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02/09/2012 5:22 PM
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The hard drive crashed on our main computer. I have been backing up to the hard drive and to a thumb drive. This may have been covered before, but what would the benefit of backing up on Amazing Charts vs using Carbonite or another internet service? Thanks.
Bill Sullivan Private practice psychiatry Sierra Vista, AZ
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There are a few benefits, but the major one would be you would have an offsite backup in case something happens to your office like a fire.
Were you able to redo your hard drive and restore Amazing Charts via the .enc file on your thumb drive?
Bert Pediatrics Brewer, Maine
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The computer shop is working on it. My real question was would the AC backup be better then one of the other backup systems like Carbonite I hear advertised?
Bill Sullivan Private practice psychiatry Sierra Vista, AZ
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Carbonite I believe is encrypted and a lot cheaper than AC. However, think how long it might take to download several GB of data and thus how long your restoration would take. Do you want to potentially lose thousands in revenue while you wait for this to download?
Chris Living the Dream in Alaska
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I use Carbonite both at home and at the office. It works great. I've had to restore files...yes of course it takes a while to download, but I love the that the backups happen automatically and effortlessly. Great of those of us who are not that techy in these sorts of issues. That said...also do onsite backups...ya just never know! Can't have too many back ups. (Take it from someone who has had more than one system failure)
Barbara C. Phillips, NP Beachwater Health Associates Olympia, WA
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I am very, very paranoid; sometimes I resemble Howard Hughes. Get this: I back up the entire server several times a day to a second server using the backup capability of Server2008. If the main server fails, we just point the AC clients to the other machine and keep going. Both servers run on a doubly backed up power source, both with RAID drives. Then I backup both the AC backup and the imported items folder every night to Jungle Disk. My IT guys do a restore from Jungle Disk every month to make sure it is still working as advertised. The single disk failure is only a matter of mild annoyance that does not really affect operations due to the RAID array.
I use Carbonite at home, but as noted, for the more likely simple single machine crash, I don't want to be down for the 12 hrs or so it takes to restore over the net.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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David, a few questions:
1. Have you ever used your backup server for AC. I don't know how you would back up using Server 2008 Imaging backup in real time. It backs up to a drive which it manages, and must be restored to be able to be used. Typically, you would restore it to the same server. Just missing how you can run AC from the backup? 2. Are you doing incremental backups? How long do they take? How much resources does the backup take? 3. JUST ASKING but why do you back up several times a day. I thought I backed up a lot. You could use a program like Backup Assist and backup SQL files every five minutes with almost no footprint. Also, don't forget about the Volume Shadow Copies which you can use to back up every 15 minutes or so. We set them for one hour. Of course, these are on the drive you are protecting.
Bert Pediatrics Brewer, Maine
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I use Carbonite both at home and at the office. It works great. I've had to restore files...yes of course it takes a while to download, but I love the that the backups happen automatically and effortlessly. Great of those of us who are not that techy in these sorts of issues. That said...also do onsite backups...ya just never know! Can't have too many back ups. (Take it from someone who has had more than one system failure) Just keep in mind that Carbonite (even Business Premiere) does not back up SQL Server programs. You can only back up a backup of SQL. If you are running a server OS that uses VSS, you will be fine. Or, a 3rd party program such as Backup Assist that uses Open Files.
Bert Pediatrics Brewer, Maine
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The hard drive crashed on our main computer. I have been backing up to the hard drive and to a thumb drive. This may have been covered before, but what would the benefit of backing up on Amazing Charts vs using Carbonite or another internet service? Thanks. Sullivan: 1. Always back up your entire server first as David mentions. Not sure you need to do it several times a day (works for him), but at least every night. Get that done. Always. Back up your entire server locally to an external hard drive (not a flash drive). eSATA is the fastest way to go. If you can't set that up, go with USB. DON'T use just one drive and don't overwrite them, i.e. make several backups in each so you have, say, a month's worth of data. 2. You make it sound like you can only do AC backups online. But, first, to deal with that, you can't beat AC backups. They are designed to back up everything you need in the case of a system failure. Always think locally and then online. So, do your AC backup, which will automatically back up to the AC folder, but back it up to an external drive as well. Is AC online backup better than other online backups. In my opinion, yes. Again, you have THE perfect backup. It's small and fast. Carbonite and most online services will NOT backup SQL. The three that I know for sure are MozyPro, iBackup and Intronis. The latter looks very good. 3. With any backup, you need to make sure it can back up databases, specifically SQL Server programs. You need to look for online backup solutions (if you go that route) that can work with Volume Shadow Services or has the ability to use that technology or has other pre-imaging software. The newer Windows OS such as WIN 7 and almost any OS after 2003 from Windows incorporates VSS. This will take a snapshot of your databases, and you then backup the snapshots. There robust 3rd party programs such as Backup Assist which allow you to add on back up programs to back up SQL. It is imperative with any backup solution that you know what OS and hardware it is compatible with and if it can backup SQL. 4. Take home copies of your .enc files nightly on your drive. Take home a copy of your entire server at least weekly. 5. There are three things you want to back up every night as well as your server/main computer. Your billing software, Amazing Charts and your Imported Items. I tend to recommend doing them manually before you go home, others schedule them. I just like to schedule the nightly server or online backups, while doing others manually. Our billing software takes 2 minutes to back up, AC takes 2 minutes, while our Imported Items takes about 20 minutes. I don't necessarily stay around to watch them.
