Jonathan McCallister

Picture it: Your computer crashed and burned, taking with it all your precious data. But don’t panic - there is a sliver of hope that you’ll be able to salvage that missing data from the dead machine.

However, before we get into what to do about recovering your lost data, I must reiterate the importance of a formal backup routine, including offsite storage. Disk recovery really should be considered as an absolute last ditch effort. While a hard disk recovery company may save your data (and your business) someday by raising your data from the dead, your practice should make every effort to avoid the need for this by ensuring you have adequate backup systems in place.

OK, lecture over. Let’s talk disk recovery.

You see it on an endless number of television crime dramas: A perpetrator is snagged because a super-geek resurrected hidden data that the criminal thought he had deleted for good from his PC hard drive. While it makes for good TV drama, there is a surprising amount of truth to what can be recovered from disk drives that have failed, or have been physically destroyed, thanks to improving technologies, and ever improving skill sets in the marketplace for data recovery.

If you find yourself in a situation where your storage media, such as PC hard drives or servers containing critical data, have failed or been physically damaged by fire, flood, or other catastrophe, there is hope - although it is an expensive hope and there is no guarantee.

It is important to understand some ground rules for disk recovery, which is the art and science of resurrecting data from dead disk drives, or other media.

First, you must understand what a disk recovery effort could potentially do for you. In your practice, the data stored on your drives (or other media such as digital camera storage cards) is a somewhat delicate arrangement of bits and bytes, which can fail resulting in the inability of your computer to see the data on the disk or other media, often referred to as the dreaded hard disk crash.

Such failures can occur for a number of reasons, which might include power surges, water damage, fire damage, dropping a laptop, or simply from a drive wearing out. Companies specializing in disk recovery can do amazing things using new technologies to recover data on such damaged drives, and can offer a last chance opportunity to recover your most precious data, if your backup solutions failed you as well. In addition to disk drives, recovery companies can also salvage data from some types of data cards, some magnetic tape platforms, and even USB keys, in some cases.

If the worst has happened to you, and you find yourself exploring disk recovery options, it is very important to understand that the disk recovery industry is largely unregulated. As such, nearly anyone can hang a shingle out advertising their services for data recovery. And if you are dealing with confidential patient data, you have no way of knowing how the drive will be handled, or if the recovery expert might make himself a copy as well, for his side business of identity theft.

Second, pricing runs the gamut. Reputable disk recovery companies’ pricing can start out around $2,000 for recovery of one standard PC hard drive, with prices increasing as the complexity of the recovery increases. Drives from servers, those that have been encrypted, or disk arrays (groups of hard drives acting as one drive) can be more costly if recovered by experts. While this pricing might seem high, in many situations those costs for recovery are quickly eclipsed by the costs the practice might incur if they cannot recover that data. As most involved in running a practice are aware, the costs of lost data includes a number of aspects, including staff downtime, loss of billing information resulting in cash flow interruptions, expense of duplicate efforts to re-enter lost data, as well potential short term and long term liabilities associated with loss of any electronically stored medical records.

If you find yourself in need of hard disk recovery options, here’s a rough guide to your next steps:

 The likelihood of a successful recovery of data from a damaged disk by an expert recovery shop can be greatly influenced by what actions you take immediately following the detection of the failure. If your drive is making noises, or is invisible to your computer, and it contains critical data, don’t touch anything. Have an IT professional physically remove the drive(s), and store them in electrostatic protection bags, in preparation for shipment. Do not attempt to download free software from the Internet to recover the files yourself. If you attempt to use such software to recover the disk yourself, you run the risk of ruining what data was still recoverable.

• Find a reputable disk recovery company.

 This is probably the toughest part of the process, because these companies can range from companies with highly trained professionals, operating in what’s known as a “clean room” environment to college kids running a side business from their dorm room. While the latter may have some level of success, you should only trust your practice’s critical data to true experts. Contact the disk recovery company (which you can often find through a simple Internet search), and ask for references. Ask if they operate a true clean room, which is an isolated, dust- and static-free environment, where the disks are handled. Ask for success rates, and how many drives they handle per year. Ask if the employees have any certification, or if the company is in partnership with or authorized as a service center for specific drive manufacturers, which can be a sign of a more reputable shop. Don’t be afraid to pry. You will probably only have one chance to recover your data, so being picky is part of the process.

