Securing Electronic Health Records: How Often Should You Backup Your EHR System?

At Calysta EMR, we understand the enormous responsibility that comes with managing sensitive patient health information. As aesthetic providers, you put your trust in our platform to protect confidential patient records. A key way we safeguard this data is through comprehensive, frequent backups of our entire EHR system.

Your patients' health records contain some of the most sensitive personal information imaginable - medical histories, treatment plans, diagnoses, lab results, prescriptions, and more. This sensitive data is entrusted to your healthcare organization when a patient enters your care. 

As electronic health records become ubiquitous, properly safeguarding the privacy and availability of EHR systems is paramount. 

But how often should you really be backing up your EHR system? What methods should you use? And how long should you retain EHR backups?

This article will dive into these critical questions to help you implement robust EHR backup strategies.

How frequently should computers containing EHR information be backed up?

Daily backups are considered the absolute minimum standard for EHR systems, according to healthcare IT experts. The Office of the National Coordinator for Health IT (ONC) states in its guide to HIPAA security for small healthcare practices that daily backups should be implemented "at a bare minimum" for EHR servers. However, in many cases more frequent backups may be warranted:

• For EHR systems with high velocity data changes, such as large hospitals with hundreds of patient visits per day, hourly or even continuous backups are likely more appropriate. One study found that for EHR databases updating 4.2 million records per day, hourly transaction log backups were optimal.
• The specific frequency you choose should be guided by analyzing the rate of new data entry and changes to existing records in your EHR system. The higher the data velocity, the more critical it is to capture point-in-time snapshots more often.
• You should also examine your recovery time objectives - how quickly your operations need to be restored in the event of a system outage or data loss. If your RTO is just a few hours, daily backups could result in an unacceptable loss of clinical data.
• HIPAA does not mandate a specific backup frequency, but does expect covered entities to have appropriate backup procedures in place depending on their environment. An analysis of your EHR system's unique data flows, recovery goals, and clinical impact should drive your frequency.

In addition to frequent backup cycles, regularly testing restores is essential to validate that backups are capturing EHR system state correctly. You should aim to test restores on isolated environments on at least a monthly basis. Only by proving you can reliably restore from backups can you trust in their integrity when needed most.

What are the different methods of backing up EHR systems?

Healthcare organizations have several options for implementing EHR system backups. Details about key methods are outlined in the table below:

Method	Description	Pros	Cons
Physical Offline Backups	Back up to removable media like external hard drives, tape cartridges, CD/DVDs. Media can then be stored securely offsite for recovery from disasters.	Data isolated from network attacks. Long media lifespan if stored properly. Low cost.	Manual process. Physical media can degrade or be damaged. Restores are slower.
Cloud-Based Backups	Replicate EHR backup data to secured cloud storage environments. Leading cloud providers meet HIPAA compliance standards.	Automated backups. Scalable capacity. Accessible from anywhere. Secured data centers.	Dependent on internet connection. Higher costs for large volumes of backup data.
Real-time/Continuous Data Protection	Backup software continuously captures EHR database changes rather than periodic snapshots. Enables "rewinding" to any point in time.	Minimal data loss in outages. Streamlines restores.	Complex to set up and manage. Higher software and storage costs.
Application-Based EHR Backup	Many EHR system vendors provide their own backup solutions tailored specifically for healthcare data needs.	Tightly integrated for smooth backups/restores. Optimized for EHR data models.	Vendor dependence and cost. Mixed reviews on reliability.

For optimal resilience, a hybrid approach combining the strengths of multiple methods is recommended. Critical patient data demands redundancy to guarantee recoverability.

How long should EHR backup data be retained?

HIPAA does not mandate a specific retention period for EHR system backups. However, your backups are useless if they do not allow you to fully recover patient data and operations when needed. Some key factors influencing EHR backup retention include:

• For backups supporting comprehensive disaster recovery and business continuity, retention of at least 7-10 years is typically recommended. This enables recovering from catastrophic events as well as meeting e-discovery needs for litigation cases, which have lengthy statutes of limitation.
• Consider if very old backup data is required. For example, tape rotation schemes often have cycles of monthly, quarterly and yearly backups, expiring yearly backups after 7-10 years.
• As storage costs decline, longer retention becomes more feasible. However, balance costs against true recovery needs.
• Ensure backups remain readable even as systems and formats change over time via proper media rotation, migration to new platforms, and documentation of backup schemas.
• Establish clearly documented policies and procedures for backup cycles, expiration of backups, tape rotation, and other data retention processes.

The criticality of your EHR system availability and the sensitivity of patient medical data necessitates retaining substantial history in your backups. Set retention periods that truly meet your organizational requirements for safeguarding HIPAA-protected health information.

Why Frequent Backups Matter

HIPAA guidelines expect healthcare organizations to have appropriate EHR system backup procedures in place, but don't mandate a specific frequency. Many providers assume daily backups are sufficient. However, for busy practices that enter high volumes of new patient data each day, daily backups can mean losing valuable information.

Our recommendation is hourly backups as a best practice. This helps minimize disruptions and data loss in the rare cases when our systems experience outages. For high-velocity environments like leading aesthetic practices, more frequent backups capture important point-in-time system snapshots.

Calysta was founded on continuously evolving to meet the needs of aesthetic practices. Our exceptional backup protocols resulted from listening to providers' concerns around EHR availability and data protection. We view backup processes as critical components that empower our users, not just technical details.