Table of Contents

Continuing Education
Cover Story
Hands On
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Inside Dental Technology

February 2012, Volume 3, Issue 2
Published by AEGIS Communications

Cloud Computing:Is it Time to Get Onboard?

Those who use e-mail, social networking, and online banking are already in the cloud. But is it safe and reliable enough for dental laboratories and dentists, given the sensitive nature of the patient information they transmit and retain?

By Ellen Meyer

An unlimited amount of storage and processing power exists “up there” in the Cloud. Access to this ultimate server in the sky can be had with the most basic of computers—even a tablet or smart phone—and Internet access with an updated browser. Using this concept, free or inexpensive applications such as Drop Box and Shutterfly, which enable upload of and access to large files, are widely used for personal and light business applications. However, businesses such as dental laboratories, which regularly interact with dental practices, may benefit from using services offering specialized management software based on a cloud computing model with management tools designed to meet the needs of dental laboratories and their client dentists and are equipped for health/dental information exchanges.

Cloud Computing Explained

According to Eli Ganon, whose company NGX Corp, a concept-to-market medical device think tank, the cloud is just another name for software as a service (SaaS) that requires little more than sufficient bandwidth to use the Internet and a tablet or smart phone.

In cloud computing, the company using the physical infrastructure does not actually own the infrastructure. Instead, companies follow a pay-as-you-go plan for accessing resources and applications from a service provider. It may merely involve using specialized software and maintaining the data compiled—for example, tax programs like QuickBooks or TurboTax. There are also services, such as those designed for the dental industry, which are described below, that regularly enable subscribers to run highly sophisticated programs on their own equipment for a fee based on usage.1 In this way, it offers the ability to employ a number of computers, hardware, software, and servers to meet computing and storage needs remotely without actually owning or running the software and hardware.2

Benefits

Those contemplating entrusting their client and business information to the cloud may well find themselves weighing security risks and dependence on Internet access against a seductive list of benefits. First is unparalleled convenience—information can be accessed any time, anywhere, from any computer with sufficient bandwidth without concern about software compatibility, processing speed, or data storage capacity. There are also reduced hardware costs, without the need to constantly upgrade equipment for speed and memory; all that is needed is sufficient processing power to run the cloud computing application necessary to connect to the cloud system. And there is no need for a large hard drive because information is stored on a remote server by the cloud provider.

Perhaps the greatest strength of cloud computing is that it is instantly scalable—that is, more computer stations hooked into the business network can be added to or removed from the cloud at any time, without impacting operation. And, because of this, there are virtually unlimited processing and storage capabilities for any user who wants to use cloud computing.3

As for fear of losing information, Ganon says, backup is nearly constant. “A great advantage of cloud computing is that it is clustered—that is, data is stored on a redundant server cluster with multiple backups and failover systems—so you do not have to worry about backing it up. You have real-time synchronization of data online with the cloud, so your data is always safe. Even if you lose connectivity, you will lose only what you have entered at the time the power goes down,” he explains.

Risks

Other than dependence on a broadband connection, which is not available worldwide, the only clear disadvantage cited by Ganon is the speed of uploading large data files. “Three-dimensional visualization of DICOM and STL files take time; in addition, presentation files such as PowerPoint and Keynote are real hogs,” he says.

While Ganon cites the benefits of cloud computing in terms of safety and convenience, because it all hinges on connectivity, he believes a second Internet provider should cover those who depend upon it most. “One recommendation is that if you are going to be dependent upon it 24/7, you need multiple Internet broadband service providers—such as AT&T and Verizon—to be assured of being up and running,” he warns.

The Dental Industry and the Cloud

Already a wide variety of cloud-based business management solutions are available to the dental industry—only a few of which are specifically geared toward dental laboratories. For dentists, cloud-based practice management software as a service is available through companies such as CurveDental (www.curvedental.com), Dentisoft Technologies (www.dentisoft.com), DDS Works (www.ddsworks.com.), and Purechart™ (www.purechart.com). There are also web-based picture archiving and communication systems (PACS) used throughout the dental industry to share and store images that are available from OmniPACS Inc. (www.omnipacs.com), Medicor Imaging (www.medicorimaging.com), INFINITT North America (www.infinittna.com), Denpax A.B. Dental Imaging Solutions (www.denpax.com), and 3Di Cloud (Shina Systems, www.shina-sys.com)

In addition, there are cloud-based software services using collaboration platforms, which promote case information sharing. Those useful to dental laboratories include Brightsquid (www.brightsquid.com), DDX (www.ddxdental.com), My Dental Hub™ (www.mydentalhub.com), ddsWebLink™ (www.ddsweblink.com), Geomagic (www.geomagic.com), and Magic Touch Software (www.magictouchsoftware.com), in addition to iConfiDent (www.iconfident.com), which is geared specifically to implantology.

