Home Forums Discussions General Discussion some beginners questions

I am going to set up my office with 3-4 providers with AC.

I have a few questions that maybe some of the more seasoned users can answer.

What kind of server is good to use?

What type of backup precautions do you take?

How large does the database file get?

Thanks so much

Are there any instability issues?

Does it slow down with say 10,000 charts?

Hi Shawnt,

These are my opinions and your mileage will probably vary... I help administer a practice with one...

>What kind of server is good to use?
Any "box" with a fast large hard drive with just about nothing else running in the background other than the normal stuff (anti-virus, back up app, etc). As with all servers, the less CPU load the better. AC doesn't use a n-tier structure so you don't really need a beefy server... BUT I remember someone saying John maybe moving towards a MS-SQL back end which will probably need a small server from HP or Dell (such as a PowerEdge 840). Probably better to get something for the future...

>What type of backup precautions do you take?
I donno about others but I'd suggest _DAILY_ back up to an external hard drive connected to the server and also across the network to a different work station (after hours) so you don't slow down the network during the day. Others have suggested backing it up off site which I also strongly suggest. Others swear by tape though.

>How large does the database file get?
Maximum size for Access database is 2 gigabytes. AFAIK, only the chart information is stored into the database. Imported pics and files are not BLOBed into the datase. Imported files are stored in a subfolder, in individual files and are limited by the size of your hard drive. As the size of the Access DB increases, the slower the program will become, partly due to the way Access transfers information across a network... which is probably why AC is moving towards a MS-SQL back end.

>Are there any instability issues?
AC's stability has improved with the new versions... and as with all software, bugs get eliminated with every new release and introduced with every new feature.

>Does it slow down with say 10,000 charts?
See my answer about Access DB above. Oh, and periodically running the compress database helps as fragmentation can slow down the DB.

Shawnt,

I would echo what scslmd has written. I may add a couple of things.

Backups: The type of backup you do depends solely on the risk/benefit just like medicine. If all you keep on your server is various files such as journal articles, etc. then your backup can be once weekly to a CD. But, if your data is mission critical, then you not only need daily backups as mentioned, but you need redundancy and something which is very dependable. In my book, daily backups to a CD or worse to a thumbdrive is asking for trouble.

It also depends on what else you keep on your server. If you also run say, Medisoft, and have all of your databases for scheduling and billing, then backups become more important. So, your server is now storing even more mission critical data. Ask yourself what would happen if you lost all of your AC data or all of your billing. The two biggest mistakes people make is not having REDUNDANT backups and not checking their backups often.

When daily backups are mentioned, some will take that to mean have one external hard drive and do a backup everyday which overrides that backup or even does an incremental or differential backup. If your system crashes or becomes corrupt, suddenly you are hoping and praying that the backup you made is good or did not simply copy over corrupt files. So, you want to make backups that go back one week (good), two weeks (better), four weeks (even better). You can do this with backup software that will date each backup so it is made separately. Hopefully, these will be backed up to multiple hard drives. Even though hard drives are best for backups (or easiest), hard drives are also the single biggest point of failure. One could be thinking the backup is occurring each day, but if the external hard drive is bad, well. there you go. The more backups you make and the more hard drives you back them up to; the more redundant your backups become. How redundant you want to be is up to you.

You should take at least one backup home every week. This has been done traditionally on tape and lately CD/DVDs. I finally scrapped these for the Seagate external portable drives. I do agree that paying the $250 for offsite backups daily is extremely useful. Finally, you can back up the entire server or at least the data drive nightly, but you can also back up the folders individually. For instance, you could copy and paste the AC folder along with say, your Medisoft folder, to the external drives or another computer.

As for the server, that is also up to your budget. If you have a limited budget, then a peer-to-peer will do. You can also set up a network with a limited machine as stated in the previous post. If you want to have a good domain, which is the ultimate way to go, then you will need a fairly good server from Dell or HP for about $2000. Again, you could spend a lot more or a lot less. Finally, you would need a server operating system. Microsoft makes an incredible OS for small businesses known as Small Business Software 2003. This allows you to have tons of flexibility with all of the bells and whistles that Fortune 500 companies have. It's very reasonably priced. Hope this helps.

I forgot to mention another reason for multiple backups that go a month deep or so. Backups aren't always for the crash that occurs today and saving with the backup yesterday.

There will be times that you or someone will delete a file from somewhere or even a patient from your billing software. It's hard to come up with a great example (until I am faced with it). All backups AFTER the error will continue to backup your server WITHOUT the deleted or corrupted file. So, it's nice to be able to go back and find that file from a month or so ago.

We go the daily two harddrive route. I have two little firelite drives, and I copy the whole AC folder to both drives every night. no if's and's or but's. I just go to my computer, get into the program files, highlight the AC folder and say copy. Then I make a new folder that I rename that days' date like ACBU 9-17-07 Mon, ( for, AC Back Up) and copy it to the external drive. One drive stays on site in a fire and water proof box, safe thing, and then the other goes home with me or my wife Nancy (my doc) in a laptop bag every night.

If I lose my house I still have my back-up, if I lose my office I still have my back-up. Only if some catistrophic event wiped out all of Liverpool, NY would we perhaps be in trouble. And even then I would evacuate with my laptop and that "home" back-up drive anyway. So good chance I would have my data safe. Unless me and my family also get wiped out (god forbid) while evacuating.

I used to have a once every week or every other week rotation rotation, of copying over two Monday's ago every two weeks let's say. But I had a real bad data issue last winter and it wasn't resolved extremely well, so now I make two individual copies, every night forever. And for the cost of 1 or 2 hundred bucks a year, just a buy two new drives once or twice a year, right? Drives and memory are really cheap now. I just picked up two new 100 gig Firelites for $89 a piece before rebate!!! Even with the program included the files sizes are just not that hugh. We are a solo office so our files are a bit smaller, but even still. Now you have a back up copy of all your data on a few different drives. So even if one fails the other is still there.

Lastly, I am thinking about investigating further into some of these other vendors of off-site back-ups. RoadRunner, Carbonite (like Hans Solo) and a few others. No matter who your EMR or PM vendor is you always have your data. It's your intellectual property and that of your patients. Roy and I are both very anal about this point. It is why we will never use an ASP based program where we never own the program itself that the data is created in. Remember in the end; only YOU the doctor will be harassed by some carrier or Medicare in three years from now as what happened with Mrs. Smith's visit back on Oct. 2nd, 2007, not this vendor or that vendor. ONLY YOU!!! Hope this helps...

Paul