EMR Backups

My favorite part of HIMSS is meeting all sorts of interesting people. One of those people I met was Lyndsey Coates from Nuesoft. I have a soft spot in my heart for Nuesoft since they were the company that trained me on my first EMR. I still remember the 3 day intense training in their office. Lyndsey and I had interacted a few times before the conference and so it was nice to meet her in person. It was just too bad that we didn’t get to spend more time together.

What does this have to do with EMR backups?

Well, Lyndsey and I didn’t have much time together at the conference, but she sent me a nice bloggers “love note” in the form of a blog post about offsite EMR backup systems after meeting me at the conference. She even sent me a friendly tweet to let me know about the post.

I was a little busy with HIMSS and all, but I’m always happy to share in a little blog sparring. So, Lyndsey, here we go.

I’m really glad to hear you respect my opinion, but I’m a little surprised that you didn’t like my post about offsite EMR backup services. I guess I could have imagined that a SaaS EMR vendor might have a different view. In fact, you make a nice case in your blog post about the challenges of backup with the client server model. Definitely a number of good points for doctors to consider when selecting their EMR.

However, somehow your post left out some of the problems related to backups with a SaaS EMR. No worries though, I’ll be happy to share;-)

First and foremost, I can’t believe you think that doctors will trust an EMR vendor to back up their EMR appropriately. I mean seriously, we’re talking about my whole clinical practice stored on your servers and trusting that your IT staff are doing my backups? I don’t think so. I barely trust my own staff to do backups, so why would I trust my EMR vendor’s staff to do something as important as the backups of my EMR?

No, I’m definitely not trusting you and your IT staff to backup my EMR. Maybe there are a lot of doctors that don’t do backups properly, but there are a lot of large vendors that don’t do backups properly either. Yes, even the all powerful Google lost some data because they didn’t have the right backups.

Plus, if you’re doing my backups that means that you establish the policy and time frame that the backups are done. If I do them in house, I get to schedule the backups, verify the backups and see the reports and logs about when backups are done. I get to choose when and how often those backups are done. With you, I just have to hope that you’re doing them.

Plus, there’s just something that doesn’t feel right about you having the backup of all my data. Maybe you don’t remember that the data stored in the EMR is my life. Not my literal life, but the life of my practice. Maybe you feel comfortable with my life being stored in your redundant data centers across redundant servers who mirror the data and all sorts of other cool backup processes. Personally, I feel comfortable knowing I have a backup of my life in my office with me. I can see it, touch it, pet it and know that it’s safe in my loving arms.

Finally, let’s not call out my previous post about Offsite Backup Service for EMR for “missing the mark a bit.” While SaaS EMR are doing very well, there’s still a VERY large number of people who will select a client server EMR. Better to help them get their client server backup services right than to just tell them that they should have bought a SaaS EMR.

Plus, maybe Nuesoft and other SaaS based EHR should consider partnering with one of these offsite backup solutions. I imagine a lot of doctors would love to have their SaaS EHR backed up to an offsite backup provider like the ones I mentioned in that post. Basically, a location that the doctor can access and control. Could be an interesting service to offer your clients.

Your turn Lyndsey!

P.S. I personally don’t care either way. I think that the client server or SaaS model are legitimate EMR solutions. Long term SaaS EMR are likely to win the day, but that’s still a long ways away. I do enjoy playing devil’s advocate though.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • John – to go along with the paragraph that it doesn’t feel right that the EMR vendor has all your data; in addition that would mean you (the practice) have none of your data. What if you decide to switch EMR vendors? I have seen a lot of EMR vendors that don’t make it easy to get your data out of their EMR. Now you don’t have a way of getting your data out and you don’t have a copy of your data. I would say you are not in a very good place and your existing (soon to be old) EMR vendor has a lot of leverage on you.
    And to your point about Google losing data, the same thing happened to Microsoft.
    If Google and Microsoft both have lost data “in the cloud” how does a practice feel safe with an EMR vendor holding all of their data?

  • My experience with the single to 8 doc practices that I primarily deal with is that they would much rather the PM or EMR company backup their data. They typically do not have the expertise, manpower and dont want to invest in the infrastructure to do a good job with backups on an in house client server architecture. It’s not so much a matter of trust as it is a matter of ability. Doc’s are not IT guys and most have little interest in paying for their own IT staff. Heck most of them outsourc all their networking and pc support too.

    For larger practices and hospitals I certainly see more of the reverse, but it definately is a scale issue.

  • John,
    At my previous employer we wrote backup software and we did not always do a good job at backup. Did not find out about this until we had to restore a particular server.

    Backup is not important. Anyone can do a backup.
    Can you do a reliable restore? That is much harder.
    Backup software’s job is to restore data. If anything goes wrong, the software will make sure your system will be back online within x minutes and with minimal data loss.

