Case Study: A US Clinic Strengthens Backup and Recovery With Encryption First
Healthcare teams do not have the luxury of downtime. If systems are down, appointments stall, billing stalls, and in some cases care delivery slows down. Even when patient safety is not directly at risk, operational disruption can ripple fast in a clinic environment.
This case study follows a US outpatient clinic group that modernized backup and disaster recovery with a focus on security, compliance readiness, and predictable recovery. Their leadership team was not asking for "more backup." They were asking for a clear answer to a hard question:
If we lose access to our data today, how quickly can we get back to seeing patients and billing correctly?
They also had a non negotiable security stance. Backups needed to be encrypted before data left their environment, not after. That requirement shaped every part of the design and made RedVault Systems Backup & Disaster Recovery a strong fit, because it encrypts data before it gets sent to Backblaze B2 storage.
Organization Profile and Environment
The client was a US clinic group with three locations and about 110 employees. They provided a mix of primary care and specialty services. Their data environment included:
- A practice management system with scheduling and billing functions
- An EHR environment where clinical documentation lived
- File shares for HR, operations, and patient facing forms
- A handful of on premises servers supporting internal apps, print services, and identity
They also relied on several SaaS tools, but the core workflows still depended on local infrastructure and data access.
Their IT team was small. They could manage day to day operations, but they did not have time for complicated backup babysitting. The solution had to work consistently without requiring constant manual intervention.
The Trigger: A Compliance Review and a Close Call
Two events pushed the clinic to invest in a stronger recovery posture.
First, they had a compliance focused review that surfaced gaps. Nothing catastrophic, but leadership saw that their backup documentation was thin. They could say they had backups, but they could not clearly demonstrate tested recovery steps, defined RTO and RPO, or consistent encryption posture across all backup data.
Second, they experienced a server failure that took a key internal service offline. It was restored, but the downtime exposed how fragile their workflows could be. Clinic managers had to switch to manual processes, and billing teams lost time.
Leadership decided they wanted a clinic grade backup and disaster recovery plan. That meant security, clear recovery targets, and documented evidence of readiness.
Goals and Recovery Targets
The clinic group defined success in four clear goals.
Encryption first for backup data
They wanted backups encrypted before leaving their environment, so the backup data itself was protected even if storage access was compromised.
Documented recovery plan
They wanted a written, repeatable process that IT and operations could follow during an incident.
Measurable recovery targets
They set practical RTO and RPO targets for core systems, with priority given to scheduling, billing, and EHR access workflows.
Routine restore testing
They wanted regular restore testing so they could be confident backups would actually work in a real incident.
Because their environment included PHI, the clinic also cared about audit readiness and access control. They wanted role based access and strong separation of backup admin access from day to day accounts.
They chose a model aligned with RedVault Systems cloud storage because it supported an encryption first posture while also supporting a straightforward recovery design.
The Implementation Approach
The rollout was designed to avoid disrupting patient care and clinic operations.
Step 1: Map Critical Workflows
Instead of starting with servers, the team started with workflows.
- What do we need working to see patients?
- What do we need working to bill accurately?
- What do we need working to access clinical documentation?
They identified the systems and data sets behind those workflows and grouped them into tiers.
- Tier 1 included the EHR database components, scheduling and billing functions, and authentication services.
- Tier 2 included file shares used for operations, HR, and clinic forms.
- Tier 3 included archives and older administrative data.
This tier model helped leadership understand what would be restored first during an incident and why.
Step 2: Create a Backup Schedule That Matches Risk
Tier 1 systems were backed up with a schedule designed to meet RPO requirements. Tier 2 data had a steady schedule that supported day to day recovery requests. Tier 3 had long retention but less frequent restore points.
They avoided backing up everything at maximum frequency. That sounds "safe" in theory, but it often creates backup jobs that fail or become too slow. Reliability matters more than brute force.
Step 3: Enforce Encryption Before Storage
Backups were encrypted before being sent to Backblaze B2 storage. That was the leadership requirement, and it became a key part of their risk posture.
The clinic's compliance team liked that the backup data was protected at the source, not just at the destination.
This also simplified vendor and risk discussions. Instead of debating whether storage encryption was enough, the clinic could point to encryption before transit and storage.
Step 4: Build the Disaster Recovery Runbook
The clinic built a short, practical runbook. It was written so a stressed person could follow it.
