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Moving Your Office to the Cloud Craig E. Scholz, PhD

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by Craig E. Scholz, PhD

Stop me if you've heard this one before… It's a busy Monday afternoon in your office when your office manager tells you that your server is getting error messages because it is running low on drive space. You immediately contact your IT person (which in many cases is you) to discuss your options. After exploring these you decide to purchase a new server, updated operating system (OS), Sequel Server (SQL) and backup device with software and antivirus. You find out you will also need to upgrade the SQL on all your workstations and will need new versions of several Microsoft products to support the new server. This will cost you two down days, some additional training and more than $15,000. You're not happy about any of this, but you almost blow a gasket when you find out that more than half of this cost is for "software." You drive home questioning how needing more space on your hard drive ended up costing you $15,000!

How happy would you be if you never had to go through this scenario again? An increasing number of small business owners have been delighted to leave behind their in-house servers and IT support by moving to the cloud. So many in fact, that Gartner (www.gartner.com) predicts more than half of all software will reside in the "cloud" by 2014. And while a move to Internet-based computing is not a panacea, it has enough upside that many orthodontists are tallying up their IT costs and headaches and making the move. This article will discuss the pros and cons of cloud computing and will educate you on some of the primary variables involved in this widespread transition from in-house servers to true Internet-based computing.

What is Cloud Computing?
There are about as many definitions of cloud computing as there are orthodontic appliances – but in its basic sense, cloud computing is location-independent computing, where shared servers provide resources, software and data on demand. Instead of storing data in your office, it resides in an off-site facility that serves, maintains, updates and backs up your files. These services are provided with monthly service fees just like your Internet and telephone services. In essence, you lease these IT services rather than purchasing them. In many ways, cloud computing is a natural extension of the expanding Internet and amounts of data accessed and stored across the globe. Data-hosting facilities house hundreds and even thousands of processors and are certified at increasingly stringent levels called SAS levels. When IT is outsourced to the cloud, the end user no longer has to have the expertise to set up and maintain his or her computer infrastructure.

Cloud computing provides a delivery model of IT services based on scalable resources, so it is easy to add storage, users and other features. Software generally takes the form of applications the user can access through a Web browser or local client, just as if the full system were installed locally on his or her computer. Cloud computing actually began in the late 1960s with the advent of large supercomputers and is designed to follow a model much like the distribution of electricity and other utilities. Instead of purchasing your own generator to create power when you move into a home, you buy it from the utility company which produces it in great volume. Similarly, by centralizing servers and data processing, new levels of efficiency and optimization are reached in the cloud. Many orthodontists are already using existing cloud computing applications such as Google, Facebook, iWork and others.

Cloud computing has been growing at exponential rates over the last several years, with Gartner declaring it the number-one new technology for 2010. The Wall Street Journal recently reported that the cloud computing industry is estimated to reach $42 billion by 2012 – nearly half the entire software business. Significant changes have occurred over the last several years with orthodontic computer usage as well. Today's orthodontists manage all kinds of patient data, and increasingly their patients and referrals demand access to this data as well. It is not uncommon for an orthodontic office to require access to management data, 2D and 3D imaging, electronic treatment records, appointment confirmation and online patient access – all from multiple locations. Many doctors, patients and referrers also increasingly need this information on mobile devices as well, and these devices are burgeoning with social networking applications such as Facebook and Twitter. Cloud computing dramatically opens up the availability to all this data.

Benefits of the Cloud
The main driving force toward cloud adoption is the same across all business, namely decreased costs and greater efficiencies. By outsourcing servers, software licensing and other expensive IT to a data center, businesses can decrease their bottom line and move away from the complexities of maintaining their networks. And while the reduced cost of an Internet-based system might not be as great for the orthodontist as it is for IBM, consider your IT spending over the last three years. Typical orthodontists spend between one to two percent of their revenue on computers and IT (and much more at startup), but many orthodontists are shocked to see the actual amount on their yearly P&L. And in many cases, cost is secondary to the elimination of the regular maintenance, backups, software updates and upgrades. Outsourcing your IT can be a relief to your wallet and also to your psyche. But remember that cloud computing will not completely eliminate your IT costs or your need for IT support. Unless you are skilled and enjoy purchasing, installing and maintaining your computers, you likely will still need a network administrator.

Is accessing your office data like trying to reach patients in retention? With cloud computing's more centralized and open platform, you can access your system anywhere at anytime. Since all of your data is available 24/7 in a data facility, remote offices, home locations, remote locations and mobile devices are all accessible to the same database. This benefit is especially significant for larger offices, which currently are forced to use a variety of servers and software systems to connect. Cloud computing eliminates this issue by only requiring an Internet connection.

Since data is stored on servers in the cloud, it is easy to expand and upgrade as you go. Using our previous example, let's say that you run of out of drive space on your existing server. Instead of upgrading or replacing it, in the cloud you just pay for more space.