 Even if your data is recovered (or partially recovered), you still will likely need the help of software vendors to fully restore your systems. If the data being recovered is from an EHR, transcription system, or financial package, contact your vendor, and make them aware of the situation, so they are ready to use the salvaged data to restore your systems completely.

 Whether you are lucky and end up recovering all of your lost data, or if you recover nothing, this is an opportunity to learn an important lesson: backups are your friend. Immediately pursue a backup solution for your practice that not only encompasses the type of data lost, but also includes all data (in every form and format) stored by your practice.

Data recovery companies can seem like magicians, salvaging data from disk drives damaged by fire, flood, or negligence. While they are a last chance type option, they are in business to help you. Of course, keep good backups (did I mention that already?), but if you find yourself with a server that took a shower from the sprinkler system, a good disk recovery company might just save your practice’s data, and your business.

is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the October 2010 issue of 

Articles

Your system crashed and your data is gone. Now what?

Recovering Lost Data

Competition has always been the name of the game for medical office suppliers. Vendors seem to be constantly trying to achieve some tiny competitive edge over their opponents in an effort to secure your office’s business. In this battle for your business, suppliers have continued to grow their use of technology perks provided to their customers, which are intended to make your life easier, and to in turn ensure you stay a customer. 

If your suppliers have become complacent, assuming your account is a done deal, and you only see the occasional “Holiday Greetings” card come December, now might be the time to revisit what your current supplier (and competitors) has to offer to ease the management of your supply chain - particularly in terms of technology tools they can provide free.

When considering your suppliers, you should evaluate how far the prospective supplier goes in providing technology for your office. Supplier-provided technologies - from advanced Web-based ordering tools to PDAs for inventory management - can help you get a better handle on your supply operations.

A good starting point for opening up the discussion is your sales representative. Ask for specifics on tools such as advanced Web reporting, barcoding systems, PC-based inventory management software, or similar products they offer that might help your office save money and have a more satisfying experience with their company.

If you are looking to leverage a little free technology for managing your supplies, here are some points to consider:

We see it all the time, and retail electronics stores count on it: the urge to have the latest gadget with the latest features. That might work for buying MP3 players, but it’s a bad approach to choosing options from your medical supply vendor. I’ve seen a small office jump from faxing in weekly orders on a decade-old paper order form to buying a wireless barcode scanner and barcoding nearly the entire office in hopes of saving money. Unfortunately, sometimes technology for the sake of technology leads to a bad fit. In that case, the tiny office spent more than $1,000 in up-front costs, only to realize that the neat equipment was not a fit for their work flow. The interest waned, and they reverted to a happy medium of using a PC to submit orders electronically, via their supplier’s free Web site, while their pricey barcode scanner and labeling system went unused. Using the free tools supplied on the vendor’s site instead, the office was able to get the supply use reports and similar data that they had hoped would have come from the system they originally purchased. Remember, the most advanced (or expensive) options aren’t always the best options for your specific office.


Regardless of your practice size, you should at minimum be exploring basic online ordering functionality, which is provided free by most vendors. Even if you still do most things on paper, using Web ordering allows you to get some of the benefits of a software package designed for purchasing - for free. While it may lack some functionality and won’t completely replace an in house Inventory software package, it can give you some basic ongoing information about your expenditures, as well as making ordering supplies a little more reliable than verbal or fax orders. 
Supplier Web sites are easy to navigate, and usually offer the ability to build standard lists of items you reorder frequently. If you’re already using online ordering with your supplier, perhaps you should explore building templates or standard lists that speed up the reordering process. If you are unsure, contact your sales rep, and ask how you can learn about advanced features of Web ordering, or if they would be willing to sit down and do a quick tutorial in your office. If you are considering a new vendor, ask them to demo their Web site and the tools available to you. And, don’t be shy about providing constructive feedback to your vendor. If you would benefit from seeing something on the Web site, chances are other customers would too.

