Paul Feuerstein, DMD
In the past, the dental office had minimum requirements for computers. Even with Windows 95 and a practice-management system, speed was marginally important. After all, you easily could store 10,000 patient files in an 850-megabyte hard drive.
However, with the increasing sophistication of management programs, it is time to upgrade, replace, or add computers. Entry-level machines for under $800 can do the basic functions of billing, word-processing, and e-mail in a very small office. But, upgrade to Windows 98, add Microsoft Word (or Office) along with your dental-management software, and you could be up to one gigabyte of space, leaving no room for new data and waiting a long time for slower processors to give you your information.
If you intend to expand to some of the new technology - especially anything involving images - you will need much faster, more powerful, and larger storage machines. Since image files (digital radiographs and intra/extraoral photos) are large, the storage of 2,000 patient files with the associated images could easily eat up a gigabyte. In addition, with slower processors, limited RAM, and low-end video cards, you could find yourself waiting awhile for an image to appear on the screen. If you add before- and after-imaging time, you may as well reappoint the patient for the "after" pictures if you have an older or budget machine.
Luckily, the entire price structure of hardware has come down below expectations of just a few years ago. As Intel, Cyrix, and AMD keep increasing the power (and the competition against each other!), last month`s less-powerful components drop in price dramatically. You probably will not see a visible performance difference from a 350 MHz to a 550 MHz processor, but you will see a price difference of more than $500! The challenge is to purchase a machine that will not be immediately obsolete and is capable of having some upgradable components (CPU and memory).
As of November 1999, the top speed available for a Pentium III was 733 MHz. If you purchase a machine with a Pentium II 350, which is upgradable to a Pentium III 600 or more, you can save a bundle. This is because by the time you need to upgrade, there will be a Pentium 1000 and the 550 or 600 will cost very little. Even in a year`s time, upgrading probably would cost no more than $200.The Celeron processor is a stripped down Pentium II. Although capable, for the same money you could get a much more powerful AMD processor or even a lower-speed Pentium II. It is notable that a Celeron only can be upgraded to another Celeron (if the motherboard allows a higher speed).
AMD has surprised the marketplace with its newest edition, the Athlon. The initial reviews show that it is faster and more powerful than its Intel equivalents. It is not interchangeable with other systems, so a new motherboard is necessary. In reality, if you were to purchase an Athlon, you would be better served by getting a complete new system. Since it is a new product, some of the software companies cannot warrant their proper performance until they have fully tested on the Athlon. Be sure and verify this with the vendor.
Memory, hard drives
With prices at the lowest ever, get at least 64 megabytes of RAM on front-desk workstations and 128 Mb or more on the server and any computer doing image-processing. Current talk says memory prices are on the increase due to an earthquake at the primary manufacturing area and also due to the sophistication of a newer type of memory. Just to confuse you even more, memory now has speed - i.e., 66, 100, and 133 MHz - with 100 being the current standard. The memory speed is a function of the motherboard of the computer. (A new faster type of memory, called RDRAM, has been introduced to work with the faster CPUs and motherboards. Some initial problems cropped up with this new memory in late 1999, but they should be resolved by the time you read this.)
With respect to hard drives, an eight to 10 gigabyte hard drive is a good entry point, although drives of up to 50 Gb are available. Remember, just as with your apartment or house, you expand to the limits of your computer`s storage capacity. All machines allow a second or third hard drive to be added if you need it. Keep in mind that if you have a network of several computers, all of the systems do not need giant disks. However, at current prices, it isn`t much of a savings to downgrade. In addition, you can duplicate (back up) all of your vital information on to another computer in the network for added safety.
You still must have a backup system that removes data from the office (to tape or disk) in case of a catastrophe. A few products, including one called Duplidisk, from Arco Computer, allow you to have two identical hard drives in one computer. Typically, this is the computer with your important data ... usually your server. A card or board for under $250 installs easily in your computer. As information is recorded on one drive, it is duplicated (mirrored) on the other. If there is a hard-drive crash, an alarm sounds, the second disk takes over, and you don`t lose a step. (Of course, you do have to replace the bad disk!) Prior to the Duplidisk, this task traditionally was done by very expensive systems called "RAID" systems. This is not a substitute for backup; it is just a safety net for the inevitable disk crash.
Video capability also is important. Your intraoral-camera or digital-radiography dealer should be able to give you the minimum specifications. Be sure that you know these specifications before you purchase your computer. Some require a special video "capture" card (ATI All In Wonder Pro, for example). Of course, you can put one in after you have purchased the computer, but you already have paid for the video card that came with your computer and which now has to be discarded or sold to a surplus place at a steep discount.
