Book Excerpt: First-Person Insights on Adopting EHRs

The following excerpt from Steven M. Hacker, MD’s new book, “The Medical Entrepreneur: Pearls, Pitfalls and Practical Business Advice for Doctors” (Nano 2.0 Business Press 2010), offers his insights for physicians on adopting electronic health records:

The key characteristics of a good information technology (IT) consultant are reliability, integrity, and experience. Networks and computer systems crash all the time. It is unpredictable, but inevitably networks crash in the middle of the busiest patient day. You need someone who is always willing and able to tend to your practice in an emergency. Spell this out in any arrangement. I pay my current IT consultant a flat monthly retainer for support of my computers and networks. Most consultants charge based upon the number of hardware systems and networks they are responsible for. Get a quote from a few different providers and compare this number with references. Remember, do not sign any support contract unless you are able to terminate at any time without penalty and without cause.

My initial fear with incorporating electronic health records (EHRs) into my practice was losing saved patient data. I think many doctors share this concern. My fear was validated one morning when I arrived at the office to find that no one could access any patient data. We could not see our patients’ schedules, billing, or patient charts. I had spent a lot of money creating a system of redundancy.

Redundancy means that the system backs up a mirror image of one hard drive to another server. We had two additional servers that served this purpose. So, redundancy was in triplicate. If one server failed, we could retrieve information from the second redundant server. If the second server crashed simultaneously, which seemed highly unlikely, we had a third server to retrieve the information from.

As luck would have it, two of my servers crashed simultaneously. I thought, no problem, we would get the information we needed from our third server. However, when we went to retrieve the data off the third server, it appeared that our regularly scheduled backups were not reaching the third server. Our IT consultant was supposed to be monitoring this. It had been months since our third server had current data. At this point, I was livid.

My IT consultant told me I would have one chance to retrieve the data. We could send the first server to a catastrophic recovery service. These are the same companies that work for the government retrieving highly confidential data off corrupted computer systems. They charge $20,000 whether or not they get the data back. We had no choice. I sent the server to the company overnight and within a day had all my data back. I found out that I had insurance for this type of event. In the end, everything worked out.

The lesson I learned from this experience was to make sure that I was always monitoring my backups. I added an additional remote offsite server to back up data. Make sure you have insurance to cover you for catastrophic data loss. The best way to minimize this risk is to use an ASP system and back up your data locally in the event that you have a catastrophic loss.

I spend a minimum of $50,000 annually supporting my software programs, updating software, licensing software and paying an IT consultant to manage and handle these functions for my practice. -- Steven M. Hacker, MD