Onwards and Upwards: Getting Your Practice Ready to go from the Server to the Cloud

Cloud-based software has permeated every-day life to the level where we rarely give it any thought. We send emails, store our photos online, and check in with friends via social media—all on cloud-based platforms. One would be hard-pressed to argue that the cloud hasn’t greatly simplified information sharing.

Yet within the dental community, opinions are split. Is cloud-based software the best solution for dental practices? Should you transition your practice management to the cloud? And what exactly does that mean?

“People kind of confuse what the cloud is, and a lot of terminology is out there,” says Lorne Lavine, DMD, founder and president of The Digital Dentist. “But for lack of a better term, is just putting your data on somebody else's server. Simple as that. But there are a lot of factors to consider before you make the transition.”

So, what should do before making the leap?

Do your research—or pay the price

It seems like a no-brainer, but doing thorough research is critical before any big technology transitions. While switching to a cloud-based model may make sense for some practices, it could mean more trouble—and money—than it’s worth for others.

“Sales reps often use cost savings as a reason a practice should switch to the cloud,” says Dr Lavine. “They’ll say, ‘Hey, you know, if you go to the cloud, you're not going to need a server, you're not going to need all that stuff.’ Moving to the cloud is pitched as a great way to save money—but oftentimes, it’s going to cost the practice even more.”

For example, Dr Lavine says, a good server may run around $3,000—certainly a large upfront cost that can seem off-putting. However, if it lasts 5 or 6 years, the cost averages out to around $50 a month. In comparison, many cloud-based programs can run around $500 a month, which means that in the long run, a practice could be paying 10 times more for the cloud than it would if it had just stomached the upfront cost and bought the server.

“The appeal to some solo practitioner is that they believe that it's going to be less costly, but when you price it out, that may not be true,” says Dr Lavine. “In addition to avoiding upfront costs, practitioners believe they're not going to have to deal with HIPAA, they believe they're not going to have to deal with backup, and encryption, and you know, all this stuff that goes into running a modern practice. But most of them, unfortunately, find out the hard way that no, that's not really the case. 

In addition to paying more over the long run, using cloud-based software doesn’t always mean that a practice doesn’t also need a server. Most offices have email, QuickBooks, Word docs, etc.—and from a HIPAA standpoint, there are 18 different identifiers that make that data protected health information. This means that all that information kept within the practice will have to be housed in a HIPAA-compliant manner.

“Even if you're using a cloud-based practice management software, in most cases you still need a server,” says Dr Lavine. “While most of the patient information is in the practice-management software, certainly not all of it is. And you still need HIPAA compliance.”

In short, Dr Lavine says, practitioners should be aware of all the potential costs associated with a switch to the cloud.

“Dentists for the most part are tech savvy,” says Dr Lavine. “They want the latest and greatest, and they want to be on the leading edge. Unfortunately, however, sometimes it turns into the bleeding edge.”

Analyze capabilities

In addition to performing a cost-benefit analysis, practices should ensure that their practice can support access to the cloud. After all, if the cloud isn’t accessible, a cloud-based practice is dead in the water.

“The first and most critical thing to think about before going to the cloud is, do you have a good internet connection?” says Dr Lavine. “Is it fast enough? Is it stable? The basic premise of cloud is that if your internet goes down, you go down. People need to make sure they got a good solid plan in place before they switch to the cloud.”

This means ensuring reliable internet will always be available, and that practices have an IT professional reliably on speed dial in the event of outages. And even if the internet is online and working properly, practitioners need to be sure that the internet will be fast enough to support the practice’s transfer of data—particularly when it comes to digital images. Dr Lavine says that one of the biggest issues he’s seen with the cloud, especially when it comes to bandwidth, is images.

“For most practice management software, it's just text, numbers, and letters,” explains Dr Lavine. “And with that, you're not going to see a huge difference in speeds, whether it's mobile or cloud based. But image files are significantly larger files than the data for the practice-management software, and so making sure your internet bandwidth can support those larger files is critical for storing any sort of digital images.”

Internet speed isn’t the only measurement that need to be taken into consideration. Cloud-based platforms rely on the practice-management companies’ servers, and their location can impact how quickly they can return information. Since this can affect the user experience, practices should know where the servers are located. Are they in the same city? Are they thousands of miles away? The farther the server, the longer it will take for a request to reach it—and the longer it will take for that server to return the requested information to you. And while we aren’t talking about the snail’s pace of the days of dial-up internet, even a few seconds in delay can affect productivity. 

“If servers are relatively close, we could be talking about fractions of a second,” says Dr Lavine. “If they’re far away, it could be multiple seconds. That can add up, and really slow a practice down.”

Evaluate security

With on-site servers, for better or worse, a practice has complete control over the security of its database and network—meaning the practice also has comprehensive control over who can access the data within. A server with user accounts, and logging and auditing capabilities can keep track of just who is viewing what information. In contrast, with cloud-based software it can often be harder to track who accesses that data. And when it comes to HIPAA compliance, this could become a problem.

“One of the big reasons why I recommend a server is that you need to track who in the office access patient information, when they access it, and what they do in the practice management software,” says Dr Lavine. “An audit trail lets you do that. There are so many other sources of patient information you also need to track. We can better control and manage all those users with a server running a server operating system that can do that.”

With cloud-based platforms, practitioners also need to consider that they are essentially putting their data in someone else’s hands. If a practice-management company’s server is compromised, so is all of your practice’s data—which could have major repercussions for the practice, since it is ultimately the practice’s data, not the company’s, that was breached. However, an in-house server is only as secure as a practice makes it—and keeping up to date with the necessary safeguards, patches, and ransomware can be time consuming and costly.

Looking forward

Ultimately, while cloud-based software may be a good solution for some practices at this time, smaller practices should be meticulous in their research and evaluation before transitioning. That being said, the cloud can also bring the benefits, accessibility, and conveniences that we enjoy every day on private cloud-based platforms like Gmail or Facebook.

“In my opinion, the cloud is an excellent solution for multi-location practices or group practices,” says Dr Lavine. “It’s the perfect solution for information sharing between locations—way better than how we typically used to do it via VPN or remote desktops and things like that.”

However, Dr Lavine still remains cautious about the benefits for single-location practices. While cloud-based technology is appealing and new, it may not provide the most effective solutions.

“For a solo practitioner, unless they just love the software, they've got great Internet, and the company also offers a web-based imaging solution, it just may not have benefits that outweigh the investment,” explains Dr Lavine. “For a lot of people, it's just not the most cost-effective option for them.”

But as technology advances, inevitably a cloud transition will happen for all practices.

“At some point, everything's going to be cloud based, though whether it happens in our lifetime or not is anyone's guess,” says Dr Lavine. “But there's no doubt that we're headed in that direction. And when we get to that point, it will make life easier, because you're not going to have to worry about the HIPAA stuff as much and you're not going to have to deal with backup (since all the data will be in the cloud). You won’t have to worry about patching your systems, or ransomware, or all the things you have to deal with in a modern practice. Simply put, it’s going to be simpler.”