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Inside Dentistry
October 2015
Volume 11, Issue 10

Is It Time to Transition to the Cloud?

A look at the options for operating practice management systems

George H. Clayton, DDS

When tackling the topic of dental practice management software, the issue is no longer whether or not to utilize this technology—a vast majority of practices are taking advantage of its many benefits. For example, a 2010 survey of California oral health care professionals by the California Healthcare Foundation found that 93% of respondents use practice management software.1

The discussion in 2015 must therefore begin with whether to opt for a traditional client-server technology or employ web-based technology. Mark Hollis, chief executive officer of MacPractice Inc., recently estimated that only 2% of dental practices utilize a cloud solution.2 However, a study from Emergent Research and Intuit Inc. predicts the adoption of cloud computing among small businesses will grow from 37% to 80% by 2020.3 To help understand that trend, and whether is it right for dentistry, the benefits and shortcomings of both technologies will be discussed.

No one software program meets all the needs of every dentist. Before making a decision about which type of technology to use, it is important to identify what is important and necessary for your practice. While we are only addressing practice management software in this article, it is nevertheless imperative that you look ahead to see what your needs and desires will be if and when you move computers to the operatories.

Understanding the Options

There are many options available today, each with unique features and benefits. Lorne Lavine, DMD, a dental technology consultant, estimates that Dentrix from Henry Schein (, Eaglesoft from Patterson Dental (, and CS PracticeWorks and CS SoftDent from Carestream Dental ( account for at least 80% of the market.4 Dentrix, PracticeWorks and SoftDent have both a client-server and a web-based solution. Eaglesoft does not yet have a web-based solution, but it is likely they will follow suit in the near future. Smaller companies include Mogo ( and Curve Dental (; their footprint is likely growing due to their cloud solutions.

Client-Server Systems

Client-server systems have been the gold standard for many years. When set up and configured properly, they provide predictable results in everyday use and easy restoration of data in an emergency. With this technology, you will have computer hardware on site that will do the work of managing your system and data.

The key is to have the server placed in a well-ventilated, locked computer closet where it is secure from environmental hazards as well as a potential thief or disgruntled employee. Data on the server should be encrypted and backed up daily, ideally both on site and in the cloud. A competent dental technology consultant can easily set up these protocols. One of the weak links in the client-server system is that while most dentists are backing up their data daily, they are rarely testing the data. Don’t assume that your backup has all the files needed for a successful restoration—make sure it does.

While the initial costs of the client-server system can surpass $10,000 for the software, installation, and training, the monthly maintenance costs that include updates and unlimited support usually are in the $100 to $150 range.5

Cloud-Based Systems

Cloud-based systems eliminate the need for a server in the office. Your data is stored on multiple servers in secure operation centers. There is also no longer the need for a separate backup protocol. Instead, data is backed up in a continuous loop, meaning the backup stays current with every change you make. This is especially beneficial to offices practicing in multiple locations. Additionally, an office using a cloud-based system is always operating on the latest version of the software. There is no need to install time-consuming updates. While that all sounds pretty good, there are several issues to consider with cloud-based solutions.

Whenever you are dealing with a cloud environment, cyberattacks are a possibility. In the health care arena, data breaches have affected 11 million individuals with Premera Blue Cross health plans and 80 million employees and current and former customers of Anthem.6 Even though most cloud providers have sophisticated security in place, hackers continue to find ways to get around even the most stringent security. When they have difficulty hacking the cloud, they will then resort to hacking your account using various phishing schemes to dupe you and your employees.

Insider attacks are also a real threat to your practice. Cloud computing makes it easier for you to access your patient’s protected health care information while away from the office. However, it also makes it easier for your staff and a potentially disgruntled employee to access your practice software as well.

Connectivity is also an issue. It is imperative to have a high-speed Internet connection as well as a redundant Internet connection. The bandwidth is dependent on the amount of users, but most cloud computing software recommends 16 Mbps download and 3 Mbps upload and most recommend 4G for wireless devices.7-9 When selecting a redundant Internet connection, it is important to select an Internet service provider that is separate from your primary provider. It is best to choose a reliable technology such as a DSL or cable connection with adequate speed to support the minimum requirements already mentioned. It is also important to note that most routers will not come configured to support redundant Internet connections.10 Consult your IT professional to see what solution will work best for you. It is worth noting that this additional Internet connection will cost between $50 and $100 per month.

Despite the lower investment for initial start-up, costs for the web-based software can approach $400 per month for a subscription, significantly higher than the client-server model.

Finding Your Solution

There is little doubt that more dentists will migrate to the cloud in the future. Now that most practice management software offers both a client-server solution and a web-based solution, the transition to the cloud will be easier for practices because it will not be accompanied by the uncertainty associated with conversion to a new software system. The questions become how much risk do you perceive with each technology and where does your comfort level lie? The best advice is to seek the services of a dental technology consultant to keep the technology component of your practice up to date. Dentists don’t think twice about hiring an accountant to keep up with changes in the tax laws, but seem reluctant to hire someone to keep the ever-increasing technology component of their practice operating at peak performance.


1. California Healthcare Foundation. Health Information Technology in California Dental Practices: Survey Findings. California Healthcare Foundation website. Accessed August 19, 2015.

2. Hollis M. Don’t assume your practice management software can do anything. Dental Economics. 2015;105(5):36-37.

3. Intuit study shows how the cloud will transform small business by 2020 [press release]. Intuit Investor Relations website. Accessed August 19, 2015.

4. Lavine L. New practice, old technology—where to start. The Digital Dentist website. Accessed August 19, 2015.

5. Lavine L. Floating on the cloud. Inside Dentistry. 2015;11(spec iss 2):S18-S19.

6. Data breach tracker: all the major companies that have been hacked. Money website. Accessed August 19, 2015.

7. Hardware recommendations. Mogo website. Accessed August 19, 2015.

8. CS SoftDent Practice Management Software v16.1. Carestream Dental website. Accessed August 19, 2015.

9. CS PracticeWorks Practice Management Software v7.9.0 system requirements. Carestream Dental website. Accessed August 19, 2015.

10. Redundant Internet connections for SMBs. Infinitech Computer Consulting website. Accessed August 19, 2015.

About the Author

George H. Clayton, DDS
Assistant Clinical Professor
Vanderbilt University
School of Medicine
Nashville, Tennessee
Private Practice in Prosthodontics
Brentwood, Tennessee

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