PROACTIVE PRACTICE MANAGEMENT
 

"I read your article last month on backing up data properly to guard against computer crashes and other events. Can you give me some more information on Online Backups?"

 

As it turns out, during an interview with a vendor of on-line backup services to prepare information on this article, the vendor related a story of a dentist who called late in the day prior to my discussion. The office manager was performing “Month End”, a regularly recommended accounting and practice management routine in Dentrix. By the way, Dentrix recommends the office perform a backup of the data prior to running this utility. After running Month End, the program reported an error and the dentist noted a significant loss of data, in particular, a large portion of the appointments, production information, accounting information, and claims was gone!

 

The dentist asked the vendor, “Did I perform that On-Line back-up we were talking about?” The vendor responded, “No, you have not subscribed to the On-Line version of our back-up services; all of your data is backed up on tape drives.” The vendor then recommended the dentist find out what tape was used for the most recent backup, place it in the tape drive, and together they will try to restore the data from that point. As it turns out, the tapes were not labeled, and the dentist and office manager spent considerable time trying to discover which tapes were used; unfortunately by trial and error! Once the correct tape was found, it took nearly seven hours to restore the data from the backup tape. Then, all of the information from practice operations over the previous 24 hours that was lost had to be reconstructed, primarily from memory, and then manually entered back into Dentrix.

 

OUCH!

 

Authors Note: Okay, so now all of you out there in dental land are going to pay attention and implement or confirm that a sensible and consistent backup routine is protecting the valuable data in your office! This event doesn’t even take into account something that would be out of one’s control, i.e., fire, theft, thunderstorm, electrical power surges, etc.

 

While we're on the subject, in the dental industry, Management Software failure and operator error are the common culprits in losing data. Hardware failure comes next, then conversion from a previous practice management software program to new management software contribute to data loss and or corruption.

 

In the past, dentists may have conducted full backups on tape as a daily routine. This was not recommended in the past and is not now. Here’s why: a corrupted file or program may kill important data and information; the daily full backup routine then wipes out all of the good data and replaces it with corrupted data. Without careful inspection each time a backup is performed, in this case daily, one would backup corrupted data until the error is discovered somewhere down the line. It begs the question, “How much data have I lost, and what do I do now?”

 

Over the years, technology has advanced to the point where there has been a logical progression for small and large businesses wanting a remote off site location to backup data. Online backups became noteworthy as early as 2005 as the capability to acquire faster and higher quality Internet speed, commonly knows as bandwidth, brought on the ability to upload and download data faster than usual. Additionally, storage mediums, as they exist today and existed only a few years ago, are a problem. Traditional backup systems were faulty in that a tape cartridge could fail, or if one were to drop an external hard drive, or HD, loaded with valuable data, it’s toast. Even if one takes perfect care of a backup device (tape or external HD), if one small element of the device becomes de-magnetized, the whole backup may fail.

 

Hardware companies also expanded their ability to produce products that will store huge amounts of data at a much lower cost; in some cases, a computer used by a company who provides on-line backup systems can store up to 30 terabytes of information. Just to clarify for you non-byte heads, one terabyte is equal to 1,000 gigabytes; and one gigabyte is 1,000 megabytes; and one megabyte is 1 million bytes of data. Okay, that’s a lot.

 

These events removed most of the barriers to entry for small businesses to utilize components, high-speed Internet and large storage devices, for remote backup services.

 

In the internal workings of a dental practice for example, data changes frequently – every minute of every working hour of every working day. And an office that has a database that changes frequently and wishes to back the data up regularly will encounter a bottleneck: bandwidth; in particular when uploading or sending files out of the system. More often than not, uploading files can be as much as 10% slower than downloads (bringing data in). This can pose a huge problem for dental office with large databases, some which may exceed 150 gigabytes (150 billion bytes of data), containing digital x-rays and digital images (pictures). If the connection/bandwidth is slow going out, it’ll seem to take forever and a day to backup online! My suggestion is to test the upload speed of the Internet service. Contact the Internet Service Provider (ISP) and ask them to test the connection speeds for uploading and downloading data. If it’s slow on either end, ask for a quote on upgrading and determine if it will be cost effective to upgrade or stay with the current configuration.

 

What was missing from the equation but is now available with high speed Internet and large storage devices is software that allows one server, the main computer in the business, to communicate with another server, a large storage computer off site. This type of application allows the customer to install software on the computer at the dentist’s office that collects data, images and all other information, and sends it over the Internet encrypted to a remote off site server, or computer, for storage. The data transferred would appear as folders with letters and numbers that cannot be deciphered by the online backup services company. This, of course, complies with HIPAA requirements to protect private information.