Some companies offer to provide free, or for a rental fee, electronic gadgets to assist with managing your supplies. These are often some type of barcode scanner or wireless PDA device intended to improve your inventory controls. These systems vary greatly from vendor to vendor. If you consider going this route, ask your vendor to let you do a three-month free trial before you commit. While it may seem useful at first, such devices can be problematic technically, as well as operationally, for reasons that usually become clear only after you’ve tried to inventory your stock late one Friday night, when technical support already closed or when the last battery in the device has died. These devices have their place, but proceed cautiously in these waters, and make sure the device improves your process, instead of you changing your process to fit the device. Work with your vendor to see what they provide for free, and how it might fit your office flow. Larger offices seem to benefit more from these types of technologies.

Free interfacing to your computer systems


In clinics with more advanced information technology infrastructure, you have options to consider surrounding direct integration and communication between your medical supplier’s computer systems and yours. Some suppliers offer (sometimes at a cost, sometime free) to provide that interface. These connections can vary in complexity from simple updates of accounting data, to usage reporting, all the way up to (in custom scenarios) just-in-time ordering. While the latter is likely only going to be seen in larger, enterprise-scale practices, talk to your vendor about their ability to interface to your accounting systems or your patient billing system. You may be able to make your bookkeepers very happy by saving keystrokes at the end of the month, by the simple transfer of a file, at little or no cost to you.


Once you get a bit savvy with using you supplier’s Web site for orders, start exploring your usage reporting options. If you are shopping for a new vendor, again, ask for a demo of their tools. Vendors can pull together your ordering history, and put dollar values on your expenditures for you, and put that on the Web site for you to use. Using such tools can lead to revelations about your supply ordering and usage patterns. Using this type of a view, supplied by your vendor, you may realize that by ordering monthly, instead of weekly, you can reduce your overall shipping costs. You may see seasonal patterns that you were unaware of, and be able to better manage finances based on that information. Whatever the analysis yields, getting that data in a viewable, understandable format from your vendor can be a big help - especially if they provide that service for free.

Regardless of where you are now with leveraging technology to improve your supply management, consider revisiting these matters with your sales rep. Talk to the vendor about developments that their company has made and new technologies they might have to offer you. In most cases, the vendor wants to make your life easier, so you are a happier customer. 

Educate yourself on what technology options you have and see if you can gain efficiencies by adopting a little more (free or low-cost) technology tools in your supply management process.

Jonathan McCallister is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via 

How to get more out of your office supply vendor

Free Technology Perks


We have all experienced the dreaded pause that’s the giveaway that you’ve entered telephone purgatory. You dial your local electric company or your credit card company, the phone rings twice, then the pause of dead air. Your stomach sinks, and that silence on the other end is broken by the sound of an automated phone system, telling you how happy is it that you’ve called and how it (an inanimate machine, remember) cares about your service. 

Telephone purgatory has become so ubiquitous, that it’s one of the cultural experiences to which we can all relate. Who among us hasn’t felt like a fox chasing a rabbit, as we push beeping buttons in hopes of getting to the end of a telephone maze, and thus the voice of a human? In fact, entire Web sites have sprouted up, dedicated to posting cheat sheets outlining which buttons to push to quickly reach a human. 


Like so many technologies in use today, automated telephone systems are a tug of war between saving money and increasing convenience for our patients. When considering automated telephone solutions (commonly known as automated attendants) for your practice, it’s important to keep your patients’ perspective in mind, and remember those painful times you have experienced on the other end of someone else’s telephone attendant handiwork. 

You must also seriously consider your goals if you are considering any type of phone automation for your office. Is your office so large you want to be able to route callers to specific staff such as billers, or does your small office want to simply send prescription refill requests to a voicemail box that you intend to check hourly? Or do you dream big and want your patients to be able to call in and cancel an appointment or pay a bill via telephone without ever talking to a human? 

It is also important to consider your audience. Is your patient base going to adapt well to an automated phone system? Are your patients among the generation who assume automated systems are all there ever was, or will they revolt the first time they are not greeted by a human over the phone? 