Three terms you should know are "AGP video," "video RAM," and "onboard or shared video." AGP is a newer, faster slot that the video card plugs into. It must be in the original configuration of the computer; it cannot be added later on (without changing the motherboard). Video RAM is on the video card. More video RAM means better image quality (limited only by the monitor) and faster image changes (important for image manipulation). The recommended video RAM is eight Mb, although 16 Mb is better. The budget machines have one or two Mb of video RAM.
You may see a specification of "shared video memory" in the lower-priced systems. This means that there is no actual video card - the computer uses the main RAM for this function. Although this is less expensive, it is much slower and inadequate for your workstations that are showing images.
To summarize: A good overall system will have a Pentium III 450 MHz processor, 64-128 Mb of 100 MHz RAM, 10 Gb hard drive, and AGP video with eight Mb of video RAM.
You also will need a network card. This is not in a normal home configuration, unless you use the computer with a cable modem. Network cards come in two speeds - 10 and 100 MBPS - with some cards having both (called 10/100-combo cards). The network hub that is installed determines the speed. Older networks are 10 MBPS. You have to check with the person who wired the network to see if it will support the 100 MBPS card speed. If so, all you need is a new "hub." This is an $80-$200 investment, with a very easy installation. You also can mix the old with the new on most networks.
Additional specifications are related to personal preference and the actual usage of the computer. High-quality sound cards, speakers, DVD drives, writable CDs, giant or flat-screen monitors, zip, or superdisk drives are all shown in prepackaged systems. If you plan on using CAESY for patient education, the DVD drive becomes important. (Some offices prefer a separate DVD player and monitor for this system, because the patient can more easily control it.) If you are purchasing multiple computers for a network, you do not need all of the components on all of the systems. You only need one CD writer on one system. (Note: some older CD players cannot read the writable CDs).
Modems and high-end sound do not have to be on all systems. With the newest version of Windows 98 (or with some add-on software), you can access any computer with a modem from the network, so only one or two computers need modems. You do not need 300-watt speakers with subwoofers at the front desk! If you are looking at a packaged system, you might save $100 by eliminating the modem and dropping down on the quality of the sound card and speakers.
Most (not all) PCs come with the operating system, typically Windows 98. Some still come with Windows 95 and some low-end "network computers" have a version of DOS as the system software. Each computer must have its own licensed copy of the operating system. It is tempting to purchase one copy of Windows for $90 and just copy it on all of the other systems, but this is illegal and a violation of the copyright laws.
You may find some places that charge more for the same hardware, but the inclusion of the Microsoft Office program could be worth as much as $400. If you are using a program on multiple computers, you must have a copy or a license for the multiple use. Companies such as Microsoft allow you to buy the network licenses for less than purchasing several copies of the same software. Also, in some cases, if you intend to share files, they will not work unless the software is set up for a network. (Note: A new operating system called Linux is now available, but as of yet, there is no stable dental application for it.)
In larger offices where eight or more computers are networked (a number not etched in stone), a central computer manages all of the others. In addition, this computer typically contains the main data file (database) which, in dental software, is the patient file data. This is called the "server." You must exercise great care when buying this unit. If you go to a large computer company, asking for a price and configuration for a server, the company may have special units that can handle not only eight, but 800 computers. A server can cost over $5,000, depending on the configuration. In a large corporation, where the computers are the business, if the server goes down, they are out of work. In the dental office, if the server goes down, you still can work, but delays might occur in processing bills, appointments, insurance information, and adding images to the patient files.
In a typical "server" configuration for a company, several backups and fail-safes are built in, and the machines are built for giant workloads and great speed. Complex administrative and security tasks also are assigned to the system. Think of a large law practice where several people are typing, printing, and doing research at the same time. If the server went down, work would come to a screeching halt.
File confidentiality also is critical. When deciding on the complexity of the server, you must think about the importance of your centralized computer system in the practice. If the dental practice is totally dependent on the system, then the typical "server" may be important. However, for the average smaller practice, the server can just be a high-end, high-capacity computer. In some instances (check with the practice-management company), the server also can be used as a workstation, saving on the cost of one extra computer.
The server in any of the configurations has to have a program to let it manage the other computers. In small networks, Windows 98 actually can do this. For more complex needs, you will have to go to Windows NT, which will be called Windows 2000 in its next incarnation.
Explaining the configuration of Windows NT goes beyond the parameters for this article; however, a few basics can be presented. The server can run on Win NT, but the workstations still can operate on Win 98 and even Win 95 instead of using WinNT on all workstations. The practice-management company will have to outline the precise configuration that it deems necessary. WinNT (2000) is much more expensive than 98 and multiple licenses must be purchased, depending on the number of computers in the network. A novice or even a dentist with reasonable experience should not attempt this setup. Also, as a word of warning, many "off-the-shelf" programs will not run under NT (although Windows 2000 promises to be more universal).
