Doctors' group picks NSI to back up medical records

Jefferson City Medical Group found an electronic medical records database necessary for HIPAA compliance. But backing it up in case of disaster took some figuring out.

From a sea of disorganized paper records in 2003 to implementing a new electronic medical records (EMR) database in two years -- so far, for Jefferson City Medical Group (JCMG), so good. But in the midst of planning out the new system, hurricanes struck Florida, and a light bulb went on for the Missouri-based physicians group; it would need a better disaster recovery (DR) plan to go along with its new and improved storage.

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Sorting through the backup software maze

"We were doing tape backups," said Phil Hartman, director of information services for the group, which consists of 65 doctors and nurse practitioners in the greater St. Louis, Mo., area. "But with the hurricanes, we started to think about what would happen if we lost the whole building -- and how we were going to get our systems back, not just our data."

JCMG 's EMR database vendor, A4 Health Systems, offered it remote backup at a site in Columbia, S.C., where it could access data over the Internet in the event of a disaster.

"But what if our Internet was down?" Hartman said. "What if we lost our building and had to set up in a school gymnasium? We could get computers, but we couldn't get computers with the configuration settings we need in a timely manner. And if we can't set up our medical records data, we can't see patients, which means we're in trouble, especially in a disaster scenario."

And so, it was back to the drawing board. JCMG looked into disaster recovery facilities closer to home where it could store hardware and go pick it up, if necessary, in the case of an emergency. Finally, the group found a value-added reseller, Integrated Solutions Group, in Columbia, Miss., which would put a duplicate of JCMG's 500 GB Hewlett-Packard Co. (HP) ProLiant DL580 Windows server into a DR facility.

"Actually, an old printing press building that had been fortified," said Hartman.

Integrated Solutions Group sold the medical group NSI Software Inc.'s DoubleTake replication software to transfer data and configuration settings to the duplicate machine in compliance with the Health Insurance Portability and Accountability Act (HIPAA) privacy regulations. A Cisco System Inc. PIX Firewall security appliance at either end of the T1 connection provides firewall protection and encryption of the data.

'There is no one size fits all solution'

The expansion of the online EMR application will mean storage growth and continued expansion of the HP SAN where the data is stored.

It will also mean a greater workload for the DoubleTake software. Already, Hartman said, the end of the day sometimes finds the DoubleTake software up to 10 or 15 minutes behind.

"Luckily," Hartman said, "We're not like a big hospital that has to run 24/7. We have a nice window where we can shut our doors at night and the replication can catch up."

But, he admits, it might not be adequate for a larger medical group, especially since his plan would also involve a traffic bottleneck if the duplicate server were accessed remotely in the event of a disaster.

"There, we're going from a nice 1 GB LAN down to a T1 connection to a server with half the memory of our primary," he said. "To us, slow is better than none -- but there's no 'one size fits all' solution."

Another caveat: Hartman said JCMG currently has to use Symantec Corp.'s LiveState software to backup any registry changes it makes to its HP servers.

"We don't have to do it often," he said, "But we would like to be able to do it all [replicating the data and server configurations] in one package."

NSI improves DoubleTake

In other news, NSI is improving DoubleTake's replication capabilities with a new version that will replicate virtual machines (See Protecting virtual servers gets smarter, Feb. 2), and will also be announcing a new modular add-on to its software for large organizations next week, called DoubleTake Application Manager.

Application Manager, a free download for companies already implementing the full version, allows application administrators to see a modular version of the software pertaining only to either the Exchange application (available now) or SQL server (available later this year).

"We think it will cut down on the confusion for application admins," said Bob Roudebush, director of solutions engineering for NSI. "They won't have to become an expert on DoubleTake to configure replication in their environments."

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