Friday, September 15, 2006


My Tablet failed. It is still usable, but when I flip the screen and shut it to turn it into a slate, the screen goes dark just as it is about to be shut. I phoned IBM; we have an extended 3 year warranty, but it does not include on-site service. They sent me a box so I can ship the Tablet to them. I'm not going to do that; I don't know how soon it will come back.

This brings me to the issue of redundancy. What do you do if some of your hardware or software fails? It was hard to plan well for that at the beginning of EMR, because I was too busy just keeping my head above water. Now that things are smoother, I have managed to put in some safety valves.

I do not know of any manual that outlines exactly what we should plan for; perhaps practices are too individual for that. I figure that it is good to identify things that you can't do without, the so called "mission criticals", and plan for what happens if they did fail. In any case, here is what I have done in my practice.


Practice data is the most "mission critical" thing there is. In my FHN, we have the server at the hospital, so they back it up nightly (as part of their routine back-up systems for the whole hospital's IT), and keep a spare copy at a second hospital site. The data has been validated, which means that they've looked at it to make sure that the copy is good. If the server fails, the most we can lose is a day's data. We had server failures early on in the project, so we know what to do if that happens: write notes on paper and scan into the EMR later; do prescription refills when the system is working again. Things are much more stable now, but if there is a problem, we know what to do.

There is also local data. The scanned charts in my external hard drive have been backed up to 2 DVDs, 1 copy at my office and 1 at home. As new charts get added from the inactive files, we back them up to DVDs weekly. The local data on my Tablet (patient handouts, clinical cheat notes, reports from committees I sit on, etc) gets backed up to an external hard drive at my home (sometimes).

Internet connection

I have a back-up internet connection to access the server via VPN in case SSHA fails. That required paying someone from Nightingale to come and do it properly; the office network is sufficiently complicated that I cannot manage this myself.


I have a spare laptop to use in case my Tablet really breaks; I carry it around, it can get dropped. The laptop is used by my resident a half day a week, so I know it is properly configured and ready to go. When not in use, it is attached to a laptop lock beside the vaccine fridge.

The Tablet has a stylus to write on its screen; I use the stylus instead of a mouse. These are always getting misplaced; I have two spares, 1 in each exam room.

There are two desktop PCs at the front. If one fails, we can still function, and can use the laptop temporarily.

As far as the screen problem on my Tablet, IBM gave me the name of several local companies that they use. I am responsible for the cost of the "housecall" (about $95/hour) if I choose to have someone come to my office, and they will pay for the repair. I phoned around, and there is a very reputable company close to where I live. They told me that if I bring the Tablet to them, there is no extra charge. That's what I will do.



Anonymous said...


I read your entries with much interest as our office started the EMR around the same time. Your reports cover many practical issues; it really is an invaluable resource as more doctors go into EMR.

Undoubtedly hardware is the most finicky part. Our local server actually failed on the same day your APS failed. Luckily our service warrantee had in house service, which restored it by the days' end.

One redundancy tool I found valuable is a multi-function machine, in case the scanner or printer fails. (we also made sure it runs on the same ink cartridge as our printer to minimize on inventory).

Like your office we keep a "redundant" tablet, in case any workstation got knocked out. During a staff shortage this summer, we thought of asking one staff to bring it home to do some filing remotely. It wasn't necessary after all, but we think perhaps if we're ever hit by another SARS-like pandemic, we'd have some staff work from home.

Thanks for your valuable postings,

Adam Chen

Michelle Greiver said...

Thanks, Adam

The multifunction sounds like a good idea. I have lots of printers, so those won't be a problem; if the scanner breaks, I'm in trouble. I have a Brother MFC as my fax, so I think I may be able to use that in a pinch.

I think if we do get hit by another SARS, we'll all be working partly from home. I was on work quarantine last time; having remote access to my charts would have been very helpful.


Jean-Fran├žois Rancourt said...

Your comments are always fine. For crash computer, we have 2 laptops that works with a RDP connection with server. So, no more installation than RDP.
For back up with buy a 200gig Tape for night back up and buy a connection with Centraldataguard who give a really good service for distant automatic back up at 10$ a month forr 500meg and 1cent for each meg over.
One thing that we must say is to buy "a service warrantee in house service" It's invaluable...

Michelle Greiver said...

Thanks, Dr. Racourt. I agree, getting in-house hardware help is better (as I've found out). One of the reasons for this blog is so that others can learn from my mistakes.