“Hey You, (Don’t) Get Off of My Cloud”

Paul Feuerstein, DMD


The backbone of any dental prac­tice is the management system. In its infancy, it merely replaced billing systems and the appointment book. As the systems became more complex and computing evolved, most practices assembled a robust network with full office connectivity and a central depot for information and network control called the server. These servers are the heart of the system and have to be constantly maintained and monitored, much like a patient in the ICU. As new updates are received from practice management software companies, they have to be in­stalled on the server and perhaps at each workstation. Many practices receive disks or email instructions for the download and ignore them for several reasons. One is the fear that an update will shut the system down or just make changes in some processes that users might not understand immediately. Of course, software companies do their best to ensure that their updates are workable, but as we all know, there might be some odd feature that a practice has in its network substructure. Some practices wait until others upgrade and await reports that all is well. Usually this means months of running an older system and forgetting to do the update altogether. Unfortunately, this philosophy fails when there is a call to a support hotline, and you are asked when you applied the latest update.
Practice networks are also connected to the In­ternet, and connections must be carefully monitored to prevent attacks from outside sources. If (or when) employees decide to “wander” in cyberspace, malware could be introduced into the network. We have all seen even the most complex corporate networks being vulnerable; data can be corrupted or even hijacked without the practice knowing it. There have to be safeguards in place.
As far as backing up data is concerned, in this day of HIPAA, the server and all backups should be encrypted, especially those taken off premises. This is a task that many practices ignore. Backups are often created by copying data to flash drives, external hard drives, DVD media, and even laptops, and these items are of­ten taken home. Many are soon returned to the practice, meaning that there are none off site, which would be tragic in case of a fire or other catastrophe. Your priority, should a catastrophe strike, should be to immediately exit the office, not look through cabinet drawers to grab the latest backup.
Also, backup storage devices could be lost or stolen, and if the information they contain is not encrypted, it becomes freely available to the new owner, and your liability could be staggering. Thankfully, there are many online backup systems available to a practice, and most maintain a copy of your data. But if there is a server failure or a catastrophe, if you get the data back from an on­line backup system, it is useless without the software programs themselves. This means you will have to reinstall the programs, but how? From the old disks you had when you started? But as you know, there have been several updates since then, and you will be spending potentially hours upon hours with tech support to get you up and running.
An online backup storage system is rarely an “image” of your hard drive, comprising all of the drive’s programs and data. Astute practices usually have virtual hard drives on the Internet such as VMware (vmware.com), but the average dentist is not always savvy enough to manage this; you need a professional information technology (IT) person/company. (And it cannot be your friend or cousin claiming to be an expert, willing to assist you in his or her spare time.)
There are many remote monitoring/backup services—some doing everything remotely; others utilizing an additional local monitor to complement the remote monitoring. Examples I have seen at trade shows are Lorne Lavine’s The Practice Byte Guard (thedigital­dentist.com) and DDSRescue, offered by Patterson Dental. And there are many well-respected local and national IT companies specializing in dental practices that not only handle this task but can also help with integration of all the cutting-edge digital products that I discuss in this column.
And yet another solution is appearing in dentistry and practically all other industries—the mysterious “cloud,” which is merely an Internet-based server. Using this protocol, all data, backups, updates, security, and more are handled remotely. A practice merely needs workstations that have Internet access and typically a browser or some software locally installed that in­cludes tablets and even smartphones. And after installation, data transfer, and initializing the practice data, these systems are affordable and usually based on a monthly service fee. However, many practitioners have concerns about Internet reliability, losing control of information, and the security of data if, for example, the service provider goes out of business. I shared these concerns with Andy Jensen, who has been working with practice management systems for years and currently is a principle in Curve Dental, a cloud-based system. In response, Andy stated, “The same thing happens to the practice when the Internet goes down as when the server goes down. The difference is this: the practice can hotspot a smartphone and have access to its schedule and treatment plans until connectivity is restored.
“The bigger question to ask is how often does the Internet really go down? For some practices, their server may crash much more frequently. It really is not that big of a deal for the vast majority of practices out there. We also recommend that a practice work with a good IT service to make sure the practice chooses a reliable Internet service pro­vider.”
And as far as data security is concerned, Andy’s company and the other companies are quite secure and will stay in business as long as there are the required numbers of customers paying the monthly fee. Also, companies allow practices to download its data at any time; the data always belongs to the user. If there is concern, this can be done on a regular basis, although it would defeat the whole idea of the cloud-based system. Today, we are seeing an increasing number of cloud-based systems. Some are new versions of existing systems such as Dentrix Ascend and Carestream Cloud; others are ICE, planet DDS, and Dentisoft; while others such as Eaglesoft and XLDent are in the wings.
I have only touched the surface here, and if nothing else, I advise you to take a closer look at your current systems.