Home Forums Discussions General Discussion What to do?

My 'plans' look like retirement in 2 , 2 1/2 years. My server is about 10 years old and the server OS will be end of life this October. renewing the server OS and hardware and paying AC/Harris to move and certify the database I figure at minimum gonna cost 3-4K and my Guardian Angel support contract comes due in a month so there's another $1850.
Maybe should just go to AC in the cloud for these next 2 years.
Thoughts, comments, suggestions are appreciated.

Every situation is different, but I am working through the same scenario -- except that I am now in the process of finally closing the office, so ahead of you by a couple of years. Your question is what to do in the next 2 years; my problem is how to maintain access to records for 10 years after the office closes. At least, AC will let me run the AC program indefinitely even after stopping the annual service fees.

I personally don't trust the "cloud" -- too much chance that whoever owns the cloud program in the coming years will not honor AC commitment to allow physicians to own their data, as you do with an in-house server. I have heard many horror stories of doctors using a cloud-based EMR, and then having to pay huge sums to access stored data when they moved to a different EMR or closed their practice. In most cases (as in my case when the nursing home where I was medical director changed from one EMR to another) the data becomes effectively unusable -- just to maintain "read only" rights to your own data is prohibitively expensive; downloading the data is prohibited, and actually transfering the database from one installation to another is essentially impossible. In my case, all the past medical history of a large number of patients was effectively erased. So much for keeping records for ten years, as we are told we must!!

At the present time, AC and whatever other programs you might need to run an office (in my case, MEDWARE and QuickBooks) can be backed up to a variety of devices -- which I am told will safely store information for 7-15 years, It is actually impossible to know how long data will last on an SSD or hard drive or flash drive -- but I have old flashcards and hard drives around that are still accurately readable after 15 - 20 years, so I imagine modern ones are at least as good.

MEDWARE will run directly from a backup, and QuickBooks will likely be around for a long time, so it shouldn't be any problem to read old data even 20 years from now. AC will not allow us to re-construct the program from backups, but they claim that they will only charge a few hundred dollars to transfer the backup to a new computer should the server experience hardware failure.
We used to be able to do a bare-metal reset from the AC built-in backup program (it is still there-- the restore program) -- but it doesn't work because AC will only allow the AC program to run on one server -- you can't have a spare. With GuardianAngel help a complete new installation can be made on a new server. They say it takes about two hours, which at current rates would be somewhere around $500-700 (and they claim they intend to be available in 10 years)-- which is certainly cheaper than hiring a data archive company.

JamesNT (on this board) has a program that will convert all of the data for each patient to a PDF. file. This of course could be read by Word or any other program -- I am considering using this option as a backup for storing data to satisfy the requirement to store records and keep them accessable for 10 years. As I have seen already, most people and even big institutions have been unable to do this.

Seems like the most economical option for you would be to buy a new server which probably is cheaper than 2 years of cloud service, depending on what you pay for IT help, and which would almost certainly last the required term of records maintenance. Of course, you or someone you hire would have to be available to release records during that period. In our case, we had a flurry of records requests in the first few months, but now the requests are only sporadic. I imagine that after 6 months or a year there will be very few -- and in any case, there really isn't much value in old records for most patients.

Thanks Tom, your reply did make me think. Maybe instead of redoing my server I'll just have AC/Harris move the database to one of my PC's and run a Peer to Peer network. There's only 2 of us in the office my wife the front end and myself the back end so think running a Peer to Peer network should suffice, save some money and keep the 'future availability' of the records in my hands.
Hopefully your golf game, fishing and interaction with the grandkids going spectacularly.
My future hopefully will be filled with the above along with the garden and learning Swift programming.

Koby --
That's what I would do..
Now that we are actually retired I'll just keep the server going to archive and transfer records, and keep a laptop or two for backup. The network has been dismantled. Don't need all that stuff any more.
Closing the office has been quite an undertaking -- haven't seen the grandkids yet.
That's in the plans, though.

In this vein but slightly different:
I have been on AC on a "server" for 15 years with about 10 client machines accessing the server: most are hard wired. Providers use wireless laptops to access AC (yes, yes, I know....I should go to hard wired machines in exam rooms).
My question is though: would AC be faster to run if I changed to AC in the cloud? I think it would because ea machine would access it over the internet...but what do I know.

Another question: current setup is peer to peer. Would an actual server run AC faster?
Thank you.

We ran a server and clients -- most staff machines hardwired, about 4 laptops on wireless.
It is so much nicer to be able to move around in the exam room, sit by patients sometimes, and face the patient not the monitor.

I couldn't see that the program ran any faster whether wired or wireless, and I really didn't see much difference when we went from peer-to-peer to server-client.

The slowdown is in the software, and especially the Rx writing and loading ImportItems.

I think AC would have to be an entirely different program to be any faster in the cloud