This is true for many aspects of computing including additional capacity, speed, processing power and user access. Costly software licensing fees are eliminated as the systems are centralized in the cloud.

Limitations of Cloud Computing
Do you get frustrated when you are at home checking your bank activity and you lose your Internet connection? Imagine if your practice management system went down on an August afternoon! The jump to cloud computing means that you are completely dependent on your Internet connection, which can be a scary fact for some users. While all major service providers guarantee "uptime," you should be sure to check your local providers upload, download and latency speeds and history before signing up (you can test your broadband speeds easily at sites such as www.speedtest.net). One way to reduce your Internet anxiety is to employ a secondary connection such as a cellular router. These devices are inexpensive and allow for a stable Internet connection that can run at relatively fast speeds – currently up to 4G. In order to move to the cloud you need to feel confident that your Internet provider has fast and stable service. Without this, your daily mood might run in parallel with the status bars of your Internet connection.

In the news section of your homepage, you are likely to read stories about Internet security issues on the Web at least once a week. Survey data indicates that the biggest resistance to Internet-based computing today involves fears around security. Clearly, health-care data security is essential, and most companies with cloud offering and services include detailed SLA (security level agreements) that document in great detail how your data is stored and made accessible to you. In addition, some cloud-based systems employ "smart clients" rather than browser-based clients. While not as ubiquitous as a browser, a smart client provides much better security and in many cases, significantly improves the browsing experience. Finally, systems that manage highly sensitive data often run on "private clouds" where information is not shared with other customers and is often compliant with HIPAA standards.

A final limitation to cloud computing is the lack of integration with third-party products. We often hear about the thousands of apps that are being developed each week for our mobile devices, but few of these have any relevance to an orthodontist. Most orthodontic offices rely on software programs to run their offices, and currently many of these systems only offer a local solution. This is changing rapidly however, as new software is being developed to integrate cloud systems together, and the latest systems are being written directly on cloud-based platforms. While this is likely to be the case for some time, the development of large scale business apps such as Google apps, increases the likelihood that orthodontic systems will replace desktop-based software with cloud substitutes.

Should I Move to the Cloud?
The answer to this question depends on many factors and should be evaluated by each orthodontist in his or her particular situation. Questions such as: "Can I get fast, reliable Internet service?","What are my current IT costs?" and "How much time does it take maintaining and servicing my current server and IT?" should be addressed. In some ways the move to the cloud computing is based on the belief that this is the direction computing is going. You certainly would not want to spend $50K to outfit a brand new office with technology that could be outdated soon. On the other hand, although it is growing rapidly, cloud computing still runs a minority of small businesses and will require more time to become fully mainstream. The U.S. is improving but still lags far behind in broadband speeds (Japan averages almost 20mbps (mega-bits per second) up and down compared to less than 2mbps in the U.S.) which will undoubtedly push more and more consumers to the cloud. But ultimately, the decision to move to the cloud must be based on the orthodontic practice management software behind it – some of which have greatly reduced functionality. Just because software runs in the cloud doesn't necessarily make it good.

Last December I attended the ninth annual Dreamforce cloud computing conference in San Francisco. It was difficult to get a hotel room as more than 40,000 attendees participated in the conference, which included a keynote by former President Bill Clinton and a concert by Stevie Wonder. The most memorable moment of the conference for me occurred on the rainy streets of San Francisco on the first day. In protest of the new cloud computing platform, Microsoft had sent dozens of employees on scooters to pass out anti-cloud propaganda (including umbrellas) to the attendees. At one point several of the pro-cloud supporters began pushing, yelling and fighting with the Microsoft employees! The police soon arrived but not before a literal battle over the cloud had transpired. It seems that the hype surrounding cloud computing has reached a pitch in much of the business world as the old guard of software platforms are being replaced by new ones in the cloud. And like any other quickly ascending technology (i.e. iPads, TADs, 3D imaging) the truth probably lies somewhere in the middle. While cloud computing won't solve all of your problems there is a great deal of evidence to suggest it is worth a good hard look.

It might not be time for every orthodontist to jump to the cloud, but it is apparent that cloud computing is here to stay. Most data points to the stable growth of this new technology and more and more applications and systems are being built for the cloud. Across the world we see a dramatic rise in mobile devices, social media and on-demand technology. Certainly the world is becoming more connected through these devices and systems. Cloud computing offers similar promise with its centralization and open platform. In a perfect world, cloud computing would be as reliable as the electricity in your house. Until then, consider where you fall on the early-/late-adopter curve. While it might be some time until cloud computing reaches such a level of reliability, remember that only 15 years ago it was hard to imagine you would manage most of your personal finances through an Internet browser. Today it is hard to imagine actually going to a bank.

Author’s Bio
Craig Scholz, PhD, is the director of emerging technology at Ortho2 and owns two dental imaging centers in Southern California. He can be reached at cescholz@ortho2.com, or visit www.ortho2.com for more information.
Orthotown Magazine
September 2025
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