Business Management

Jeff Noles is CEO of SoundBite Technology, a company that provides completely web-based dental laboratory management software systems. According to the SoundBite website, SoundTrack, Soundbite’s web-based dental laboratory and supply-chain management software platform includes “a suite of innovative tools to increase cost savings, drive revenue growth, and strengthen customer loyalty.” Among its features are case-flow management between doctor and laboratory, client relations management to monitor and track sales, accounting for billing and invoicing with a Quickbooks interface, and production.

“We sell SoundTrack as a complete package with a modest setup fee that includes 8 hours of online training and a monthly fee based on volume,” says Noles. He emphasizes the program’s flexibility and connectivity. “Our core IT philosophy requires that SoundTrack connects to everything—whether it is CAD/CAM software, Fedex/UPS, Quickbooks, existing enterprise resource planning (ERP) systems, or e-mail marketing campaigns.” Special features include digital case management with “virtual” barcodes to ensure paperless management. Through a “dashboard,” laboratories can provide dentists with secure online access to all case, shipping, and billing information.

Beyond discussing the virtues of the SoundTrack program, Noles stresses the ease of working with cloud-based systems in general. “Bottom line,” he says, “all you need to get started is an internet connection and an updated browser.”

Mark Nelson is co-owner of Dental-Tech Labs in Westlake Village, California, which has 28 employees and handles 1,200 to 1,400 cases monthly. He likes that the system can be used from any Internet connection both by the laboratory staff and the client dentist, and says that he uses the feature that enables clients to log on to view case status as a selling tool. “I say, ‘While you are watching Jay Leno in your pajamas, you can log in and see which cases are due and when they are do.”

The software is already used widely throughout his company—by accounting, which uses its interface with Quickbooks; by sales, which uses the prospecting module to track calls to dental offices; by quality control, which uses it because there is a module that tracks remakes.

Nelson says he especially likes that it reduces call volume. “Internet-savvy dentists can see more than you can imagine in just a few clicks. Among those using the system, calls go almost to 0 because no one has to call to find out where their case is.”

Jane Goodfellow, director of Evident Dental Lab Management Software, calls the system “software that puts the right information in the right hands.” Describing the Foundation software, which is included in the monthly subscription price, she says, “Evident’s interface is based on employee job descriptions, providing employees with exactly what they need and helping managers manage employees better, a challenge that is one of the biggest laboratory managers face.” Evident’s Exception Reporting, she adds, is another key feature. “Problems are brought to the attention of laboratory staff before they become emergencies. Exceptions range from scheduling issues to data entry irregularities, to missing data, and more.” This Foundation program, she says, offers “a lot of functionality geared to save time,” and integrates with e-mail, generates case letters, provides marketing features, and helps laboratories comply with the Dental Appliance Manufacturers Audit Scheme (DAMAS) and International Standards Organization (ISO).

Additional features that can be added include the Evident Dentist Gateway, which Goodfellow says “saves countless phone calls and empowers dental practices to monitor information and enter prescriptions at their convenience.” This feature, she explains, “can be fully integrated into the laboratory’s website and attracts tech-savvy dentists.” Other add-ons include inventory, custom reports, integrated fax, and text messaging.

Goodfellow claims, “Providing technical support is so much easier in the cloud.” The subscription price includes online support, and phone support is free up to the first statement, and will be available for a monthly fee after that, she explains. “With the Gateway, dental practices are generally calling about issues with cases, and we want the connection to remain between the laboratory and its customers. If the laboratory cannot answer a question, they call us and that support is covered by the subscription,” she says.

Loren Ford, owner of Thorn Ford Dental Laboratory in Bothell, Washington, says for him, it was the functionality of the Evident software—not that it was cloud-based, which he found “a little scary at first”—that sold him. He found that other types of software did not meet the needs of his laboratory. “We are a full-service crown-and-bridge laboratory, but we do a lot of denture work. Most packages are designed strictly for crown or bridge operations and not for cases that go in and out multiple times. This software application was just what we were looking for.”

