Backup and Disaster Recovery for Medical Practices: What You Need

“We have backups” is not a disaster recovery plan.

Every medical practice backs up data. But when disaster strikes—ransomware encrypts your systems, a server fails catastrophically, a fire damages your office—the question isn’t whether you have backups. It’s whether you can actually recover. And how fast.

Most practices that think they’re protected discover gaps when it’s too late. Backups that haven’t been tested. Recovery procedures that don’t exist. Recovery times measured in days when the practice needs hours.

Here’s what medical practices actually need for backup and disaster recovery—and how to know if what you have is enough.

Why Medical Practices Need Better Backups

Healthcare data isn’t like other business data. The stakes are higher.

Patient Care Depends on Access

When patient records are unavailable:

• Providers can’t see medical histories
• Allergies and medications are unknown
• Previous test results can’t be reviewed
• Care decisions lack critical information

This isn’t just inconvenient—it’s dangerous.

Regulatory Requirements

HIPAA requires covered entities to:

• Maintain retrievable exact copies of ePHI
• Have contingency plans for emergencies
• Implement procedures for data restoration
• Regularly test and revise plans

Inadequate backup and recovery = compliance failure.

Financial Survival

Extended downtime threatens practice viability:

• Lost revenue during recovery
• Costs of emergency IT support
• Potential HIPAA fines
• Patient attrition
• Reputation damage

Practices have closed permanently after ransomware attacks because they couldn’t recover.

Ransomware Reality

Healthcare is the most targeted industry for ransomware. Attackers know:

• Medical practices often have weak security
• Patient data is valuable
• Practices are desperate to restore operations
• Many will pay ransoms

Good backups are your ransomware insurance. Without them, you’re either paying criminals or losing everything.

Learn more about healthcare cybersecurity

HIPAA Backup Requirements

HIPAA’s Security Rule addresses backup and recovery in several areas:

Data Backup Plan (Required)

You must establish and implement procedures to create and maintain retrievable exact copies of electronic protected health information.

What this means:

• Regular, automated backups of all ePHI
• Backups must be complete and accurate
• Must be able to restore from backups

Disaster Recovery Plan (Required)

You must establish procedures to restore any loss of data.

What this means:

• Documented recovery procedures
• Assigned responsibilities
• Defined recovery priorities

Emergency Mode Operation Plan (Required)

You must establish procedures to enable continuation of critical business processes while operating in emergency mode.

What this means:

• Procedures for operating during outages
• Alternative means of accessing critical data
• Business continuity planning

Testing and Revision (Addressable)

You should implement procedures for periodic testing and revision of contingency plans.

What this means:

• Regular backup test restores
• Plan updates when systems change
• Documentation of testing

Criticality Analysis (Addressable)

You should assess the relative criticality of specific applications and data in support of contingency planning.

What this means:

• Know which systems are most critical
• Prioritize recovery accordingly
• Allocate resources appropriately

The 3-2-1 Backup Rule

The foundation of solid backup strategy:

3 Copies of Data

• Original production data
• First backup copy
• Second backup copy

One copy isn’t a backup—it’s a single point of failure. Two copies can both fail simultaneously. Three provides real protection.

2 Different Media Types

Don’t store all backups the same way:

• Local storage (NAS, server, external drive)
• Cloud storage
• Tape (less common now but still used)

Different media protects against media-specific failures.

1 Copy Off-Site

At least one backup must be physically separate:

• Cloud backup in remote data center
• Tape stored off-site
• Replicated to another location

Protects against site-wide disasters (fire, flood, theft).

For Ransomware: Add Air Gap

Modern ransomware targets backups. Add protection:

• At least one backup that’s disconnected from the network
• Immutable backups that can’t be modified or deleted
• Cloud backups with versioning and retention locks

If attackers can reach your backups from your network, they can encrypt them too.

RTO and RPO: How Fast Do You Need to Recover?

Two critical metrics define your recovery requirements:

Recovery Time Objective (RTO)

How long can you be down?

RTO is the maximum acceptable time from disaster to restored operations.

Example RTOs for medical practices:

System	Typical RTO
EHR	4-8 hours
Email	4-8 hours
Practice Management	4-8 hours
Phone System	2-4 hours
Website	24 hours
Archive Data	48-72 hours

Consider:

• How long can you operate without this system?
• What’s the cost per hour of downtime?
• What are the patient care implications?

Recovery Point Objective (RPO)

How much data can you lose?

RPO is the maximum acceptable data loss, measured in time.

Example:

• RPO of 1 hour = you can lose up to 1 hour of data
• This means backups must run at least hourly

Example RPOs for medical practices:

Data Type	Typical RPO
EHR/Clinical Data	15-60 minutes
Financial/Billing	1-4 hours
Email	4-24 hours
Documents	24 hours

Consider:

• How much work would need to be redone?
• Is there a paper trail for recent entries?
• What’s the cost of recreating lost data?

The Trade-Off

Shorter RTO and RPO = more expensive backup solutions

• Faster recovery requires more sophisticated infrastructure
• More frequent backups require more storage and bandwidth
• Instant failover requires redundant systems

Find the balance between protection and cost.

