The pros and cons of the cloud: What every dentist needs to know

Dental Products ReportDental Products Report July 2019
Volume 53
Issue 7

We spoke to experts about what practices should consider when choosing where to keep their data.

The cloud was once a concept used to help people understand where their information was going when it wasn’t stored locally. Now, it’s a pervasive entity, hovering around all of us, our data and our technology-and that includes your dental practice.

Every practice must choose at some point whether to host its data “on premises” or “in the cloud.” Like everything in life, there are pros and cons. We spoke to three experts on dental software programs about what they see as potential benefits and drawbacks of cloud-based software, what practices benefit most from it, and when is the time to make your move to the ubiquitous, if not mysterious, cloud.

Adam McDaniel, director of product management for Henry Schein, says there are many considerations for whether an on-premises or cloud-based practice management software solution works best for you, which he breaks down into three parts.

The first in McDaniel’s breakdown is to choose a computing platform (i.e., mobile devices in the operatories or desktop systems throughout the practice). Also, choose an operating system (i.e., Mac or PC). Either has implications for an on-premises-hosting or cloud-hosting solution.

The second part of the decision-making process involves how to deliver your desired patient experience.

“Your hardware is also an aspect of your patient experience,” McDaniel explains.

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For example, hardware systems in the operatory could result in the team member with his or her back to the patient while taking information. With mobile devices, the team member could be facing the patient, which would be a better representation of the experience you want.

The third part of McDaniel’s breakdown is the IT support you envision. Do you want to have someone on site to manage all the servers and equipment or rely on an outsourcing option? Many cloud-based software solutions don’t require as much on-site IT support.

The pros of the cloud                                         

Pro No. 1: Less on-site IT expertise required

Brant Herman, CEO of MouthWatch, says a benefit of the cloud is outsourcing or simplifying the IT requirements for a practice. Cloud solutions don’t require servers and as complex a networking setup or all the required maintenance.

“I’ve been in plenty of practices where you’re sharing drives from the server and the server gets pretty outdated, and you’re always trying to figure out what that issue might be,” Herman says. “Bundled turnkey IT is pretty helpful.”

While many cloud-based companies use the reduced need for IT expertise or staff as a selling point, McDaniel says this part is only one consideration for the whole decision-making process.

“There’s a lot of benefits to working in the cloud, and reduced need for IT is definitely one of those benefits, but it shouldn’t be the sole contributor of the decision,” McDaniel says.

McDaniel says IT expenses adjust with a cloud-based solution, or at least shift them. Practices will spend less on servers and more on networking, internet service providers and internet redundancies.

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Mike Uretz, executive director of Dental Group Partners and founder and editorial director of, advises many emerging group practices and DSOs that are looking for new software. Uretz has been involved with the growth of cloud-based software technology for more than a decade. The cloud discussion is a regular part of his evaluations and a topic he’s discussing and exploring daily.

Uretz agrees cloud-based software doesn’t need much IT support from the practice end but also reminds dental practices behind the scenes, a good data center staff that hosts the cloud application will keep the software “tuned” to provide optimal performance. Systems change over time and need tweaks to stay efficient.

“It’s like a car. You have to tune it up over time to keep it running efficiently,” Uretz says.

Pro No. 2: Your data is safer when managed by professionals

Encrypted HIPAA-compliant databases that are professionally managed by expert staff at the cloud data center are critical. Having and securing your patient data is vital. However, some practices still believe patient and practice data is more secure on premises than it is on the cloud.

Uretz says that’s more of a myth. If your on-site system has an internet connection, there’s a possibility hackers can get in, he says. With a professionally managed data center that hosts cloud solutions, there’s always a possibility of a breach, but there’s probably less of a chance because of the amount of resources devoted to security 24/7.

“If the practice has their software on-site on local servers, it typically is still going to have some pipe to get to the information. It’s not necessarily secure,” Uretz says. 

Ransomware is when software blocks access to your data until you pay a specified sum to free it. McDaniel is aware of ransomware attacks that have happened to dental offices he knows. Also, there are thefts and compromises to the networks or security measures.

Related reading: How to protect your practice from ransomware

“Your practice data is a lot more vulnerable in your practice than you probably believe or want to believe,” McDaniel says.

McDaniel says it isn’t because doctors are careless with the data. The difficulty with protecting data comes from not having the proper skill set. McDaniel says it isn’t practical to have an IT person on site with the expertise and the knowledge the cloud-based platforms provide.

“You don’t have a full-time security person who meets and collaborates with the CIA and the FBI on cyber terrorism and theft. You don’t have people who run databases and systems for tens of thousands of customers doing millions of transactions a year,” McDaniel says. “We hire those types of experts in the industry and bring them in to focus on securing and keeping your data private.”