Phone system automation comes in many technology flavors. Platforms range from modules that add on to your existing phone system (aka PBX) for larger offices, to new waves of “phone system in a box” technologies, where the automated attendant runs on what looks to be a normal PC with a number of special connectors hooked to your phone system. Additionally, more advanced, large enterprise solutions can even include what are called Interactive Voice Response (IVR) systems, which can actually recognize the words you are saying, such as “connect me with billing.” While IVR is a nice feature, its practicality is questionable in many cases, particularly for anything less than large enterprise deployments. 


The meat of telephone automation comes not from the specific technologies you choose, but in how you choose to set it up, operationally. I’ve had clinic managers insist I build a special prescription refill line, which dumped script refill calls to a voicemail box, to be picked up every 30 minutes by the nurse. Setting up such a line that intercepted calls to our clinic was technically an easy task. Unfortunately, when someone was out sick, or the clinic got too hectic, there could be more than 40 refill voicemails waiting (in some cases, the same patient calling multiple times). This then can take huge amounts of time to keep up with, leading to frustrated patients and nurses wanting to poke that little voicemail notification light out of their phone with a sharp instrument. 

So, while it was technically possible, it wasn’t necessarily a good idea in that clinic’s operation. This case illustrates why it makes sense to have small pilot projects in a single clinic before rolling out major phone changes to the entire organization. Solutions that looked good on paper may be a little bumpier in practice. 

Another common myth is that by setting up a queue (sometimes called ACD/UCD groups) for patients to be on hold, patient access will improve. We all have heard the phrase “please wait for the next available agent.” The problem with that logic is if your single front desk telephone operator is already overwhelmed, the only thing happening to patients who call in to an automated queue is they are going to be on hold, and likely for extended periods of time, especially if that front desk person is also making photocopies and checking in patients. You must first consider whether the workload is simply too much for one operator, or whether the automated system can help route calls by bypassing steps, rather than just replicating the current call flow in an electronic, “on hold” world. 

When building a system, avoid getting hung up on a single setup you had in mind. Just because you’ve seen other people use call queues at the front desk, doesn’t mean it’s the best solution for your practice. 

Practices should discuss and document their goals before undertaking a telephone automation project. Gather input from all sides, including patients, as well as your front desk and clinic staff. Hire a technical partner who has experience in setting up what are called call centers, or similar environments, and discuss your goals and concerns. 

If your patients are complaining about being unable to get through to schedule an appointment, perhaps your office phone coverage hours need to be reviewed, in combination with considering setup of call queues and the ability for patients to directly dial nurses’ extensions after calling your main telephone number. Explore your options (and your budget) with your technical partner, and discuss your long term and short term goals. Perhaps you initially want to improve patient telephone access, but eventually you would like to allow patients to cancel their appointments by just pushing a few buttons. If you build a roadmap and work with your technical resource, your route on the technology road should lead you somewhere other than telephone purgatory. 

 is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via 

This article originally appeared in the June 2010 issue of Physicians Practice.

How to create phone system efficiencies without driving your patients nuts.

Automated Phone Trees


I once had the fortune of working in an academic medical environment affiliated with a very tech-savvy university, where most nonclinical computer system activities, including Web surfing and e-mail, were managed by the university. I found myself constantly grumbling under my breath when, during my Web surfing, I was confronted with the dreaded message, “This site is blocked by your system administrator,” and some other warning about how my computer would probably melt or turn into a black hole. 

I’d often lament to my peers about the woes of such strict policies. That was, until I heard about my colleague’s experiences. His medical group, which was quite large, had considerably more lax Internet policies regarding Web surfing and e-mail attachments. After years of such an approach, their network was crippled by a relatively common virus, which had not even produced the faintest hiccup at my facility. Even the medical equipment with PCs attached had succumbed to the attack, as many of those devices were configured with unfettered-Web access. 

In medical practices, particularly with regard to technology, daily operations tend to focus on support of the fundamentals. Activities like generating claims and getting electronic billing out the door often take precedence over the more mundane matters such as virus and malware blocking. Even worse, some of the best of us in IT can see issues like antivirus and malware blockers as problems for the rookie PC junkie on staff, not as something that needs to be part of high level IT strategy planning. 