Given the nature of his business, he especially appreciates being able to send case-specific quality control checklists to his dentists. “We get a lot of those back from our clients so it is becoming another good communication tool—something we did not have the ability to build into our old software,” he explains.

While Ford has not yet added the Gateway feature to enable dentists to access case information, he says the software has improved efficiency at his 20-employee laboratory. “Now, my technicians and administrative staff do not have to wait in line for information—anyone with a smart phone or benchtop Internet access can log on and look up case information.” He says it also makes locating cases internally much easier. “For the most part, each production step has been properly signed off on the software, so you know who is currently working on the case.”

Collaboration

According to its website, “Brightsquid Dental Link is the first system in a new category of dental applications known as Integration, Archival, and Collaborative System in Dentistry (IACS-D).” Brightsquid Dental Link is said to improve communication between dentists, dental laboratories, and the patient by centralizing information relevant to treatment. Using collaborative web technologies, all caregivers can view, annotate, and comment on the treatment—directly improving the quality of patient care. The HIPAA-compliant program integrates with most dental practice management and laboratory systems and enables DICOM files, digital X-rays, photos, patient case details, digital impressions, and CAD/CAM files to be shared quickly and easily between the dentist and laboratory without extra data entry or delay.

Rohit Joshi, who is the CEO of Brightsquid in Calgary, Canada, explains that this software was developed to fill an identified need. “Dentistry is such an esthetically conscious profession, but there was no generally accepted way to share patient images—including prescriptions—that is HIPAA-compliant. There was also poor integration from the dentist’s practice management to laboratory management systems on their side.”

He notes that specialists are especially interested in this software, which he says functions “as a collaborative patient treatment timeline product” in that it aids communication between the dentist and specialist, who need to collaborate around a single patient’s treatment, much like that of the laboratory and the clinician.

“The idea behind Brightsquid is to enter data once and have it transmit through various systems, to streamline that entire flow of information from the entry of patient data right to the laboratory connection for that specific data on the prescription.”

Brightsquid user Mark Maier is the president of Core 3d Centres and vice president of business development for the Aurum Group. His company has 500 employees at 14 locations, including two milling centers. He notes that in Calgary, Canada, where his company first initiated the use of Brightsquid, adherence to privacy regulations is generally “casual,” so he appreciates Brightsquid’s security control and compliance with HIPAA and its Canadian counterpart, PIPEDA (Personal Information Protection and Electronic Documents Act). “Unlike with e-mail, you have control over who sees what information and where it is shared,” he says.

Maier explains that Brightsquid software enables his company to interface with a full range of clients regardless of the system they use. “As a milling center, we want to be neutral. We want to be able to aggregate the work of our clients on a first-in basis and provide them with the status of their work and the approval processes within it no matter what system or laboratory it comes from,” he says.

He also appreciates the ability to access a true digital prescription online. “This is a fantastic thing from the laboratory’s perspective, because that information can be imported directly into our laboratory management system, which increases clarity and eliminates re-entry. It also creates a kind of transparent audit trail of what has been done, what has been agreed to be done, and how it is being done.”

Maier says he considers the monthly fee—less than $50 for the basic software—inexpensive, but points out that it is the specialists—including the implant and orthodontic doctors his own company works with—who seem especially enthusiastic about this collaborative software. “They have large referral bases with complicated workflows, and there is no real effective, transparent, real-time mechanism to manage that workflow, comment on it, make sure that everything is going according to plan.” He adds that a version designed especially for specialists enables them to share freeware access to scans and images with as many referring doctors as desired for $2,500 per year.

Compliance Support

A cloud-based solution to OSHA and FDA compliance documentation is offered through SafeLink™, which provides dental laboratories with the information they need to stay in compliance with third-party regulators such as the Federal Drug Administration (FDA), Occupational Health and Safety Administration (OSHA), and DAMAS.

Mary A. Borg, president of SafeLink Consulting, Inc., says, “With OSHA, the employer must make all components of the safety program available in writing to workers. Most laboratories now have a manual placed somewhere in the laboratory. But those manuals tend to disappear.”

While the company traditionally developed hard-copy materials for this purpose, they have contracted with UQ system to offer its clients a cloud-based application that helps dental laboratories and practices implement and manage quality systems and safety programs online. The program makes appropriate changes to files based on federal and state requirements, thus keeping documentation up-to-date without the user having to research FDA or OSHA regulations.

