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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Cloud-based practice-management software is making office expansion simpler and more streamlined for dentists.
Expanding one’s practice from a single location to a multi-site DSO involves many variables. One of which is that the dentist must learn how to operate as an entrepreneur. And while that, of course, is critical for success, there are practical nuts and bolts considerations. When one considers practice management software, a consideration is whether the practice should use a traditional client/server model or the currently popular cloud computing model.
The chief difference between the two is that a client/server system maintains all the computing infrastructure within the practices’ walls. The cloud model, on the other hand, maintains the core software at an off-site location, allowing computers from various locations - no matter how many - to access that data through a web browser.
When considering expanding one’s practice, the easiest solution seems to be a cloud-based option.
The chief benefit for practices utilizing a cloud-based practice management system is that their information is accessible from anywhere.
“When someone is doing a multi-location practice, typically they want to have access to data from all locations,” says Dr. Lorne Lavine, founder and president of Dental Technology Consultants. “Also, a lot of times, you might have a scenario where a patient might be seen at more than one location. Most people don’t want to run their practices as separate entities. They want to be able to look at the data across all locations, so because of that, it’s typically easier to have a central location for all the data.”
While it’s possible to link disparate practice locations utilizing local client/server systems, a cloud-based system takes the headache out of the prospect.
“You can do that yourself,” Dr. Lavine says. “It’s not always that easy, and depending on the practice management software you’re using, it can be expensive and challenging to set up. You’re going to need to set up one office up as the central location. You’re going to need encrypted connections from all the other locations, which tend to be a bit slower - and they’re not easy to set up. It takes a lot of know how to be able to set that up properly. Your internet speed, your bandwidth is going to come into play. With a cloud-based solution, all of those issues are resolved. That central location is managed by somebody else, but you’re just using your browser in order to be able to access the data.”
And once a cloud solution is in place, you can do anything you want with the data.
“It’s divided by locations. It’s divided by doctor. You can divide up the data anyway that you want,” Dr. Lavine explains. “So long as you’ve got some sort of internet connection, all locations have access to the data without the need for virtual private networks, without the need for encryption, without the need for firewalls - you will for other things, but not when it comes to the practice management software.”
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The core of any practice is its practice management software. When considering an expansion, that software is key to your goals. A cloud-based solution allows you to maintain your data in a centralized location so that all locations can access it with a browser and without complication or the need for additional technology.
“The benefits of moving from one location to multiple locations using cloud-based technology is that it’s much easier to utilize a centralized database or a centralized repository for all locations and associated data,” says Mike Uretz, a dental software and Electronic Health Records (EHR) expert and the founder of DentalSoftwareCompare.com and DSOconnect.com. “When you have your server managed locally at one location, you can, potentially, hook all of the other locations into your local server, but it takes more technical skill and technology to set up and manage than you would have with a true cloud-based model using a standard browser. Many times, when you see vendors that install client/server systems for multiple locations, each location will have its own database. So, instead of having a true, centralized repository for information, each location will have separate local databases, and then you have to sync those up to a central database. You should have your data in a central database in the first place. It’s much easier to do this in a cloud system than to implement the technology needed to do it with a locally based client/server system.
“And there are a number of benefits to having a centralized database on the web when you grow,” he continues. “You can implement process standardization and clinical consistencies over the whole organization. For example, you can have centralized libraries of templates and procedures that are agreed to internally and that all of your dentists can follow. You can have consistency because the templates that you’re using for exams and procedures can be held in a library at one centralized location. This helps standardize patient care from one location to another.”
As the practice expands, you must be able to analyze and assess your data either as a whole or at a very granular level. A cloud-based solution allows this functionality much more easily because of the ease of access of the information needed.
“From a clinical standpoint of doing analytics, you can analyze the efficiencies of your practice,” Uretz says. “I work with a number of groups and, typically, the IT folks report that specialists can be a bottleneck to get analytical reports on all kinds of things about the group. However, a number of my clients would like more of a ‘self-service’ approach, with the ability to get analytics and reports when they want it, wherever they are. The newer cloud-based systems allow you to do this.
“You want to be able to make sure that you can access data from a clinical, administrative and financial standpoint,” he continues. “Your cloud solution should allow you, through security roles - that is, not everybody can do everything - to access all the clinical, all the administrative and all the financial information and be able to aggregate it for both the company and separate locations. It’s key to be able to slice and dice your information both on a location basis and aggregated as an organization. The technology of a cloud-based centralized database allows you to do that.”