It also isn’t practical to expect to become an expert in these areas yourself. McDaniel says a dentist’s No. 1 job is patient care, not Payment Card Industry (PCI) compliance for financial transactions and Red Flag Rules for data privacy, and then HIPAA on top of that. While moving to the cloud doesn’t absolve the practice of all responsibility in these areas, it does take much of the burden off the dentist.

“Moving to the cloud, you’ve added a team of people who work with you to help your practice be more productive and more secure,” McDaniel says.

Related reading: 8 ways to keep your practice HIPAA-compliant

Practices get more support and help by moving to the cloud.  With on-premises solutions, the practice must secure and backup the data as well as create redundancies. Also, don’t forget HIPAA regulations.  With cloud computing, McDaniel says, you get trained security professionals who specialize in HIPAA and data security.

“Now, that doesn’t put the burden completely on the software company, but it does mean you have trained security professionals whose job is to make sure that data is secure and managed securely,” McDaniel says.

“Conversely, if you have your own computer, I doubt very much you’re going to have an expensive expert checking all security breaches,” Uretz says. “In effect, you’re more secure with the data center because they’re responsible for a lot of clients and responsible for HIPAA liability.”

HIPAA liability is critical. In the event of a data breach, you’re not solely liable. If you handle HIPAA compliance internally, that’s not the case, Uretz says.

“So, from the standpoint of liability and security, you have more coverage with the cloud,” Uretz says.

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Pro No. 3: Easier updates, fewer conflicts and errors

Herman says cloud-based deployments allow for easier or faster upgrades, so no downloads or CDs. Also, a practice doesn’t have to determine how to update the software across multiple locations.

With cloud solutions, the provider can push an update, and the practice is using it the next day. McDaniel says developers like cloud computing because of the easier updates.

“One of the great benefits from a software development point of view on our side, the companies who build practice management, is we can roll out software updates more frequently and without our users’ help to update those computers with on-premises software,” McDaniel says.

Another benefit of a cloud-based solution is you have fewer programs installed on your hardware because you’re using a web browser. McDaniel says it creates fewer opportunities for errors and conflicts.

“With an on-premises solution, you are installing things, so you could have driver conflicts, or you could have a Windows security update that conflicts with your latest version. You could need Flash or other tools to make your on-premises software work with cloud software,” McDaniel explains.

Related reading: 4 steps to take after suffering a data breach

Moreover, Uretz says the connected world we live in is more attuned to connecting apps in the cloud. From analytics to patient education to customer engagement, the cloud facilitates interconnectivity of the “best-of-breed” applications.

“These are all third-party apps, just like different apps on your mobile device. The most efficient way to tie these together so they can talk to each other is in the cloud. The technology in the cloud is designed so different applications can pass information back and forth,” Uretz says.

Practices are typically much more limited trying to get third-party apps to interface with their office-based client server system.

“Being in the cloud gives you much more opportunity and flexibility for where things are going in the future and how information is going to be used,” Uretz says.

Pro No. 4: Anytime, anywhere access for productivity and collaboration

Finally, cloud-based solutions allow the dentist to work more easily offsite. Uretz appreciates that the cloud enables you to get your data anytime, anywhere, using any device. He uses the example of a doctor who’s out of the office, or even out of the country, who needs to rewrite a prescription for a patient. The doctor can use his or her phone or tablet browser to access the practice’s system.

“It’s much easier and much more standard to get to your data from any device, anywhere,” Uretz says. 

Herman says it also can benefit your team, enabling someone with a flexible work schedule to work from home. Cloud-based systems allow for that without the need to build a remote desktop and the related IT networking.

“If you want to log in at home, you can,” Herman says. “You could finish your case notes or your treatment planning from anywhere. You don’t have to be in the office to do it.”

Cloud-based solutions also allow for different types of collaboration with other practitioners. When you work through the cloud, Herman says, you remove the requirements for physical locations, and you can have coordination between providers.

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For example, MouthWatch has developed a cloud-based teledentistry platform called TeleDent using MouthWatch intraoral cameras to streamline referrals and support the specific needs of teledentistry programs. One way it does this is by allowing care providers to interact and communicate on a case, regardless of where they’re physically located at the moment.

“We’re doing live video conferencing. If I need to consult with a specialist or a team member, I can do a live video consult about it and screen share. So, I could pull up a cone beam on my computer, share it with the GP who referred the patient, and we’re all seeing the same data in a more efficient and convenient way.”

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The cons of the cloud

Con No. 1: Your internet connection and redundancy are crucial

There are also drawbacks to the cloud, such as the internet connection and bandwidth demands. Our experts recommend before you adopt a cloud system to have at least a “business-class” internet from cable or another ISP in the area.

“As long as it isn’t dial-up, it can be a lot of things,” McDaniel says.