    I will speak for small practice physicians. They don’t have IT staff. They don’t want to be responsible for backups.
    Even if SaaS EMRs offered onsite backup service, what does it gain? Sure it gets you piece of mind. The physicians cannot restore it to something useful.

    For every Google and Microsoft failure, there are tons and tons of good examples of how data was restored within a short period of time. I know the point is moot when it is your lost data 🙂

    Here is my advice, ask your SaaS EMR vendor, how often do they test their backups? That is, assume the production server is dead. Restore backups on a clean server and make sure everything runs. Do they have remote disaster recovery? If the data center burns down, is there a remote archive?


  • John, Since this is my first post on your blog, I wanted to say now interesting I have found your posts and have come to read them regularily. We have an increasing number of medical clients so I’ve been on the hunt for some new sources for information to bring back to them, since organizations hire us and turn over their IT to us.

    I watch the data backup solution space constantly, as a better mousetrap appears to be born every few years. I too have come to recommend offsite data backup services to my client, but ONLY if they subscribe to it through our service. The reason being is the need to have monitoring, testing and periodic due diligence on the vendor included in the package; without this diligence you may be left in the lurch when you find out there was a problem getting the files offsite or getting them to retrieve your data.
    We have found that although a vendor’s solution may appear to work and may be attractive from a price standpoint, SOMEBODY besides the VENDOR needs to be MONITORING. The real proof is when you need to recover your data. Some things we now consider in evaluating partners is:
    1. whether the offsite vendor offers on onsite copy as well
    2. what the SLA is to recover over an internet connection and what speed they will commit to out of their data center
    3. what the SLA is to drop the data to an external drive and ship it; what happens on a weekend or a holiday to that SLA
    4. and THE MOST IMPORTANT – whether they provide us a way to monitor the success of backups. I have come to insist that our partners provide us a count on the number of files sucessfully backed up AND TRANSFERED OFFSITE as well as the number of skipped files (oh that open file problem).

    Data Backups must follow the auditors rule, trust and VERIFY.


  • Thanks for all the comments. All very good stuff to consider and great additions to the commentary. At the end of the day, there’s no perfect solution. My point with backups isn’t that you find the perfect solution. My point is that people become more educated about the risks, opportunities and challenges associated with backups in all the various scenarios. Thanks for fleshing out more of those details.

    I always love when new people comment and I’m happy to hear you’ve been reading regularly. I really do appreciate it. Please do contribute more as you have time. I feel like I learn as much from my readers as I teach.

    Also, I wrote my EMR selection e-Book with companies like yours in mind. Hopefully you’ll take a look and see if it’s something that your clients might find useful.

  • Sadly, while I agree with John that ideally the data would be squarely in the hands of the doctor, I’ll have to say that MSangston’s point is valid: there are many who will just not do it. Consider: even with the wide availability of external hard drives and online systems like Mozy, how many personal computer users regularly back up their data? If people don’t care enough/have the expertise/make the effort to save their own information, in their free time, how easily/likely will a doctor busy with other matters do so with their practice? And @ Abhi, too true, backup is only half the battle.

    But a point I thought of in the post itself: doctors need to have the ability to manage backups, even if they mostly leave it in the hands of someone else, if only because of the massive computing resources a backup can consume. You wouldn’t want a backup to occur, say, on Monday morning, probably one of your buisest days. And you certainly want to make sure you can use that data if you need to restore it (and, no matter how good your system is, you will need to one day). Another thought occurs: is the outside agency making this backup making multiple backups? One is simply not good enough.

  • Michelle,
    Good points. I do want to make it clear that I’m not suggesting that you should go SaaS or client server. I was just making the case for client server backups over SaaS backups. I could do the opposite for SaaS.

  • You definitely know how to stir-up the pot. 🙂

    At AXEO PM+EMR, you can deploy and run:
    Internet (cloud-based, ASP, …)
    Local Net (client/server)
    or a combination, AND the UI/UX stays the same.

    You can:
    Export and/or backup your data at any time
    We can do it for you,
    or a combination of both

    Your post has touched on more than just backup, and blurred some borders.
    • Backup
    • System fault tolerance
    • High availability
    • Disaster recovery
    • Total cost of ownership (TOC)

    One last point. Depending on the make and model of some systems still in use today (obviously not limited to EMR), the hardware maybe in a state of “failing” and not dead in the water. As a result, the data AND the backups could be corrupted to a certain extent over time – possibly almost unusable when the system finally does fail completely.

    Thanks again for the venue. Very helpful for us.

  • John – Your post has certainly inspired some chatter not only here, but around our offices. Our directors of Business development and marketing along with our CTO and CEO got involved. Our CEO thought it best to answer some of the points you raised. You can check out what he had to say here.

    I certainly enjoyed meeting you as well. the bloggers panel was fantastic and the knowledge and info you’ve given post-show is terrific. Keep up the great work and I look forward to working with you in the future!

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