Cloud Backup Options

Cloud backup has become the standard for medical practices:

Advantages of Cloud Backup

Off-site by default: Data automatically stored remotely Scalable: Storage grows with your needs Automated: Set it and forget it (but still test!) Accessible: Restore from anywhere with internet Cost-effective: No hardware to maintain

Types of Cloud Backup

File-level backup:

• Backs up individual files and folders
• Simple and straightforward
• Good for documents and data files
• Slower full-system recovery

Image-based backup:

• Captures entire system state
• Faster full-system recovery
• Larger storage requirements
• Can restore entire servers

Application-specific backup:

• Designed for specific applications (databases, EHR)
• Ensures application consistency
• May be provided by software vendor

HIPAA Compliance for Cloud Backup

Cloud backup providers handling ePHI must:

• Sign a Business Associate Agreement
• Encrypt data in transit and at rest
• Provide appropriate access controls
• Meet HIPAA security requirements

Major HIPAA-compliant backup providers:

• Datto (popular for MSPs)
• Veeam Cloud Connect
• Carbonite (Endpoint and Server)
• Acronis
• Druva

Verify before using:

• BAA availability and terms
• Encryption standards
• Data center security certifications
• Breach notification procedures

Learn more about cloud solutions

Testing Your Backups

Here’s the uncomfortable truth: most practices don’t test backups. And many discover during actual emergencies that their backups don’t work.

Why Backups Fail

Silent failures:

• Backup jobs error without notification
• Storage fills up, backups stop
• Credentials expire, jobs fail

Configuration drift:

• New data locations not included
• System changes not reflected in backup
• Applications added without backup config

Corruption:

• Backups complete but data is corrupted
• Ransomware encrypts files before backup runs
• Media degradation over time

Incomplete scope:

• Critical data not included
• Application-specific data missed
• User data on local machines overlooked

Testing Approaches

Verification reports: (Minimum)

• Review backup job completion
• Check for errors in logs
• Verify expected data volume
• Automated alerts for failures

Spot restore tests: (Monthly)

• Restore random files or folders
• Verify data integrity
• Test restore speed
• Document results

Full system restore tests: (Quarterly)

• Restore complete systems to test environment
• Verify applications function
• Test data consistency
• Measure actual recovery time

Disaster recovery drill: (Annually)

• Simulate actual disaster scenario
• Execute full recovery procedures
• Involve all relevant staff
• Identify gaps and update plans

What to Document

For each test:

• Date and type of test
• What was tested
• Results (success/failure)
• Actual recovery time
• Issues discovered
• Corrective actions taken

This documentation supports HIPAA compliance and continuous improvement.

Disaster Recovery Planning

Backup is only part of the equation. You need a plan to actually recover.

Key Plan Components

1. Risk Assessment

• What disasters could occur?
• What’s the likelihood of each?
• What’s the impact of each?

2. Recovery Priorities

• Which systems are most critical?
• What order should they be restored?
• What can wait?

3. Recovery Procedures

• Step-by-step restoration instructions
• Who does what
• Contact information for key personnel
• Vendor contact information

4. Communication Plan

• How to notify staff
• How to notify patients
• How to handle media (if applicable)
• Status update procedures

5. Alternative Operations

• How to operate during recovery
• Paper-based procedures
• Alternative locations (if needed)
• Manual workarounds

Sample Priority Order

Typical recovery priority for medical practices:

1. Network infrastructure (everything else depends on it)
2. Phone systems (patients need to reach you)
3. EHR/EMR (clinical operations)
4. Practice management (scheduling, billing)
5. Email and communication
6. Workstations (can use shared/spare initially)
7. Secondary systems

Plan Maintenance

Plans go stale quickly:

• Review after any major system change
• Update contact information regularly
• Test procedures when updated
• Annual comprehensive review

Building Your Strategy

Step 1: Inventory Critical Systems

List everything that needs protection:

• Servers and their roles
• Applications and databases
• User data locations
• Cloud services
• Configuration files

Step 2: Define RTO and RPO

For each system, determine:

• Maximum acceptable downtime
• Maximum acceptable data loss
• Business impact of different scenarios

Step 3: Design Backup Architecture

Based on requirements:

• Local backup for fast recovery
• Cloud backup for off-site protection
• Frequency to meet RPO
• Retention to meet compliance

Step 4: Implement and Configure

• Deploy backup solutions
• Configure all data sources
• Set up monitoring and alerts
• Test initial backups

Step 5: Document Procedures

• Recovery procedures for each system
• Roles and responsibilities
• Contact information
• Alternative operations

Step 6: Test and Maintain

• Regular test restores
• Annual disaster recovery drill
• Plan updates for system changes
• Continuous monitoring

Common Mistakes to Avoid

”Set It and Forget It”

Backups need monitoring. Jobs fail. Storage fills up. Configurations drift. Without regular attention, you’ll discover problems when you need recovery most.

Backing Up the Wrong Things

Common misses:

• Application databases (just backing up files isn’t enough)
• Cloud data (assuming cloud providers back up for you)
• Workstation data (when users store data locally)
• Configuration files (system settings, not just data)

No Off-Site Copy

Local backups protect against hardware failure. They don’t protect against fire, flood, theft, or ransomware that reaches your backup server.

Untested Backups

A backup that’s never been tested is a hope, not a plan. Test regularly.

No Documented Procedures

When disaster strikes, stress is high and thinking is impaired. Documented, practiced procedures are essential.

Inadequate Retention

Ransomware can lurk for weeks before activating. If your backups only go back 7 days, you may not have a clean copy to restore.

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Is Your Backup Strategy Ready for the Worst?

At MedTech Consulting, we design backup and disaster recovery solutions specifically for medical practices—with HIPAA compliance, appropriate RTOs, and tested recovery procedures.

Contact us for a backup and recovery assessment.

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Related reading: Cloud Solutions for Medical Practices | Healthcare Cybersecurity | Managed IT Support