Home Forums Discussions General Discussion Last Note Backup gone

Since upgrading to V 7.1.3, one of my workstations lost the LastNote Backup utility. I tried repairing the program, still could not find it.

Does anyone know how I could locate it?

Thanks

I've been told the capacity for last note backup has been purposefully removed due to security concerns -- MU-2 won't allow it.

I have resisted upgrading for that reason, as well as other things I have read on this board about all upgrades past 6.3.3.

Eventually, I suppose I will have to upgrade to get ICD-10 capability, but that is still a future event. I gave up participating in Meaningful Use, so 6.3.3 is stable and quite functional.

I am curious how many physicians have adopted my approach.

I too will stay at 6.3.3 Until ICD-10 requires an upgrade (maybe) next year

6.3.3, no Meaningless Use, and wait as long as possible to upgrade! (Prob not til ICD-10 requires upgrade, hoping there will be another extension....)

Gene

I have remained on 6.1.2. It is so ironic that HIPAA has gone so far overboard and that MU have made it so common sense can no longer be used in documentation. If you have written a long note and suddenly AC freezes or your computer reboots, you have no way of reconstructing the note. I do not see how that benefits the patient but apparently our government does.

Here is what I posted on last note back-up in September:
"Apparently this is neither broken nor missing, just changed. Looks like MU2 says that the EMR should not store un-encrypted PHI on a hard drive, and the old "last note file" does not meet that criteria.
The good news is that the note should still be available in V7. On your main screen, go to the "View" menu and the last option is "View last note backup". Should give you what you need, though I am not on this version so I cannot verify it.
Thanks to Chris Conrad at AC for the info on this."

It is there in v7.1.2 as Jon said. I even found it without Chris' help.

This is the dumbest "fix" to the PHI restrictions I've ever heard of! Why not simply remove the patient's name and other demographics from the Last Note Backup rather than encrypting the whole thing? I'll bet that the next time AC loses contact with the databases or crashes/freezes for some other reason, you'll reopen AC only to discover the Last Note Backup menu item grayed out (unavailable). That's what happened to us this evening, and over an hour of work on a complicated patient evaporated!

Honestly, we've been using AC since version 1, and even as it was then, if the app quit, you had your last note backup there in the AC folder.

So this is progress! If I were starting again, I would NOT buy this program.

Hi kurt,

I feel your pain. I am sorry that happened to you. That is one good thing about a backup program like BackupAssist which allows SQL backups every five seconds. But, you should be able to set that up in SQL itself. But, I am not sure if it is worth doing a complete backup just for one note.

One thing I do, if I find myself going deep into a note. I send it to my inbox, then reopen it and not delete it. Sort of like Word saving it.

I won't go into whether it is AC or not, I have certainly been just as upset. But, the real blame, IMO is the government. They have and they ARE ruining medicine in every conceivable way. Not enough to do everything they have done with paperwork and CCHIT and now MIPS and ICD-10, but they had to go after the hardware. Now, basically, all EMRs have to go through government inspection. And, I understand doctors not being able to turn down that amount of money, but we have all signed up for MU -- some. I have hesitated to write this before, because it is not up to me to worry about what others do. But, MU along with the first attempt at an ACPM by Jon B., set AC back three years.

Then throw in HIPAA. Talk about throwing the baby out with the bathwater. I mean the whole medical establishment needs to re-think risk/benefit. Is the benefit of making sure that NO ONE's health information ever gets leaked worth the risk of all of ths bullshit. I mean you would still have that backup note if it weren't for MU likely basing it on HIPAA. It was a friggin' Health Insurance Portability Act. I am so tired of hearing the word HIPAA. It's not like we went around advertising what patients had HIV before HIPAA. It is called confidentiality.

Anyway, sorry to vent on your question. I am sorry that happened. Work with AC to fix it. I would like to hear your reply on some of the things I said.

It also doesn't make any sense since all the Imported items which have tons of PHI are not encrypted. I don't get what it's supposed to protect against. Someone can just copy your entire II folder or a backup if it's a network attack. The backup restore utility no longer requires an admin password to restore a backup.

Thank you for stating that. Also, in the past, the backup was labeled with amazingcharts, making it rather easy for someone to use it if found. Now, it is labeled with the name you have chosen for AC. I haven't seen the new backup program, so it may be different. It would be good to be able to label it what you wish.