 

Where online backups can be useful is when documents of a much smaller size in Dentrix or QuickBooks, for example, can be backed up quickly and frequently. These include the appointment book, patient notes, the ledger, the QB data file, just to name a few.

 

Some software will also keep record of modified files in the history – keeping previous versions of files.

 

Timeliness is an essential element in backing up data. In most cases, one would have a removable HD system to handle large databases (i.e., x-rays, and digital images), with one cartridge for every day, removed off site each day in a rotation. Human error may enter into the event; the person responsible may forget to take the cartridge home, the backup may fail unbeknownst to them, or the employee leaves the same cartridge in day after day.

Redundancy, or concurrent backups, is a strategy where one configures the backup of critical data during down time (evenings) while the database isn’t being used, and then uploaded to an off site server. Further, the backup system of choice usually can be configured so that the system only backs up when the system is idle – in most cases, this occurs during the evening hours when the system isn’t being utilized.

 

Most backup systems can run concurrently. For example, an office could run a backup system using an external HD and set a window of 11 pm to start, and an online function to begin from 8 pm to 6 am; both won’t conflict with each other, and the backups will function together.

 

An opinion regarding online backups is that it would not be a suitable backup solution for extremely large databases (images, x-rays, etc.). Some advanced restorative dentists who collect many digital extra-oral images, digital x-rays, etc., create such large databases that the online backup systems may cause a problem when transmitting these large files of data. In addition, to retrieve a significantly large database in case of a crash, or to restore missing information, can be very slow and take a considerable amount of time. An alternative, and a significant advantage to online backups provided by some vendors, is after the first initial backup of all data on the client’s server, only additions, changes, deletions, and modifications may be backed up. This will save considerable time when conducting routine backups on a daily basis in that smaller amounts of data are transferred and backed up, rather than regularly backing up the entire database.

 

The vender of online backup services has a choice to put their servers used for online backup in Data Centers. These typically provide government rated security with key card and biometric entry, and lock and key cabinets for safeguarding the data. In other words, the only way to access the computer with the data stored from your dental office is for the person to have an electronic key card, a thumbprint of the vendor, and a key to open the lock on the cabinet where the computer is stationed. Pretty secure, I’d say.

 

Finally, what happens if “operator error”, a hardware crash, or other catastrophe falls upon the dental office? Using a reputable vendor will assist in retrieving your data in case something happens. One potential “fly in the ointment” is that downloading data from the remote source in an attempt to restore the data may take a considerable amount of time due to the large file size being transferred. Sure, this is one negative aspect of backing up information remotely. However, a good vendor will be able to retrieve the data and place it on a portable storage device and hand deliver it to the office and conduct the restore function on-site.

 

Pricing. Traditional backup services have been a “pay for amount service”; the more you backup, the more you pay. Recent innovations offer a much more reasonable solution, in terms of pricing, with no limits to the amount one can backup.

 

Reasonable industry rates seem to be in the neighborhood of $2 per gigabyte backed up. Fees can vary from $50 per year, to $25 per month up to $55 per month for larger databases with added services, such as recovering lost data by bringing the backup to the office and assisting with restoring.

Summary. The main advantages of online backup is there are no tapes to worry about, no worries about a CD or DVD being scratched or cracked, no external HD to worry about malfunctioning, or any storage device being left behind in the car during the sizzling hot summer months. And did I mention this earlier? Any backup function that involves people is open to human error; which happens to be the most common culprit.

A business, dental office is no exception, without proactive backup and recovery policies will face considerable hardship in lost business and revenue; and may face the risk of being out of business within a short period of time following a major computer disaster. Loss of business data may ruin a company’s reputation and/or may lead to expensive litigation as a result of not properly protecting important information.

Make sure the vendor who provides online backup services provides details of what is included. Ask if application data is being backed up, such as Dentrix, QuickBooks, MS Office, digital imaging applications (Dentrix Image, Dexis, Kodak, TigerView, etc.). Also, what kind of communication is sent back once a backup routine is performed; such as e-mail’s sent nightly to the customer, and messages if the backup failed or if a problem occurred. If data is lost at the dental office, will the company come to the office and assist with the restore process to be sure the business doesn’t lose valuable time, data, and money.

 

Databases are becoming larger every day.  Data such as e-mail's, accounting entries, and patient appointments, change daily.  One can never have too many redundancies in backup up critical data.  Hiring a competent computer technician is a good idea to help with the Information Technology aspect of a dental practice.  Be Proactive, and don't get caught with a computer crash or human error causing a problem where a good backup routine was missing or inefficient.