Backup and Recovery: Dodging the Digital Danger

Wayne Rash

I was frustrated because I'd been trying to reach my doctor on the phone all day, and all I got was a busy signal. I needed a prescription refill, and the doctor needed to make the call. So, while I was in the area, I cruised over to see his office manager.

Then the reason for the phone problem became clear. First was the yellow crime scene tape. Then I saw the big white truck, clearly labeled, 'City of Fairfax, Crime Scene Investigation.' Then I saw the cars of the Fire Marshall and the Fire Chief. Clearly, this wasn't a good sign.

Following my reporter's instincts, I wandered around until I found a door that hadn't been blocked by yellow tape, and went upstairs to the doctor's office. Things were quiet. The phones didn't ring. The computers were off, their network, along with the phone wiring, damaged by the fire on the floor below. But the office was open.

I entered and approached the receptionist. Someone had torched the restaurant downstairs, she told me. She gestured to the smoke clearing equipment. 'It still smells pretty bad,' she noted. So I asked about the prescription. I was worried. I knew that the office had converted to digital records some time ago, and now the network was down.

The receptionist left the room, returning with a thick file, dropping it to her desk with a thump. 'We keep a paper backup,' she said, seeing the question in my eyes. Then she took out a piece of notepaper emblazoned with the name of a medical device manufacturer, and wrote down what I wanted. 'I'll take care of it,' she said.

Later I recalled my discussions with the physician who owns the practice, and his concerns about moving to an all-digital environment. He wondered how he'd treat patients if the power went out. I realized now that he had a point. In his case, the patient records were mission-critical information. Without them, he couldn't operate his business, but more important, he'd also be putting his patients in danger.

I knew that we'd talked about solutions to that problem, from stand-by generators and UPS installations, but in reality, they weren't an answer. He depended on his building's owners to provide the power, and if there was to be a standby generator, it would need to come from them. A UPS will last long enough to save data, but not long enough to stay in operation.

In this doctor's case, moving to an all digital environment was a risk he wasn't willing to take, at least without a backup that didn't require being digital.

It was an important lesson because it's frequently glossed over in the conversation about eliminating paper in many industries, including healthcare. What do you do when the power goes out? What do you do when the phones or the network go down without warning? What is your backup? How do you know it will work?

In this case, the backup was paper files, and they worked perfectly. But what's your backup? And how do you know you will be able to meet your mission-critical requirements when something bad happens?

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Nov 4, 2009 5:11 PM Paul Robertson Paul Robertson  says:
First of all, we're starting to get to the point where analog records are too difficult to store, index and update, so we're going to have to deal with the fact that medical records will be digital. Medical systems will put out digital data, diagnoses will be done with digital equipment, and unless we think we're likely to convince physicians that they need less information, we're not likely to get away from that curve- so it's going to have to be more about digital backups than analog ones. Secondly, analog backups in the same office space as the digital ones are a placebo. If the fire had gone upstairs, they'd both be toast- or even if the sprinklers had gone off or if the health department had cut off access because downstairs was a server farm that put PCBs into the air- where would you have been then? People have to understand that off-site backups are a necessity, and they need good continuity of operations plans that provide for their primary place of business to be out of play- it's especially important for small businesses that don't have multiple offices. Worse-yet, your doctor is probably thinking that his backup plan is perfect, since in this instance it saved him. Finally, there's little danger in not having access to medical records for a patient- hospitals treat a staggering number of patients every day without records- alert tags and bracelets are important for those who need them- but there's little that's emergency-critical in medical records. When I went from dependent care to the Army, my medical records didn't follow me (which they could have if they'd been digital) and all of the doctors who treated me didn't have an issue with that. When I left the Army, they didn't forward my records from the White House Medical Unit to my new civilian insurance provider. The healthcare field is doing very interesting things with digital records, and mining them does actually start to save lives- and since that's a good thing and digital records are cheaper and easier to maintain, the goal shouldn't be to have analog backups, it should be to ensure access to the digital ones in the case of a disaster- and to secure them from unauthorized access. Want the government to do something useful? Have them build a survivable and sustainable infrastructure for digital medical records. Take the problem out of the small doctor's office and move it into the information infrastructure space. Make it really difficult to access identity information and really easy to access medical information- then if it's critical that your health insurance card link to the fact that you had Spatulaitis at the Rocky Road Grill in 1902, the information will be there- and we can deal with access via wireless non-power grid connected devices to take care of the small provider's issues. Regards, Paul Reply

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