Scott Udell, owner of Udell Dental Laboratory in St. Louis Park, Minnesota, says he likes that the system helps keep dental laboratories out of trouble. “It is a huge undertaking for a laboratory to maintain documentation and to be aware of all statutes that must be abided by. Using this software, Safelink enables us to keep abreast of updates related to laws that apply to our business,” he says, adding that his employees can access the online manual with a user name and password, so the data is protected.

“The distribution of documents and the revision process is all automated, minimizing both labor and paper to print manuals. Access by all employees is very easy to control. We can now easily find all of our controlled documents,” he says.

Coming to Terms

Use this basic glossary to familiarize yourself with common “cloud computing” terminology.

Cloud Provider: A company that provides cloud-based platform, infrastructure, application, or storage services to other organizations and/or individuals, usually for a fee.

Cloud Storage: A service that allows customers to save data by transferring it over
the Internet or another network to an offsite storage system maintained by a third party.

Cloudware: Software that enables creating, deploying, running, or managing applications
in the cloud.

Cluster: A group of linked computers that work together as if they were a single computer, for high availability and/or load balancing.

Consumption-based Pricing Model: A pricing model whereby the service provider charges its customers based on the amount of the service the customer consumes, rather than a time-based fee. For example, a cloud storage provider might charge per gigabyte of information stored. See also Subscription-based pricing model.

Infrastructure as a Service (IaaS): Cloud infrastructure services in which the provider delivers a virtualized environment over the Internet. The infrastructure can include servers, network equipment, and software

On-Demand Service: A model by which a customer can purchase cloud services as needed; for instance, if customers need to use additional servers for the duration of a project, they can do so and then drop back to the previous level after the project is completed.

Pay as You Go: A cost model for cloud services that encompasses both subscription-
based and consumption-based models, in contrast to the traditional IT cost model that
requires upfront capital expenditures for hardware and software.

Platform as a Service (PaaS): Cloud platform services in which the provider delivers the computing platform (operating system and associated services) over the Internet.

Service Provider: The company or organization that provides a public or private
cloud service.

Software as a Service (SaaS): Cloud application services in which the provider delivers applications over the Internet, so that the applications do not have to be purchased, installed, and run on the customer’s local hard drive. SaaS providers were previously
referred to as ASP (application service providers).

Source: Mini-glossary: Cloud computing terms you should know. Available at: http://www.techrepublic.com/blog/
datacenter/mini-glossary-cloud-computing-terms-you-should-know/2308. Accessed: November 21, 2011.

Conclusion

Clearly the cloud is here to stay, concludes Ganon. However, he says, for cloud computing applications to become the norm in the dental community, the applications must be HIPAA-compliant and transparent by adhering to standardization of DICOM and prescription data. “Products will need to be HIPAA-compliant and secure to protect patient data in keeping with interoperability standards such as ADA Informatic Standards and Open Exchange Dental Interoperability Group (OXDIG),” he explains.

Ganon further foresees the day when the widespread use of smart devices will allow the synchronization of data between the cloud appliance and the cloud. This, says Ganon, will eliminate what he considers the “bottleneck” of needing redundant access for an appropriate level of security. “Right now you must always have a redundant provider such as a wireless card to back up a primary provider such as Time Warner or AT&T. With synchronization between the cloud appliance and the cloud, if you do not have Internet access, you can work locally, then synchronize data once reconnected to the Internet.”

In conclusion, Ganon claims, “I envision the cloud becoming a dental communication hub for collaborating and exchanging 2D/3D imaging data, with open, not closed, architecture that would enable data from one laboratory management system to intermingle in the cloud with data from any other system.” He further expects the dental community to be able to make meaningful social and professional connections using cloud-based applications such as My Dental Hub. “It will make it possible for multispecialty providers, laboratory technicians, imaging diagnostic centers, and vendors to collaborate 24/7.”

References

1. Cheng R. ‘Cloud computing’: what exactly is it, anyway? The Wall Street Journal. 8 Feb. 2010. Available at: http://online.wsj.com/article/
SB10001424052748703580904574638391318085158.html. Accessed October 27, 2011.

2. A Simple Explanation of Cloud Computing. Available at: 2http://www.cloudcomputingworld.
org/cloud-computing/a-simple-explanation-of-cloud-computing.html. Accessed October 27, 2011.

3. Cloud Computing Concerns. Available at: http://computer.howstuffworks.com/cloud-computing/cloud-computing3.htm. Accessed October 27, 2011.