The Times, They Are a-Changing

Feb. 1, 2002

Internet-based practice-management software saves money.

by Ron Barnett

Dr. Hoefler's office manager came in one morning, turned on the computer system, logged onto the Internet, and printed the day's patient schedule. Then, she looked to see what claims had been sent electronically while she slept the night before, and began inputting information about a new patient who was coming in that day. That afternoon, she posted all the charges and payments for the day, filed more insurance claims, scheduled recall visits, and printed several patient letters and birthday greetings. She didn't use a dental software program that the office purchased, yet she was able to do all of these things on her system just like the office next door does with its $20,000 practice-management software system. She did it all on the Internet without purchasing dental software!

How can this be? She was using a new technology that allows conventional software programs to be run over the Internet. The process is called "application hosting." In application hosting, the software and data files reside on a host computer that is not in the dental office. For this to happen, a software vendor sets up a host computer that is powerful enough to handle thousands of online transactions simultaneously. The dental software is installed on the host system, and dentists participate by contract to share access to the system. Each dentist has a separate area to store his or her practice information on the host computer. Dentists can access their practice data across the Internet through a secured connection.

Certain precautions assure that the host computer remains available at all times. These include a backup power generator and multiple servers that are mirrored in case of any hardware failures. Such safeguards must be in place to provide this type of continuous service. Data backups are made automatically on a daily basis. The host computers are housed in a secure, restricted-access location. Practice data is far more secure there than in any dentist's office.

Application hosting vs. Web-enabled packages
Application hosting is sometimes confused with packages that are "Web-enabled." Web-enabled programs are easily identified if the advertising material states that they are JAVA or HTML-based programs. Although many of the benefits seem to be the same, there are some distinct differences between the two methods of delivery.

In a Web-enabled program, each time a new screen is displayed, the software to run that portion of the program is downloaded. This substantially increases the amount of time necessary to load each screen. The user is forced to sit and wait while each screen is slowly loaded, which decreases office efficiency. For this reason, Web-enabled software providers usually recommend a high-speed Internet connection (DSL or cable Internet). An application-hosted screen, on the other hand, requires no program to be downloaded and is displayed instantly. Performance (even on a 56K modem connection) often rivals that of a program running on the local computer.

Application hosting offers several distinct advantages over the conventional method of obtaining practice-management software, including:

Lower initial cost. The office does not incur the major up-front expense of purchasing the software. Instead, any fees are for actual services rendered. Specifically, these include fees charged by the application hosting company, fees for telephone-based software support, and per-claim charges for electronic insurance claims processing. The pay-as-you-go concept better matches the cash flow of many dental offices.The data can be accessed from anywhere. For offices with satellite locations, or dentists who like to access the data from home, this is a huge advantage.Practice information is securely stored. There is no risk of information loss should the office be burned or burglarized and the computers stolen. No practice information is actually stored on your system, so if your computers were stolen, the thief could not access confidential patient or practice data.Updates are performed automatically. On a conventional system, the software vendor must constantly send program updates to be installed by the dental staff and paid for by the dentist. With application hosting, updates are provided automatically by the vendor at no extra cost, and there's nothing the dental office needs to do to implement them.Users can purchase a less-expensive computer. Since the program is actually running on a fast host machine, the local computer acts as nothing more than a terminal. It simply displays screens and allows the operator to type in additional information. It doesn't matter if your office computer is an old 386 40 MHz or a brand-new 2 GHz Pentium 4, for example. The performance is the same on them all. The only requirement for the office system is Internet access. The system doesn't even have to be a PC. A Mac, Thin Client terminal, or UNIX workstation with Internet access will do the job just as well as a $20,000 computer system.

Familiarity with the future
Many operators also prefer application-hosted programs if they are accustomed to the look and feel of Windows-based programs. Since the program being run actually is a Windows program, there is an easy familiarity with it. Also, application-hosted programs are designed to run on a local computer, so the companies marketing these hosted services are more than happy to sell you the program to install on your own system. You can run the hosted application for several months to try it out, and then convert to the same package installed locally with no loss of data and no new learning curve. This option usually is not available with Web-enabled software.

Be prepared to see lots of ads for both Web-enabled and application-hosted dental software. Several companies believe so heavily that these two options are the wave of the future in dental computing that they have invested millions of dollars in developing Internet-based offerings for the dental community. One particular company now has purchased most of the larger dental software companies with the hopes of eventually converting those companies' 50,000-plus dentists to one package, which then will run over the Internet. As with any new technology, there also are companies that market an application before it is thoroughly tested and available.

If you sign a contract for online dental software, make sure that the service is indeed available. Talk to clients who are already using it before taking the plunge.

As always, read the fine print in your contract. Is the contract open-ended (meaning you can cancel at any time with no penalty)? Or, is there a required minimum time period that you must maintain your subscription? Be aware that some companies also offer a very low monthly payment for the first few months, expecting you to stay onboard when it substantially increases months later. So, ask how long the low price will stay in effect.

Also, it is important to be sure that the company you select offers an exit plan. A wise office will make sure that its contract with the hosting company allows for the dentist's data files to be exported in a format that will be easily readable by another dental software program. This way, if the hosting company decides to discontinue the service, or if you decide to cancel your subscription, you won't lose any patient information.

There may soon come a day when the majority of dental software is distributed in this manner, so be prepared. The times, they are a-changing!

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