It included:
- Incident triggers and who to contact
- Containment steps for suspected ransomware or unusual activity
- Restore priorities by tier
- How to select restore points
- Validation steps for clinical and billing teams
- Communication checkpoints for clinic managers
The runbook also included an "if scheduling is down" manual workflow checklist, so clinic staff could maintain basic operations while IT restored systems.
This is an often missed point. DR is not only technical. It is operational.
Step 5: Test Restores
They ran restore tests before the project was considered complete.
- A file level restore of a folder used daily
- A system level restore simulation for a critical service
- A validation drill where billing staff confirmed data integrity
These tests revealed two small issues early and allowed the team to fix them before a real incident happened.
If you want the same kind of baseline for your environment, the setup behind RedVault Systems Backup & Disaster Recovery supports that exact style of readiness: secure backups and recovery discipline.
The Incident: A Ransomware Scare That Became a Real Test
About three months after rollout, the clinic experienced a ransomware scare.
An endpoint detection alert flagged suspicious activity tied to a user account. The pattern looked like mass file modification attempts and unusual access to network shares. The clinic had learned that waiting is a mistake, so the IT team treated it seriously.
They immediately:
- Isolated the impacted workstation from the network
- Disabled the suspicious user account
- Reviewed access logs for lateral movement
- Restricted access to a subset of shares while the investigation continued
The clinic did not shut down operations immediately, but they did take decisive steps to prevent spread.
Confirming Impact
The investigation showed that some operational file shares were impacted. A small number of documents were modified and became unreadable. It did not appear that the EHR core database was encrypted, but there was enough risk that the clinic decided to restore the affected file shares from a clean restore point.
The goal was not just "get files back." It was "restore trust in the data."
Recovery Plan Execution
Because the team had tiers, they did not panic restore everything.
- They restored what was impacted first.
- They selected a restore point from the previous evening, before suspicious activity began.
- They performed a targeted restore of the impacted folders.
- They validated restored files with operational staff.
- They reopened access after validation.
Total time to restore impacted operational data was under four hours.
During that time, clinic managers used the manual workflow checklist for a small set of processes. Appointments continued. Staff had to do some extra steps, but the clinic avoided a full stop.
The clinic leadership team was impressed because there was no confusion. The IT team had a plan. Operations understood what to do. Communication was consistent.
This is what disaster recovery should feel like. Controlled, not chaotic.
What Made the Difference
Three factors shaped the successful outcome.
Restore practice
Because they had already tested restores, the IT team knew the steps and the timelines. They were not guessing.
Clear RTO and RPO alignment
Leadership knew what was realistic. They had agreed on targets beforehand. That prevented pressure to do impossible things and allowed the team to focus on a clean recovery.
Encryption first posture
Even though this incident was primarily about file shares, leadership's comfort level came from knowing backups were protected before storage.
In healthcare, confidence matters. When leadership lacks confidence, they make reactive decisions. When they have confidence, they support disciplined execution.
The clinic's compliance lead also appreciated that the incident response and restore steps were documented, which supported audit readiness.
Outcomes and Business Impact
The clinic group saw measurable improvements after the project.
- They maintained operations during an incident without major appointment cancellations.
- They restored impacted data quickly and confidently.
- They reduced downtime risk for scheduling and billing workflows.
- They improved audit readiness through documentation and test evidence.
- They strengthened security posture by ensuring encrypted backups.
The less measurable win was trust. Clinicians and managers stopped seeing IT as a mysterious black box. They saw it as a reliable partner with a plan.
Lessons Learned
This case study highlights lessons that apply to many US clinics.
- Backup must be designed around clinical operations, not just server lists.
- RTO and RPO targets should be agreed with leadership, not invented during an incident.
- Encryption should be enforced before data leaves your environment, especially for backup data containing PHI.
- Restore testing is essential. You do not want your first restore to be during a crisis.
- DR runbooks should include operational steps for staff, not just technical steps for IT.
The clinic also chose to schedule quarterly restore drills and annual full tabletop exercises. They kept these simple and realistic. The goal was readiness, not drama.
References
- General HIPAA Security Rule concepts and administrative safeguards guidance (general reference)
- NIST contingency planning and incident response concepts used in healthcare continuity planning (general reference)
- Common US healthcare ransomware readiness best practices (general reference)