AAOS Bulletin - February, 2006

Are your electronic files protected?

Tricks and hints for maintaining the totally electronic office

By A. Herbert Alexander, MD

You’ve successfully implemented a totally electronic office (TEO). You have a computerized practice manager (PM) that handles your appointments and billing, an electronic medical record (EMR) system that keeps track of your phone calls and patient-related “to do” items, and computed radiology (CR) so that there isn’t an X-ray acetate in the office. Your office is integrated with the hospital so that you can electronically transfer ultrasounds, bone scans, MRIs and CTs.

You like your system and you’re happy with all the time and money you save by not having to store and handle paper charts and X-ray films. But you realize you still need to make some improvements and safeguards to your system.

Does this scenario sound familiar? This was my office situation several years ago after first implementing a TEO.

Disasterproof your records

In a conventional office with paper charts and X-ray films, all these materials can be lost in a devastating disaster or fire. With a TEO, your stored EMR charts, PM data, and digital X-rays are at risk of being lost in a disaster—or, more likely, a hard-drive failure. The question isn’t “if” a hard drive will fail, but “when.”

Fortunately, the same precautions can be taken to protect your electronic materials from loss in either event. The trick is to keep multiple copies of your data in different locations.

I keep one copy of my PM and EMR data on my server (a computer with all my practice data on it) in a computer room at the opposite end of the medical facility. I keep the second copy on my workstation in my personal office. So if I lose the data on my server, I have a copy of it on my workstation computer.

Several inexpensive, automated backup programs will copy this data from one computer to the other. The backup software copies the data from the server to my workstation on a preprogrammed automatic schedule each night. I make a separate copy for each day of the week, so that the most data I could ever lose would be one day’s worth.

These methods protect me from data loss because of a computer or a hard-drive failure, but what about loss of both computers because of a fire? Some practices make a copy of their data each day and take it home or store it in another off-site location. In fact, this is what I’m doing for my X-ray data. The vendor that services my picture archiving and communications systems (PACS) makes DVDs of the data and sends them to me as a backup.

For my EMR and PM data, I back up the data on my server to my home computer each night. Simultaneous disasters at my office and my home would have to occur to lose this data. Again, programs can be set up to do this automatically.

Access your data off-site

Having the peace of mind that your electronic files are safe allows you to more fully enjoy the benefits of a TEO. How many times have you been at home, whether on call or not, and wanted to see X-rays taken at the hospital, the emergency department or at the office? If you have a TEO with digital X-rays, you can see your images and your EMR on any computer with Internet service, even if this feature is not included with your EMR or PACS software. Third-party software, such as GoToMyPC and Access Remote PC, allows you to remotely connect to your office PC.

I continue to expand my use of this remote access feature. Recently I have started to use GoToMyPC to access my EMR remotely from the hospital so that I can generate my templated postoperative orders and operative reports with just a click of the mouse. This time-saving procedure has eliminated the need for me to dictate and transcribe operative reports. My EMR allows me to tailor the orders and the operative reports as necessary, and eliminates the need to correct and sign them.

A. Herbert Alexander, MD, is chair of the AAOS Internet Communications Committee. He can be reached at herb_alexander@msn.com


• For a review of the essentials of a totally electronic office (TEO)

• For a primer on computed radiology (CR)

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