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?"
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!
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.
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.
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.
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?”
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.
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.
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.
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
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
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.
software will also keep record of modified files in the history –
keeping previous versions of files.
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
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.
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.
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.
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.
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
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.
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.
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.