It's time to bust a dangerous myth or two. The first is that your paper files are safer than digital records. The second is that all electronic storage can equally protect your data.
Our Electronic Assumption
Most of us know that electronic devices can fail. Our cell phones die, our computers crash and our televisions go out. These are just the annoyances that come with modern life. So naturally, many of us assume that storage of an electronic health record (EHR) would be no different, so therefore paper appears safer. After all, paper files can be locked up in one location at the end of the day. They seem more tangible than digital data. In fact, this tangibility is just one reason why our paper records are more vulnerable than any properly stored EHR.
Catastrophic Loss vs. Paper
Recent history has shown us that paper files don't do well when nature strikes. Hurricane Katrina was a landmark event for many reasons, but one of them was how EHRs and EHR storage offered patient protection. Even though entire hospitals were underwater, EHRs (saved on offsite digital storage) were ready to follow patients in their evacuation. The most notable of these stories took place at the VA Hospital in New Orleans, which had initiated an EHR system protecting patients with proper offsite storage. Patients at other hospitals and other private practices were not as lucky.
Of course, disasters don't have to be Katrina-sized in order to impact your practice. Frozen pipes, backed-up sewers and electrical shorts can be enough to ruin several thousand files. While most practitioners won't experience this kind of loss, those who do would have taken great comfort in knowing that their loss was minimized because data was properly protected.
Consider for example, a client of our company in the Midwest. This young chiropractor was hardly in practice for two years when a fire swept through part of his office and destroyed his paper patient files. While the damage done to the furniture, carpet and equipment was substantial, all of the physical components of his practice were insured and replaceable. The patient information and encounters in his records were not.
When it came time for him to decide how he would protect the files of his rebuilt practice, there was no question in his mind that EHRs, with proper backups and storage, were worth it. He realized what he lost permanently could have been replaced in less than 24 hours with an investment in a digital clinic with data backups in multiple locations. It was a shame he didn't have the power to save his data before the fire. However, he was now able to see the futility in investing thousands of dollars in paper-storage devices when the paper clinic is facing obsolescence.
Insuring Your Blue Sky
What this doctor learned was that the one thing which represented the truly intangible value of his practice was not actually protected from loss. After all, nothing in his office actually proved his success more than his documented patient encounters. The physical records themselves do not have value, but the information and potential revenue from the record is the value. This intangible value is commonly referred to as "blue sky."
You cannot place your hands on blue sky, yet it represents the major worth of a company or practice. All the tangible goods in your office are guaranteed to devalue. Only your real estate and the blue sky available in your active patient files (i.e., your patient base) actually can increase in value. Your files are the evidence of the credibility, longevity and retention of the practice. They have personal value to the chiropractor, and they have value in negotiations when buying or selling a practice. I know because I've helped my colleagues buy and sell 300 clinics nationwide, transitioned owners and brought their agreements to terms.
From everything I've said so far, the relative vulnerability of your blue sky should be obvious. If you're using paper records or a digital document system that doesn't protect your data, you literally have no insurance policy on the value of your customer base. The only way to protect it is to ensure its existence with properly protected data storage.
Not All Storage Is the Same
This brings me to an important and essential point: Not all digital data storage is the same, and therefore not all companies actually offer maximally protected data. The difference between real protection and no protection is rooted in the difference between true EHRs and digital records. EHRs are encrypted, portable, searchable, organized, electronic patient histories and files. They are automatically backed up on a local server and should have the option to be saved on one or multiple offsite devices. Digital records are only patient data saved in a digital format, meant to be used locally. They are limited in their portability, rarely searchable or organized, and often saved to the hard drive sitting at your staff's feet. They are not backed up anywhere else without your direct intervention.
Offsite Storage Guidelines
There are more than 60 companies that currently sell chiropractors some kind of digital documentation, billing or both. Only a small handful actually offer true EHRs with proper offsite protection. A generic digital health file is no more protected than paper. In fact, it is even more vulnerable due to power surges, computer crashes, fires and equipment theft.
Now that we have established why paper isn't safe and generic electronic files are not a true solution, here are a few things to keep in mind when you consider offsite storage and EHR companies.
- Don't choose a provider of data storage lightly. You're legally accountable for what's on your records, even if they are stored incompetently by a third party. Make sure they are protecting you.
- Make sure that your data backup is supported with a good plan for getting you back online. This is known as disaster recovery. You're investing in a data contingency plan, not just access to hardware. It will complement your office's contingency plan. It is a good idea to choose a company that will "test-restore" a few files to see how it will work.
- Don't save offsite in a place that might suffer from the same catastrophic loss. You gain nothing if the same disaster that ruins your server also ruins your offsite storage facility. The offsite location may need to be in another geographic state.
- Choose a location that's environmentally controlled and properly secured. This is pretty obvious, but still worth noting. It's good to double-check on the space that your EHR company may be using in order to backup your files.
- Ask questions so you know what to expect. Your EHR company should be able to tell you the frequency of backups, how it's done, your offsite storage location, how the backups are protected, the life of the storage media, if there will ever be downtime, etc. Your backup doesn't have to be Fort Knox, with every bell and whistle, but your EHR company should be transparent on how it's protected.
The Future of Data Storage
I hope that I have been able to bust a few myths for you or at least get you to reconsider what you assumed about the future of patient data storage in your clinic. Now that the IT world has vastly improved its ability to guard and reproduce data, the relative security offered by paper files has quickly dropped, creating vulnerability for most chiropractors. While it may feel safer to have all of your files visible and tangible in one place, they're simply not as safe as properly protected data with offsite storage. Only offsite storage gives you the ability to restore all of your patient data in a few hours, effectively insuring your patient base and protecting the evidence of your reputation. It's a feature that's only available in the properly backed-up clinic of the future.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.