded back into the South Bay and the power is back up; my disaster plan.

There you have it. Simplicity from a simple urologist. I'd love to hear your thoughts.