Much of the safety of the server is related to the backup system. In most office configurations, one of the computers on the network could act as the server temporarily, if the main unit was down or being repaired. When setting up the network, this must be addressed at the beginning. We all know that a hard drive is going to "crash" at some time. Everyone who has experienced this is now an expert on the backup process. Of course, these new "experts" have gone through an agonizing and fairly expensive time of trying to (or, in some cases, not being able to) restore lost data.
Computers will fail due to external factors (power surges, lightning, operator error), internal factors (component failure), or will just wear out. You lube your handpiece and replace turbines at regular intervals. What about the computer, the backbone of your receivables, insurance information, and now, digital imaging?
You must have a rigid backup protocol! You can do your backups on tape, floppy disks, zip or superdisks, CD-R, or other media. These must be removed from the office daily and periodically should be verified or replaced. Although many of the tapes or disks are guaranteed for a lifetime, it is inexpensive to get new ones after a couple of months and archive or store the oldest ones. You also can back up the data by copying the files from one computer to another (in addition to the mirror described above). An evolving technology allows backup to a Web site, but it is somewhat slow, costly, and limited at the present time. The key words here are "present time."
The original programs installed on your computer do not need to be backed up daily. However, the original disks should be kept in a safe and known place - preferably off site - in case of disaster. Each of these programs has a data file, which is the one that changes and has to be backed up. Make sure you know what and where these files are! In addition to your management software, you also will have other programs - such as Quicken, Word, and others - which are not part of the dental programs. Be sure these programs are included in your backup schemes.
Ideally, there should be a periodic backup of the whole system. The problem, though, is that we now have multi-gigabytes of information, which takes an extraordinary amount of time and a lot of media to back up. Each office has to decide on its comfort level in this regard.
The first line of defense against problems is eliminating a common failure scenario - power fluctuations and outages. Every computer should have a "UPS" - a battery backup, uninterrupted power supply. APC, Tripp, and Blackout Buster are common brands. The higher-end units have line-filtering and backup times varying from five to 15 minutes. Some have software (requiring a cable attaching the computer to the UPS) that will automatically shut the computer(s) down in case of a power outage. This is a critical feature if you leave the computers on overnight. If the power outage occurs at night and lasts awhile, the computers eventually will shut down when the battery is exhausted. Then, when the power comes back on, everything is rebooted with no one around to monitor that. If there are multiple-outage on/offs ? as can happen during storms or other interruptions ? the hardware and the software could be damaged. The shutdown feature has names such as Smartups, Power Alert, and Power Chute. Auto-shutdown features are found on the better models of the UPS units.
Back up to tape
This is the simplest and least expensive system. The new tape drives and tapes can handle the multi-gigabyte storage needs. The easiest ? and least efficient ? system is a drive that plugs in to the back of the computer (parallel or printer port). Others connect to USB, SCSI, or internal cards, or are, in fact, installed directly into the computer. The down side of the latter is that if that computer goes down, the restore system is inside. If you decide to buy a SCSI tape backup, be sure it includes a SCSI card for your computer ? and then make sure you install it!
Old hard drives
After you upgrade, you may find yourself with an old computer with a smaller disk drive (540 or 850 Mb or more). Although the computer may be obsolete, kits are available that allow you to put the old hard drive into a case that connects to your printer/parallel port for additional and fast backup. The kits are around $50.
If the data you are backing up is in the 100-Mb range, then one of these disks could be helpful. Zip drives come in 100 and 250-Mb configurations. The Superdisk is 120 Mb and HiFD is 200 Mb. The latter two drives also can read regular floppies. The Zip drives have been around the longest and are closer to universal, although none of these removable drives have great capacity.
The bigger disk is the Jaz drive, which is 1 GB or 2 GB. These drives and disks are very expensive, but will handle the larger data. Although slower, I would recommend the external drives. If the main system goes down, the external drive can be plugged into another computer and get the system running in a short time.
The newest and most promising system is from Castlewood, called the ORB. This is a 2.2 GB removable-disk drive, with the media itself costing about $20 per disk. If the ORB becomes more universally accepted, this could be the ultimate in backup and actually may replace the floppy drive on most computers.
These units are capable of storing 640 Mb on one CD. The CD-R disks are under a dollar, so this is the most cost-effective setup for large backup. An external drive in this case is impractical and too slow. The compromise is to put the CD-RW drive on one of the computers in the network that is not on the server.
One minor problem exists with this backup ? some of the older CD-ROM drives cannot read the CD-R disks. Just make sure that at least one of the other computers on the network has a newer CD-ROM drive. The CD-RW disks are more expensive, but can be used over and over. Be sure and check the CDs you have used periodically to see if they still are functional. If they are not, throw them out and replace them.
Although quite technical, this article should serve as a resource and an aid. As you are given confusing lists of specifications from dental companies, keep this information nearby. Remember, though, that all of the specifications are subject to change by the time this article goes to press in the fast-paced world of computer development.
For more information about this article, contact the author at email@example.com.
Feuerstein, DMD online at