McDaniel says mobile internet is improving in speed. With the new 4G LTE and the latest 5G systems rolling out in certain parts of the country, practices could use mobile internet providers for the cloud-based system. To determine if that’s possible in your area, McDaniel says to ask the providers, as they can give you the details for the speed of the internet in your area.

When you consider moving to a cloud-based solution, you must have a plan for when the internet goes down. Outages are an inevitability.

“You don’t want your whole practice to slam on the brakes if that happens,” Herman says. “It’s not that it doesn’t happen with the server. It definitely happens with that one room with the dusty server, too.”

While he thinks internet outages will not cause more losses in productivity than having server problems or other issues with an on-premises solution, McDaniel says effective planning for internet outages goes a long way for a practice’s productivity.

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“You should have less downtime with your cloud, as long as you plan correctly,” McDaniel says.

Redundancy options for internet outages can be inexpensive. For example, dual routers with dual internet connections are available for less than $1,000. With these routers, McDaniel explains, you can have internet connections from different providers. Mobile-enabled iPads or tablets could be another redundancy if the internet is down. Also, mobile hot spots can work.

“Some offices keep the hot spot off unless the internet connection goes down. It’s just sitting there as a backup,” McDaniel says. “If you have a small practice, the minute the internet connection goes down, you fire it up, connect it to your laptops and your computers, and you’re ready to go again.”

Herman says another drawback of cloud-based systems is sometimes you need a lot of bandwidth and it isn’t always available. For example, with teledentistry working at full capacity, a practice might have an HD webcam, a MouthWatch intraoral camera and the other dental provider’s webcam (meaning live video stream plus intraoral camera video stream).  That much bandwidth needs top-notch connectivity.

McDaniel says you should consider how else the internet will be used in your practice. Will you be streaming music or video? Are you offering guest WiFi? Are you sharing the connection with any other business, and if so, how is it using it?

McDaniel says when choosing a company to partner with, select one that has these types of conversations with you about the practice. It shows the business understands how its system works and it takes a holistic approach to managing the details.

“If it is someone who is only going to sell you cloud practice management, then you have to figure out all of this on your own,” McDaniel says.

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Con No. 2: You must clarify the terms of your contract

Having negotiated numerous cloud-based contracts over the years, Uretz advises dentists to protect themselves with a good software contract. Also, a side benefit of negotiating your contract is through the back-and-forth process, you can get a feel for how your relationship with your chosen vendor might pan out.

Uretz recommends covering the following three areas (at a minimum):

  • Transitions: Should you transition to another vendor at some point, will your present vendor cooperate with you in transitioning your data? Or, will it either resist or charge you an exorbitant fee? Clarifying upfront can save you heartache and hassle on the back end.

  • Accountability: Is there a service level agreement that guarantees uptime and system performance? The best vendors either have these metrics and associated fees “baked” into their contracts or are willing to discuss them with you.

  • Right to cancel: If it isn’t working out, can you terminate your contract? In a perfect situation, this item won’t be necessary. However, if it is, you’ll want to know you aren’t stuck in a contract with a vendor that isn’t delivering.

“Remember, your data is hosted somewhere else when you’re in the cloud. You can protect yourself from issues that can occur with cloud-based software if you structure a protective contract,” Uretz says.

McDaniel also cautions dentists when searching for software-look for business partners, not just features. People can be enamored by bells and whistles. However, McDaniel wants practices to ask the right questions to qualify vendors as a worthy partner.

The team at Henry Schein considers the practice’s growth goals and how to accomplish them while providing the patient experience you want to deliver. Then, McDaniel says, the team members present a solution from their suppliers that fits best.

“Henry Schein is uniquely poised to provide that because we have multiple practice management systems,” McDaniel says. “It’s not ‘one size fits all.’ It’s ‘What are your needs?,’ and then we’ll provide you with the best plan for those needs.”

Related reading: How teledentistry can bring new patients to your practice

Con No. 3: Watch out for hidden fees

Herman says a cloud-based practice management transition to a new system can feel uncomfortable. Most companies have a few differences, including how they charge. Herman recommends clarifying whether they’re integrating everything into their fees or if it’s module-based. Also, find out if support is included as well as the availability of onboarding or training resources.

“Some of those apply beyond the cloud,” Herman says. “That’s any practice management transition.”

Another drawback for cloud-based systems can be integration with other systems and hidden fees. Herman says you ideally want cloud-based systems with an open Application Programming Interface (API). Some services have fees to open up to other third-party care providers, like text reminder systems or online forums. There could be development fees to create the bridge to the system or an annual license fee to access the other system.

“There might be these hidden fees for integrations you’re not expecting, but you want that functionality,” Herman says. “Interoperability-the open platform-creates huge opportunities for practices to get better analytics, to get better patient engagement features, to open up teledentistry opportunities, billing opportunities and all of that, but you’ve got to be careful what their policies are.”

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