Bert Pediatrics Brewer, Maine
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Bert,
I know when the IT guys set it up they tested it and it seemed to work switching servers. I have not tried it myself in a while, so clearly it's time for another test run. We are doing incremental backups. The reason for this scheme is that it is the closest my IT guys said I could get to a complete mirror machine without a total of 4 servers, and that was too much even for me. I need to minimize the potential for losing even a small amount of work. I tend to push my personal memory "erase" button the instant I complete a chart; my nurse can literally ask me about a patient two hours after the encounter, and without notes I have little recall of any details. Since I no longer have any notes to jog my memory, losing even a morning's work is scary.
I am not really knowledgeable about the gory details of my system. But, you bring up some interesting points, which I will pass on to them.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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David, a few questions:
1. Have you ever used your backup server for AC. I don't know how you would back up using Server 2008 Imaging backup in real time. It backs up to a drive which it manages, and must be restored to be able to be used. Typically, you would restore it to the same server. Just missing how you can run AC from the backup? 2. Are you doing incremental backups? How long do they take? How much resources does the backup take? 3. JUST ASKING but why do you back up several times a day. I thought I backed up a lot. You could use a program like Backup Assist and backup SQL files every five minutes with almost no footprint. Also, don't forget about the Volume Shadow Copies which you can use to back up every 15 minutes or so. We set them for one hour. Of course, these are on the drive you are protecting. Well, I checked more with my IT guy, and here is the reply. Not quite as instant a fix as I thought, but not bad... In the event of a system failure of DSGRECSER1 it would be necessary to restore prior to connecting to DSGRECSER2 The fasted way to do this is in two parts 1. Restore AC Database: Elapsed time approximately 5 minutes. Once this step is done AC can be used however Imported Items may be out of date or missing. 2. Restore AC Imported Items: Elapsed time approximately 20 to 30 minutes. AC can be used while this is being restored.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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I think you should listen to your IT guy. You need 4 servers.
Jon GI Baltimore
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I think you should listen to your IT guy. You need 4 servers. That may be the funniest line on the ACUB ever. Leave it to Jon.
Bert Pediatrics Brewer, Maine
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That may be the funniest line on the ACUB ever. I think that says more about your sense of humor than mine, Bert. 
Jon GI Baltimore
Reduce needless clicks!
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Anything worth doing is worth doing to excess. Isn't that the basic rule? Here is what he has in mind... ![[Linked Image from ]](/ub/attachments/usergals/2012/02/full-4-147-full_2316_146_images.jpg)
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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@JBS true.
@David, I think I see exactly what they are doing. Not sure I would do it that way, but I am not there.
What I first read was this second server being updated quite often, and you simply change the path of each client if there is a problem. That would BE cool! I think though, they are advocating making backup images, then if your first server "Domain Server_first four letters of your last name_SER1 (I will just refer to Server1)Server1, goes down, you restore from the latest image and use it and then restore II while working.
I don't know how many progress notes you do an hour. It just SEEMS like it would be easier to switch to premade paper templates and enter them in later.
If you ever have to do it, please let us know how it goes.
Bert Pediatrics Brewer, Maine
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We are so thoroughly committed to the computer now, Bert, that it would be difficult to do. I am not sure we even have prescription pads in the rooms. Almost none of our visits are for acute issues, and I really have to review each chart before seeing each patient. When we are down, we are down hard. My understanding is that the AC back up is set to go several times a day on to the first server, and is then copied to the second server. If the first server dies, we do a quick restore on the second and switch paths, while the first server is repaired. The servers are identical, so the repair can be pretty leisurely. I realize I need to know this better, so I have scheduled a session with IT this week to show me how to do this without their help. If my description is wrong, I'll post it here.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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Makes sense. The reason why I was confused is the two following conflicting statements: I back up the entire server several times a day to a second server using the backup capability of Server2008. I was just envisioning a complete backup of your server several times a day. My backup takes a little under two hours. the AC back up is set to go several times a day on to the first server, and is then copied to the second server. If the first server dies, we do a quick restore on the second and switch paths, This would make much more sense; even sounds like a great idea. That backup (which would likely prove much more useful) would take about three minutes. So, that brings up two questions for your IT guys. First, why copy to the first server and then copy to the second? Why not just copy directly to the second server? Second, how long does it take to do an AC backup with imported items? Thanks David. Not trying to give you a hard time. I am always looking for better ways to do things. I am wondering if a robust CDP program would work better, although rather costly.
Bert Pediatrics Brewer, Maine
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What is a CDP program? I, too am looking for the best way.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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http://en.wikipedia.org/wiki/Continuous_data_protectionSorry, I should have written it out. Most will just give you point in time backup for near real time restoration. There are some though that will allow one computer to be practically the other. Trying to remember the name. A user told me at my only ACUC right after I gave an overly complicated back up lecture.
Bert Pediatrics Brewer, Maine
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Don't knock that lecture. I wasn't there, but watched the recordings, and thought it was great. Some things get simpler with time, and maybe this will be one. The Mac "Time Machine" that ships with the OS is awfully good, simple, and (Oh, yeah) free.
David Grauman MD Department of Medicine Commonwealth Health Center Saipan, Northern Mariana Islands
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Thanks for that, David. I guess the best backup is the one you never need. 
Bert Pediatrics Brewer, Maine
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