Bert, Sandeep,
HIPAA regulations have been promoted as privacy protection for patients. But in reality the regulations actually reduce patient privacy: They specifically allow for far greater dissemination of private patient data by insurance companies than was previously allowed. In particular, since HIPAA implementation, an insurer specifically has permission to share its data with numerous commercial entities as part of its business practices. Almost no one understands this for what it is, along with other new-speak such as "meaningful use" and "accountable care" [shudder].

@kurt,

Thanks for that. I agree with everything you said.

I think I am going to start calling it the Kennedy?Kassebaum Act. That sounds much more mysterious. Just the K-K Act.

Effects on clinical care

The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their legal privacy responsibilities and often responded with an overly guarded approach to disclosing information...than necessary to ensure compliance with the Privacy rule".[40] Reports of this uncertainty continue.[43]

Costs of implementation

In the period immediately prior to the enactment of the HIPAA Privacy and Security Acts, medical centers and medical practices were charged with getting "into compliance". With an early emphasis on the potentially severe penalties associated with violation, many practices and centers turned to private, for-profit "HIPAA consultants" who were intimately familiar with the details of the legislation and offered their services to ensure that physicians and medical centers were fully "in compliance". In addition to the costs of developing and revamping systems and practices, the increase in paperwork and staff time necessary to meet the legal requirements of HIPAA may impact the finances of medical centers and practices at a time when insurance companies and Medicare reimbursement is also declining

I have a new found respect for the President. I mean how can he actually read through all this stuff, much less understand it, before signing it into law. I guess he has people who are specialists in this area, read it fully and then summarize it.

@Bert,
Regarding prep for HIPAA, I remember I just got the required boilerplate gibberish online, did a few copy and pastes so we had our new "regulations" printed and posted, and then fashioned a HIPAA agreement with similar boilerplate for all of our lucky patients to sign (as required by law). Then I sat back and waited for the HIPAA police to arrive, confident in my compliance with the letter of the law.

BTW, I've lived, worked and paid taxes in Belgium; I've experienced how a single-payer, tax-funded medical program can work pretty well, but we here in the USA have the worst of both worlds! Increased interference in the practice of medicine (in our case by both govt. and insurance companies) without the benefits to society at large.

But, we have to have faith that our government knows best. But, HIPAA worked great today. One of my patients with Neurofibromatosis was seen at one of the best Neurofibromatosis clinics in New England out of Boston Medical Center. Since it has been a month, just thought I would give them a call and see if they had decided to send along the consult note. They said they have the note. They just don't have a release.

She also saw the Neurofibromatosis clinic at the Mass General. No problem with HIPAA there. They just have no record of her ever being there. Mom states she spent three hours with the consultant there. Plus, little 'ol Eastern Maine Medical Center somehow was able to do surgery and remove three fibromas and send two H & E slides of a biopsy to MGH. But, I guess it is difficult to match up biopsies with a patient when you have no record of the patient. My favorite part is when they said, maybe she no showed. At which point, I politely reminded them that in order to no show, you have to be on the schedule to show.

All of this busywork must be good for someone.
Just not the patients or the physicians.
We sometimes have difficulty getting records on our own patients from our local 25-bed hospital -- for lack of medical releases. HIPAA, you know.

You're right. Much of the new legislation like Meaningful use and ICD10 is focused around data collection. The focal point is sharing "anonymized "data. These data sets will be publicized and will most likely be used to determine new insurance rates and other public health purposes. Loopholes were specifically implemented to allow companies like EHR vendors and insurance companies to pull "anonymized "data without notifying the physician or healthcare organization.

Physicians were forced into collecting this data under the guise of implementing electronic healthcare record systems. Previously this data was very very expensive to collect. Now it's free (for them). The costs have been shifted to the physicians/healthcare organizations and tax payers.

This type of data is very valuable. A prime example is practice fusion which is completely free. There's been lawsuits against them for messaging the practice's patients regarding new drugs for their condition as if they were coming from their doctor. The doctor only found out because the patients came in and told them about the emails. They are valued at around a billion dollars.

The main part most physicians find agitating is that the data is not really useful to them but mainly for insurance and drug companies. They get all this data for free.