Note: Other than the "MDS Software Change After Change of Ownership" section at the end of this document added 2-11-2004, all of the following information is from the 11-28-2003 numbered letter: NH #2003-036 entitled Backup For Local MDS Data.
The following information is important for nursing home administrators and staff responsible to back up and protect Minimum Data Set (MDS) data. If you have questions regarding any of the following or have suggestions of best practices, please contact Judy Bennett, MDS Automation Coordinator, (360) 725-2620 or judy.bennett@dshs.wa.gov.
Introduction - Centers for Medicare and Medicaid Services (CMS) has requested that the states remind administrators of their responsibility to assure that their local MDS data is backed up. This is part of assuring that medical records are safe. A number of unexpected problems can occur with electronic data, both MDS and other records: A hard drive may fail or a computer may be stolen. Files can be mistakenly overwritten or deleted. A natural disaster such as fire, flood, or earthquake may damage software/hardware. CMS expects administrators to make sure that staff regularly back up data.
Backup Data - It is the responsibility of nursing homes to have a regular backup plan for all local assessment data. For the MDS long term care facility database, the main database file is called mds.mdb. In addition to this file, backup the export.mdb, and any archive databases that might have been created. The default archive DB is titled mdsarch.mdb. There may be others that have been created, which you can identify by looking in the archive setup menu. It is also nice to have a backup of all the transmission files that have been created/sent in the past so that if you lose your mds.mdb backup you can import these file to rebuild the database. Export.mdb will give you the paths to these file as the export.mdb is simply a database of previous export file paths.
National Repository - Nursing homes cannot depend on the national repository to restore lost files because 1) the national repository doesn't contain all the same data as the state does, due to state specific requirements* and 2) the data is stored in a different manner at the national repository than at the local level. CMS contractors will attempt to restore data, but it cannot always be done. The outcome can be very disappointing, as it is difficult and many times impossible to restore this sort of information from the national repository.
Media - Use a reliable media such as ZIP drive, tape drive, CD writer, or FTP off-site storage . MDS Software or other mechanisms that create an automatic backup on the user's hard drive is helpful, but is not a substitute for a comprehensive backup strategy. Do not just back up to another location on your computer hard drive, as your data will still be lost if the hard drive 'crashes'.
Software - Backup can be accomplished through a variety of software programs and your MDS software vendor may be prepared to assist you. Also, MS Windows, which you likely already own, includes a backup program, MS Backup. Clicking 'Start', 'Programs', 'Accessories', 'System tools', and 'Backup' can find MS backup. MS Backup includes online instructions.
Unique File Name - When submitting a MDS file, do not write over the previous file, because then you have lost the previous assessment. Always create a unique name for each MDS file submission.
Restore - If you ever need to restore data, be sure to restore files in the same order as submitted.
IT Policies/Practices - Nursing homes determine their own information technology policies and practices, with the advise/assistance of their information technology staff and/or software vendor. It is the responsibility of administrators to be sure a set of policies are in place and adhered to. The following is offered as a few examples of some desirable policies and practices:
File Naming Conventions - Develop a naming convention that will make it easy to identify files over a long period of time and train staff to use it. For instance, you may want to list Year, Month, Day, # for the day (in the case of multiple submissions in a day), and the initials of your home/facility. Always create a unique name for each MDS file submission.
Backup Schedule - Institute a regular procedure of backing up the MDS database nightly to another computer via a secure network or a reliable portable media devise such as ZIP drive, Tape Backup, or CD Writer. S tore the dated backup in a secure remote location, multiple locations if possible. It is a typical practice to back up data nightly on an incremental basis and to conduct a total replacement backup on a weekly basis that is stored off-site.
If Moving Equipment - Include a procedure to create a retrievable copy of data before moving equipment.
Periodically Test Backups - Retrieve backed up data to be sure the data is not corrupted and that the mechanism used to conduct backup is, in fact, really backing up data, rather than empty files. If you use tape backup, rotate tapes.
Back Up People Too - If you have a computer network and only one staff person with administrator access, that person needs a backup. Consider the alternative if that person 'disappears' - you could lose just about everything. Some businesses lock the administrator password in a safe.
Develop off-site standards and utilize off-site storage for copies of essential records - Off-site storage minimizes the chance for total destruction of records, since the possibility that a disaster will strike in a different geographic area with the same severity is small.
Stick to a Schedule - If you don't have consistency, you don't really have backup. Set a schedule and stick to it. Consider automation of backup.
MDS Software Change After Change of Ownership - When Nursing homes are sold, the new organization may change the MDS software utilized and/or the old organization may remove computers as they leave. With new software installed and/or old hardware removed, staff are sometimes in a quandary when they need to modify or inactivate a given assessment because they cannot access data input during the previous ownership.
CMS requires that nursing homes retain the ability to correct data previously submitted for residents who have been transitioned from the old ownership to the new ownership as needed. This means that the old and new owners must work together to make sure this is possible. Following are three methods that can be used to access old data so that it can be modified/inactivated and transmitted:
- Make a backup of the data from the old software and import it into the new software so that all the previous MDS records are available. Having everything in one place is the easiest for staff who work with the MDS. (Some software, however, is not amenable to this solution for a variety of reasons.) OR
- Retain a computer that has the old MDS software installed with connectivity to allow transmittal. If an assessment from the previous ownership time period needs modification or inactivation, you can do so from the old environment. OR
- Install the free MDS RAVEN software produced by CMS/IFMC. Make a backup of the data used with the old software and import it into RAVEN. Retain the old assessment data and complete any needed modifications or in-activations based on the old data from within RAVEN.
* These sections include Section S, Section U, and option '2' in the SUB_REQ field. The State of Washington does not currently use Section S, U or option '2' for the SUB_REQ field.