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Head in the Clouds

by Liam McNaughton

“Can’t I just put everything in the cloud?”

The techier of our clients will often ask me about this, and it’s a good question. Why do they have to spend thousands on a server when, these days, our music and films are hosted online, our books, our photos, our calendar and contacts, and even our social lives! Well let’s get one thing clear; cloud is really just another name for “online”. And online computing and storage has been around for quite some time now, it isn’t really that new.

The Cloud

Cloud computing is where the data and (usually) the application itself are stored and run from servers hosted online. There are many advantages to this (and some disadvantages) but most people would understand that the more of your IT you can host online, the better. And they are right – in general this is a good thing: you don’t have to worry about installing, maintaining and updating your software, you don’t have to carry out backups or (generally) have to worry about data loss or data security, you may not have to have a costly server at all, you can access your applications and data from anywhere and on most devices, it’s 24x7 “always on”, and licensing and support costs may be cheaper too. On the downside, you have to trust that the provider is actually looking after your data properly for you (which is an assumption you cannot always make), and your Internet connection has to be completely reliable and quick.

What are the Benefits?

At the moment, very little. Very few practice management systems appear to offer this feature in the UK. Dental Plus claim that their practice management software “Pollen” (www.dentalplus.co.uk) is able to run from a “cloud” server online, but a “hosted” package without a server (where Dental Plus would host your data on their servers online) isn’t actually offered on the website, so I assume isn’t actually deployed in the real world yet, if at all. Aerona (www.aerona.com) appears to be truly entirely hosted, but as far as I can see, doesn’t seem to offer NHS support (FP17/WebEDI etc) so will likely only be of interest to practice practices. Of the mainstream dental practice management systems I have heard that R4 is available as a hosted product, but at time of writing there is no mention of this product anywhere on the Carestream website; if it does exist, it may be that it is just the data that is offsite, not the application.

What about having the application running at the practice, and hosting the server offsite? Well, this is technically possible with ANY current dental practice management system, and indeed at Dental IT we have done some testing of this, with a view to offering this service it if was technically possible. Since the applications were not natively written to support this setup, and or not optimised for working across the Internet, this requires the presence of a VPN (virtual private network) to host the server online whilst the workstations connect to your local network. Unfortunately the performance of most DPMS systems across a VPN is poor to dismal, with Software of Excellence’s Exact being particularly slow and unusable in this scenario. Without significantly greater bandwidth available, this just isn’t an option.

Other Technologies

It IS possible to use a technology called remote desktop/terminal services (similar to GoToMyPC, or Logmein), to setup a permanent remote server with workstations accessing remote sessions across the Internet – indeed some of our sites already do this successfully, so they can operate branch sites from their main site without the cost of an additional server. However, this is only really an option where there is no DI (digital imaging) such as digital xray. Although the appointment book and clinical records can be accessed and worked on remotely through remote desktop, accessing your digital x-ray sensor in such a scenario simply wouldn’t work. So even if you went for a service like Aerona, if you had any form of DI, you would still need to operate some kind of local server to host the data for this, thus more or less negating the major financial benefit of a hosted DPMS solution.

With Office365 and Skydrive, Microsoft are pushing hard to move all our office documents online, and the latest versions of Office (Office 2013/Office 365) natively support Microsoft’s Skydrive for storage of Word, Excel and other office files. However whilst the home package for Office365 is an attractively priced proposition, the business case for Office365, for the typical dental practice, is simply not there. As a subscription based model, Office365 is a cost per user, per month. Total ongoing costs are likely to be significantly more than an outright purchase of Office 2013 per machine.

Where Cloud computing is used extensively at the moment, is as a destination for storage of your remote backups, and in many ways this is currently the only really benefit of “Cloud” to the dental practice. And indeed at Dental IT we have been offering a remote backup service for many years now. However, we do not recommend the practices ONLY backup online, even if that service is dependable and secure. There are a number of reasons for this, but the main one is that remote backup is seldom, if ever, comprehensive.

Yes, you may have backups of your core clinical data, but in reality, if you ever needed to restore that data, you don’t really want to restore JUST the core data, but also the applications, the server build and configuration, the user accounts, the documents, the emails and all the other data that resides on your practice network. If you only had the core data to restore, it would typically take days to get a complex network setup fully back up and running before you could restore that data into it. We always recommend that practices utilise a mix of both comprehensive local (ideally imaging) backup, to allow for fast, comprehensive restore of the entire system, combined with remote backup as a last resort, to cover the offsite requirement for the “fire and theft” type scenario.


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