Healthcare overspends on long term backup retention

There is a dramatic range of perspective on how long hospitals should keep their backups: some keep theirs for 30 days while others keep their backups forever. Many assume the long retention is due to regulatory requirements, but that is not actually the case. Retention times longer than needed have significant cost implications and lead to capital spending 50-70% higher than necessary. At a time when hospitals are concerned with optimization and cost reduction across the board, this is a topic that merits further exploration and inspection.

Based on research to date and a review of all relevant regulations, we find:

  • There is no additional value in backups older than 90 days.
  • Significant savings can be achieved through reduced backup retention of 60-90 days.
  • Longer backup retention times impose unnecessary capital costs by as much as 70% and hinder migration to more cost-effective architectures.
  • Email retention can be greatly shortened to reduce liability and cost through set policy.

Let's explore these points in more details.

What are the relevant regulations?

HIPAA mandates that Covered Entities and Business Associates have backup and recovery procedures for Patient Health Information (PHI) to avoid loss of data. Nothing regarding duration is specified (CFR 164.306, CFR 164.308). State regulations govern how long PHI must be retained, usually ranging from six to 25 years, sometimes longer.

The retention regulations refer to the PHI records themselves, not the backups thereof. This is an important distinction and a source of confusion and debate. In the absence of deeper understanding, hospitals often opt for long term backup retention, which has significant cost implications without commensurate value.

How do we translate applicable regulations into policy?

There are actually two policies at play: PHI retention and Backup retention. PHI retention should be the responsibility of data governance and/or application data owners. Backup retention is IT policy that governs the recoverability of systems and data.

I have yet to encounter a hospital that actively purges PHI when permitted by regulations. There’s good reason not to: older records still have value as part of analytics datasets but only if they are present in live systems. If PHI is never purged, records in backups from one year ago will also be present in backups from last night. So, what value exists in the backups from one year ago, or even six months ago?

Keeping backups long term increases the capital requirements, complexity of data protection systems, and limits hospitals’ abilities to transition to new data protection architectures that offer a lower TCO, all without mitigating additional risk or adding additional value.

What is the right backup retention period for hospital systems?

Most agree that the right answer is 60-90 days. Thirty days may expose some risk from undesirable system changes that require going further back at the system (if not the data) level; examples given include changes that later caused a boot error. Beyond 90 days, it’s very difficult to identify scenarios where the data or systems would be valuable.

What about legacy applications?

Most hospitals have a list of legacy applications that contain older PHI that was not imported into the current primary EMR system or other replacement application. The applications exist purely for reference purposes, and they often have other challenges such as legacy operating systems and lack of support, which increases risk.

For PHI that only exists in legacy systems, we have only two choices: keep those aging apps in service or migrate those records to a more modern platform that replicates the interfaces and data structures. Hospitals that have pursued this path have been very successful reducing risk by decommissioning legacy applications, using solutions from Harmony, Mediquant, CITI, and Legacy Data Access.

What about email?

Hospitals have a great deal of freedom to define their email policies. Most agree that PHI should not be in email and actively prevent it by policy and process. Without PHI in email, each hospital can define whatever email retention policy they wish.

Most hospitals do not restrict how long emails can be retained, though many do restrict the ultimate size of user mailboxes. There is a trend, however, often led by legal to reduce the history of email. It is often phased in gradually: one year they will cut off the email history at ten years, then to eight or six and so on.

It takes a great deal of collaboration and unity among senior leaders to effect such changes, but the objectives align the interests of legal, finance, and IT. Legal reduces discoverable information; finance reduces cost and risk; and IT reduces the complexity and weight of infrastructure.

The shortest email history I have encountered is two years at a Detroit health system: once an item in a user mailbox reaches two years old, it is actively removed from the system by policy. They also only keep their backups for 30 days. They are the leanest healthcare data protection architecture I have yet encountered.

Closing thoughts

It is fascinating that hospitals serving the same customer needs bound by vastly similar regulatory requirements come to such different conclusions about backup retention. That should be a signal that there is real optimization potential both with PHI and email.

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