Floating on the Cloud
New technology and software present varied options for dental offices
Lorne Lavine, DMD
Every dentist knows that the technology landscape of the dental office has changed dramatically in the past decade. It’s impossible to pick up a dental journal without seeing editorial and ads about high-tech systems such as CAD/CAM, digital impressions, and cone-beam 3D imaging. Another area where there appears to be a paradigm shift for many practices is practice management software. While these software systems have been using an older client-server model for many years, newer web-based systems (often referred to as cloud-based) have started to gain popularity. This article will explore the different options available to dentists and discuss the pros and cons of each.
Out With the Old?
While some newer companies may not even consider it an option, client-server software—that is, software that you physically install on your computers—is still the most popular format for dental practice management systems. This type of system has been in place for more than 40 years, ever since dentists introduced computers into their practices in the 1970s. While software used to be delivered on floppy discs and CD-ROMs, most vendors today have their customers download both the core program and software updates directly from a company website. These systems are very stable and offer dental offices a long, successful track record. Many of the companies selling this type of software have been in business for decades and have support systems in place should customers need them. The monthly maintenance fees for these systems is usually very reasonable—around $100 to $150 per month, which includes updates to the software and unlimited technical support.
Of course, there are reasons why this model may not be ideal for everyone. While the monthly maintenance fees for these systems are typically low, upfront costs can easily top $10,000 once you add in the cost of the software, installation, and training. Computers have become increasingly complex and there are literally millions of combinations of processors, video cards, printers, memory chips, and other components, all of which must be compatible with the software to prevent ongoing problems. Another common issue is that many offices are reluctant to upgrade their software with the annual patches they receive from the software vendors, as they had negative experiences doing this in the past and would prefer to avoid a repeat of that scenario.
Another challenging area for offices using client-server software is the need for HIPAA compliance. While the HIPAA rules were first proposed in 1996, it’s only been in the last few years—since the implementation of the HITECH rules in 2009 and the Omnibus rules in 2013—that dentists have realized how critical it is to be HIPAA compliant. The fact is that compliance is more challenging for offices using client-server software. While the databases really should be encrypted, few vendors offer this as an option. Many of them do not allow dentists to send secure emails directly from the software to referring dentists, and many of the HIPAA rules regarding encryption and disaster recovery can be difficult for practices that don’t have adequate IT support.
In With the New?
About 20 years ago, software vendors began to see some of the frustrations and limitations of the client-server model and looked to different delivery system: web-based software. Today, many of us use the web to manage our daily lives, but this level of personal dependence wasn’t a viable option when the Internet was first introduced. This is because there simply wasn’t enough bandwith. Dental offices didn’t have access high speed broadband Internet, and trying to run software over a dial-up connection was an exercise in frustration.
Of course, things are different today. Bandwidth for the majority of the country isn’t a concern, and using the web on a daily basis is the norm rather than the exception. A number of software vendors have developed web-based dental practice management software systems over the past decade, and more are being introduced all the time.
There are numerous benefits to this approach. Unlike the client-server model, updates are done on the software company’s servers, not manually handled by the practice. You would always have the latest version and would be notified of the update when you log into the software. As long as you have an Internet connection, you have easy, 24/7/365 access to your data. Since there is no data on the server, you don’t have to deal with backup, although you will need to backup non-practice management software data, including QuickBooks, Invisalign, and internal spreadsheets. As you use a web browser to access the data, you can use older, less powerful computers and may not need a dedicated server. Many of these Internet-based companies use a subscription model, meaning you pay a fixed monthly fee for everything, so start-up costs are quite low. Web-based software is significantly easier for practices that have multiple locations, as remote access wouldn’t be necessary with software that is web-based. And, HIPAA compliance is much, much easier when you don’t physically store the data in your office.
While there are certainly many advantages to this cloud-based model, there are also a few concerns for many dentists. As mentioned above, it requires always-on Internet service to function. You could supplement your main Internet service with a backup connection like DSL, or even tethering a smartphone to the computer, but this is not ideal. Additionally, while web-based software systems have much lower start-up costs, the monthly subscription fees can often top $400 per month, well above what you would pay with a client-server software. Many of these companies are also very new, which presents two concerns to dentists: the software may not be as fully developed as a long-established client-server software, and dentists may not have confidence that the company will be around a long time to continue to develop and support the program.
There are certainly many good options for dentists today when it comes to choosing their practice management data. The author’s best recommendation is to evaluate the different systems out there, look at the pros and cons of the different programs and the software models, and decide what is the best option for your specific practice.
About the Author
Lorne Lavine, DMD, is president of The Digital Dentist, a company that offers HIPAA, data, and IT solutions for dental practices. More information is available at https://thedigitaldentist.com.