Dental office backups: how to know a restore will actually work

Having backups is not the same as knowing they will bring the practice software, X-rays and documents back after a server failure or ransomware. This guide covers what to back up, how to test a restore, and how to keep one copy out of an attacker's reach.

What a dental office needs to back up

• The practice management database. Your schedule, charts, treatment plans, ledgers and insurance claims usually live in a database on the server. A plain file copy of a database that is open can be unusable, so back it up with a method your software vendor supports.
• Imaging. X-rays, intraoral photos and scans are often the largest set of files in the office. They are sometimes stored in a different folder, or on a different machine, from the practice software.
• Documents. Scanned forms, signed consents, letters, spreadsheets and anything staff save to the server or their desktops.
• What you need to rebuild. Software installers, license keys, vendor support contacts, server settings and a network diagram. CISA recommends storing software and license agreements with your offline backups, and keeping offline backups and paper copies of network diagrams and asset lists.

Ask your practice software and imaging vendors where each program keeps its data and how they recommend backing it up. Then confirm your backup actually includes every one of those locations.

A backup you have never restored is a guess

Backup software reports success when it has copied files. It does not tell you whether the office could run from those files. The #StopRansomware Guide from CISA tells organizations to test backup procedures on a regular basis, and to test that backups are available and intact in a disaster recovery scenario.

A test restore in a dental office looks like this:

1. Pick a recent backup of the practice management database and the imaging data.
2. Restore it to a spare PC or a test machine. Never restore over the live server.
3. Open the practice software against the restored copy. Look up a patient seen yesterday, open the chart and open an X-ray.
4. Time the whole restore. That is roughly how long the office would wait in a real outage.
5. Write down the date, what you restored, how long it took and anything that failed.

Run a test after any server change, software upgrade or switch to a new backup product. Otherwise pick a schedule, such as once a quarter, and stick to it. Keep the written results. They are the only proof you have that the backups work.

Keep a copy that ransomware cannot reach

CISA warns that many ransomware variants look for backups they can reach and delete or encrypt them, so the victim has no way to restore without paying. Its guide recommends offline, encrypted backups of critical data. A backup drive that stays plugged into the server, or a network share that every office login can write to, can be encrypted along with everything else.

• An offline copy. A drive or other media that is disconnected after each backup and kept away from the server.
• Immutable cloud storage. CISA notes that some cloud vendors offer immutable storage that protects stored data, and recommends turning on delete protection or object lock, plus versioning, where the storage supports it. CISA also cautions that immutable storage does not meet the compliance criteria of certain regulations and that a misconfiguration can be expensive, so check the setup with your compliance adviser.
• A separate login. The account that manages backups should not be one staff use every day, and it should not be the same password as the server.

Encrypt every copy that leaves the office. A lost backup drive holds the same patient records as the server.

Decide the restore order before you need it

CISA’s guide says to rebuild systems in order of the services that matter most, to restore data from offline, encrypted backups, and to take care not to reinfect clean systems during recovery. For a dental office, decide now which machine comes back first, which PCs the front desk needs to check patients in, and when the operatories come back.

CISA also recommends keeping up-to-date “golden images”, which are ready-made system images that can rebuild a server quickly. It notes that some images will not install on different hardware, and suggests keeping spare hardware or replacing out-of-date hardware that would get in the way of a restore.

Write the plan down. CISA recommends keeping a paper copy and an offline copy of your incident response plan, because the server holding the plan may be the one that is down.

Questions to ask your current IT provider

• When did you last restore our practice database to a test machine, and can I see the notes?
• Where is the offline or immutable copy kept, and who can delete it?
• Do the backups include imaging and scanned documents, and from which folders?
• How long would a full restore of the server take?
• Who is told when a backup fails, and how quickly do they look at it?

Where we come in

Backups and monitoring are part of our IT maintenance and support plan. If you are not sure your last backup would restore, start with a free on-site assessment.