As with any piece of software, not all practice management solutions are created equally. Finding the right one for your practice requires some time, research and consideration.
“There are a lot of factors that go into choosing a practice management software,” Dr. Lavine says. “There’s the functionality of the software, there’s the cost, there’s the ease of use, there’s the support fees, there’s level of support that you get, there’s the hardware and high-tech systems - all those come into play. From my standpoint, a practice really needs to look at the software for how it runs their practice and all that other stuff can be worked around. But if you don’t like using the software, if it doesn’t have the reports, the functionality, the features you need to run your practice, then all that other stuff doesn’t matter because you are going to be miserable. But beyond that, if you’ve decided that a specific cloud-based program is the best choice for your solo practice, there’s really no reason to believe that it wouldn’t be able to function exactly the way you want in a multi-location setup because all cloud-based systems are set up to be able to handle that.”
It’s also necessary to understand how software candidates work with your existing software.
“No one vendor has every feature that you want,” Uretz says. “It’s very standard and much easier to connect to a third-party software in the cloud. The way to look at it is that the vendor practice management software is the main engine and then you have all of these other applications that you might use, such as specialized accounting, patient education and analytics, which might not be built into the main software. It’s much easier to connect those things up in the web. There’s standard technology that’ll allow different pieces of software to work together in the cloud. If you don’t have a web-based software, it will limit your ability with the amount and number of partners or software that you can hook up to the practice management software. It’s very standard for web-based solutions to work with each other. It gives the growing group the opportunity to have much more functionality because they can hook up different apps to one piece of software.”
Once the practice has its cloud solutions set up, the heavy lifting is done.
“That’s basically it,” Dr. Lavine says. “You’re opening a browser and using it. Some of them are a little limited because they want you to use specific browsers, they want you to use Google Chrome, but for the most part you log onto the portal, you enter your username and password, and you’re good to go. Now, of course, they would set it up so that everybody does not have the same features, the same access. A dental assistant shouldn’t have the same access as the practice administrator shouldn’t have the same access as the dentist.”
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The fine print
A cloud-based solution is certainly a great model, but there are some details to be aware of.
“Bandwidth would certainly be the No. 1 limitation,” Dr. Lavine says. “You need a certain amount of speed. Whatever they tell you the minimum speed is, it’s always been my belief that if you want the minimum performance, use the minimum speed. For the most part, DSL is not going to be ideal. There are still some people using DSL, but a cable connection, FiOS, something like that would be ideal.”
Practices must also consider whether or not their practice management software – cloud-based or otherwise – works and plays well with others.
“A lot of practices have existing image management systems that may not work with their practice management software,” Dr. Lavine says. “So, that really should be evaluated before choosing a cloud-based software. How does it work with my existing stuff?”
The big limitation to working in the cloud is that since it utilizes the internet, your practices must maintain internet access.
“Of course, if your internet goes down, you go down,” Dr. Lavine says. “That’s a big concern for a lot of people. You should have, and usually your IT people can do something to help set this up, some type of rollover or fallback, whether it’s connecting to a smartphone or a router that handles both cable and DSL, or two different cable connections. There are a lot of ways you can do that, but you want to have that set up so that if your internet goes down, you’ve got a way to get back online, ideally within minutes, not hours or days.”
Ease of expansion
The main takeaway of all this is that cloud-based practice management software eases the expansion into a multi-location DSO.
“There’s a lot of stuff you just don’t have to worry about,” Dr. Lavine says. “You don’t have to worry about, ‘Well, how am I going to back up that data?’ ‘How am I going to encrypt that data?’ Some cloud-based companies, I think, their marketing goes beyond reality. They will tell people, ‘Hey, you don’t have to worry about backup at all;’ ‘You don’t have to worry about encrypting at all;’ ‘You don’t need computers;’ ‘You don’t need to patch;’ ‘You don’t need firewalls,’ but that’s not the case. And the reason for that is that the practice management software, while it’s the main source of patient information, it’s certainly not the only source. You have images. QuickBooks, Invisalign, emails, Word documents, spreadsheets. All that stuff has patient information. So, any of that information that is sitting on your computers, you still need to back it up, you still need to encrypt it, you still need to patch the systems.”
Uretz also points out that with cloud-based software, instead of having to hire internal IT staff, you get the benefit of having IT experts at the cloud-based data center managing and maintaining your system, which provides optimal efficiency.
There are plenty of challenges related to the dental practice’s expansion. However, embracing a cloud-based solution can help ease some of your burgeoning growing pains.