While the term “computer virus” has been on the scene for some time, the word “malware” is a bit newer to the vernacular of even the savviest PC user. While a computer virus may take many forms, malware is a more gray area. Malware is software that can originate from any number of places, much like a virus. Basically, it shouldn’t be on your PC. It can potentially damage your computer, steal confidential information, or be used to leverage your PC as a “zombie” to attack other computers - all without your knowledge. 

To compound the issue, malware is often installed on a PC without the user even knowing it. The most horrifying part is that malware exists all over the Internet, and can come from Web sites, as hidden parts of e-mail attachments, or even in what might seem like dead or invalid Web links sent to you from what appears to be the e-mail address of a friend. 

After my friend’s experience, I realized that the organization in which I had worked might have seemed a bit harsh in their policies, but the reality was that those very policies kept our systems shielded from this new flavor of security breach (caused by malware), as well as from more traditional virus attacks. 


How should you protect yourself? It’s a combination of technical solutions and staff education. First and foremost, if you are serious about protecting your systems (and you should be), there can be no sacred cows. Everyone must accept that these policies are in place to protect one of your most valuable assets: your data. There can be no exceptions. 

Next, it is important to establish and enforce a well-defined understanding that computer assets within your organization are for use in work activities only. While some amount of personal use of the Internet is going to happen, it needs to be clearly established that such personal use is the exception, not the routine. 

In more technical matters, smaller practices may need to farm out this work to their chosen IT contractor, but the following are some fundamentals to help protect you from problems. It’s important to understand there is no single solution. Protection from threats is a multilayered approach, and often involves a number of different software applications, hardware applications, and user policies, all of which must be vigilantly maintained to deal with an ever adapting set of threats.

Choose and deploy one centrally managed antivirus software solution. Compare costs, and consider the cost to your business if you should experience data loss and system downtime from a virus outbreak. 

Establish rules that no personal external devices may be connected to company computers or equipment. This includes USB storage devices, digital music players, PDAs, cell phones, and digital cameras. Allowing this type of activity is just asking for trouble. You might even consider disabling USB ports on your PCs. 

Implement a spam filtering system as a complement to your existing e-mail system to help block harmful attachments and links from making it into your network. If you are a small shop and your e-mail is hosted by another company, contact them and discuss options for spam filtering. Educate your staff on the numerous paths by which viruses and malware can make it to your network. Ask your IT staff to show you some example scam e-mails, including e-mails that might look legitimate, but are instead methods for introducing malware and viruses to your network. 

If possible, isolate your network into different subnets, sometimes known as VLANS. This puts devices such as PCs linked to medical equipment on an isolated network, and may help minimize the impact should something make its way into your network. 

Implement centralized control systems to limit Web surfing. There are a number of good vendors in the marketplace selling low maintenance hardware solutions, which can be placed between your network and your Internet provider, that block known Internet sites containing malware, viruses, or any malicious or questionable content. While not fool-proof, this layer can substantially reduce your risk. Be careful of shared drives, which are common file storage areas, and the administrative rights provided to users on these drives. Drive sharing is handy and common in the office, but be certain these arrangements have correctly set permissions to prevent someone from having too much access. 

Close ports in your firewall. Smaller offices often have a tendency to set up their Internet connections wide open, meaning many unnecessary ports, or doorways between your network and the Internet, are open. 

Before you decide these moves will be too expensive for your practice, consider the overall costs. Can you say with 100 percent certainty your PC is free of malware? 

There are upfront costs, as well as some ongoing maintenance costs (in both staff and software), but those are miniscule, especially when you consider the costs from the loss or corruption of data and interruption of system availability. Implementing a layered approach, with varying combinations of the above items which fit your budget and setup, will save you money (and headaches) in the long run. 

is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via 

This article originally appeared in the March 2010 issue of

Insidious software and hidden viruses living in your computers could be threatening confidential records and practice productivity. Here’s how to protect yourself.

Author | Jonathan McCallister

Articles

Recovering Lost Data

Free Technology Perks

Automated Phone Trees

Malware and Antivirus Protection