Crash Course

It's been said that death and taxes are the only sure things in life. But in this age of technology, a computer crash is something else you can bet will happen to you, at least once. For physician offices dependent on their computers for housing patient records, patient management systems, e-mail, and more, a computer breakdown can paralyze the practice for days -- even months.

"Can you imagine a practice trying to run with its total information source gone -- every patient record, all the demographics of all the patients, their phone numbers, names -- everything?" ponders David Wilcox, chief information officer of IntegreMed, a wholly-owned subsidiary of Pediatric Physician Alliance, an Atlanta-based provider of business services for medical practices.

The bad news is that crashes are nearly inevitable. Whether a virus or worm creeps into your hard drive from the Internet, a fire or lightning strike destroys your system, or the equipment simply breaks down or malfunctions, there is no such thing as a crash-proof computer. The good news is that by taking simple steps, physicians (and their office managers) can rest assured that, whatever problem crops up, the bulk of their data will be safe.

Back up, back up, back up!

"You can't avoid computer crashes," Wilcox confirms, "but you can prepare for them. The key to survival is called 'disaster recovery.' That's a concept that says, 'I know that my system will fail.' The key is to come up with a concept that protects you from that kind of loss."

Wilcox says the most important element of disaster recovery is a "robust" backup system. Simply, it means that every day you take critical data from those files that have changed and copy them to a tape or disk. Every week, run a backup of the entire system and make sure that the tapes are sent to an off-site storage location. This, Wilcox says, protects your data in case of theft, fire, or other disaster.

John I. Sutter, a pediatrician practicing in Clifton, N.J., remembers a hard drive crash that caused him to lose about 50 patient files. "I was able to restore the data from my backup except for about five days' worth of patient data. That required entering it by hand and it took me a whole weekend of doing nothing but that," Sutter says.

Most backup tapes used today are high-capacity magnetic data tapes, which store between 20 and 50 GB (gigabytes) each. According to Ralph Jacobs, senior systems architect with Denver-based J.D. Edwards, the average small practice should easily be able to back up an entire server onto one tape. Some practices manually set the backup to run as staff leaves for the night. Tape backup systems are fairly affordable -- especially given the cost of losing information. Jacobs says the backup systems themselves are available for $600 to $700. Tapes cost another $10 to $40 each.

Don't neglect to monitor each backup's success. Wilson suggests sampling backup tapes to make sure that everything is there and is accessible. "That entails taking the backup tapes about once a week, putting them into the system, reading them, and making sure that the information you thought was there is there and that you can read it back," he says. "It's possible that you can have a defective tape drive that looks like it's recording your data, but it can't be read back." Discard the tapes after about six months because, like VCR tapes, they wear out.

Redundancy helps

Practices that operate their own servers often have a "redundant" disk system so that, if one of the disks fails, the information is contained on the rest of the system. In techno-speak, these systems are called Redundant Array of Inexpensive Disks, or RAID systems. What that means is, rather than having just one hard drive, a server will have two or three, so that if one fails, the server can easily back up to the second or third hard drive instead, Jacobs explains. "That way, you can survive a complete hard drive failure."

"A lot of practices that have servers might not have this [redundant system]," Wilson says. "That's unfortunate, because if you're going to run your business off your computer, you should have a computer with that kind of reliability." RAID controllers only cost $100 to $300, according to Jacobs. Now that's truly inexpensive redundancy.

The careful, consistent backup approach works. After 13 years of practice, Debbie Grosheim, an office administrator, reports that the practice she runs, East Coast Medical Associates in Delray Beach, Fla., has never lost any data, despite one crash and occasional computer glitches. "We back up on a daily basis. We had a crash about seven years ago but we didn't lose anything because we've always backed up daily," she says.

Can't be too safe

For an added measure of safety, physicians should also consider purchasing backup power supplies in case of a power outage - although according to Rosemarie Nelson, a Syracuse, N.Y.-based information technology consultant for medical practices, many systems are already configured with an uninterrupted power supply, or UPS. Most offices, Jacobs advises, really only need a UPS for the server. But if staff or physicians enter a lot of data on workstations, you'll want a way to save work there, as well.

Typically, these systems are designed to protect computers against a "five- to 15-minute power outage," says Jacobs. A backup system for a daylong outage is probably too cost- and space-prohibitive for most practices. "They're file cabinet-sized," Jacobs warns. If, however, there is a short, sudden power outage in your office complex or community, a simple UPS system will start beeping and give users a few minutes to save their work and shut the machines down. A UPS system on a server will start the backup and shutdown process automatically if the power shuts off. A UPS costs less than $100, says Jacobs.

Antivirus software is another must-have for practices that are connected to the Web. Nelson warns that physicians should do more than just buy the software and load it on their computers. They should also subscribe to an antivirus service and configure the computer so that it updates virus definitions regularly to guard against new viruses.

The ASP option

Since his system crashed, Sutter, who was backing up to a server in his office, has changed to an application service provider (ASP) model. Now Sutter's office data is sent daily over the Internet to another company's server. Sutter has nothing more than keyboards and screens at his office -- all the data is stored at another facility. He feels more confident with the ASP model.

"The backups are not my problem; they're done automatically and on a much more high-efficiency system. There are people who are much more adept at doing hardware work who are taking full responsibility for it."

Despite the convenience of the ASP model, about 90 to 95 percent of practices are still on the in-office server model, according to Nelson. "I think there's still a wait-and-see attitude among physician practices," she says.

"There's quite a level of comfort that the physicians feel about having that server under their own roof. There's also the financial consideration. They think, 'Why would I want to rent when I can own?' They haven't bought into the fact that technology changes so quickly that owning might not be an advantage."

Nelson considers ASPs safe but says it's important that physicians do their due diligence because of some recent instability in the ASP industry. For example, physicians should be sure the contract with their ASP addresses how the data is safeguarded, whether the data is stored off-site (and, if so, where), and how frequently the ASP does quality checks.

"The reason you are outsourcing is that backing up is a pain in the neck. You want to be really sure that the folks you are outsourcing to are taking on that responsibility."

Post-crash survival

So, what if you've crashed and haven't had a good backup system in place? No need to lose all hope. There are services that focus on retrieving seemingly irretrievable data from hard drives and disks.

Eco Data Recovery of Palm Beach Gardens, Fla., is one of many companies that specializes in recovering data from hard drives. According to Chuck Roover, vice president, industry averages for successful data recovery are from 50 to 90 percent, depending on the problem.

Data recovery services can help if all else fails, but it's a much less expensive and less stressful option to do daily backups and get a UPS instead. Most data recovery services charge a flat fee to see what needs to be done to retrieve data on the hard drive or tape; then charge for the data recovered. The cost can be from around $100 to tens of thousands, depending on the amount of data recovered.

"They can be really expensive, depending on the level of damage," Jacobs confirms. "But if it's important data, it's probably worth it."

Lisette Hilton can be reached at editor@physicianspractice.com.

This article originally appeared in the March/April 2002 issue of Physicians Practice.