Patient Records into the Clouds?

I know many people have heard of "The Cloud". This is an emerging technology that seems to be the "way" of doing business. I was wondering if practice management software or imaging software could embrace "cloud" technology. Looking into DentistryIQ.com , I came across such software.

New Web-based digital imaging technology allows dentists to capture images directly to the cloud

http://www.dentistryiq.com/index/display/article-display/3380096759/articles/dentisryiq/products/technology/2011/08/curve-digital_imaging.html



What is cloud technology?
As Wikipedia (http://en.wikipedia.org/wiki/Cloud_computing) writes :
"Cloud computing provides computation, software, data access, and storage services that do not require end-user knowledge of the physical location and configuration of the system that delivers the services. Parallels to this concept can be drawn with the electricity grid, wherein end-users consume power without needing to understand the component devices or infrastructure required to provide the service"

(Image Courtesy from Wikipedia's webpage on Cloud Computing)

In laments term, you do not need to worry about the investment and cost of physical assets as well as maintenance. All you need to know is how to access and utilize your data. Cloud computing is over the Internet. I think of those old mainframe computers as cloud computing in that the clients are nothing but dummy terminals (except that it is over the Internet and resources do not necessarily need to be mainframe computers).

Why is this significant?
Dentists are mostly K.I.S.S. type of people. The acronym stands for Keep it Simple Silly (the last S could be different with varying people). Dentists like to keep their operation smooth and clean. Taking the responsibilities of hardware and software purchase and maintenance off their plates, they would focus on their operations (business practices) and minimize cost.

As Curve Dental emphasizes:
"Using the cloud to capture and store patient images helps eliminate the need for a server, affords unlimited storage and a proven backup and business continuity solution, and provides the dentist with access to the data from any computer with Internet access."

As the article points out, the imaging software allows the office to acquire image acquisition with digital x-ray sensors, intraoral cameras, and panoramic/cephalometric equipments. As they stated:

"Switching to our software shouldn’t require the dentist to invest in new digital devices; that is our goal."

With the software being upgraded, maintained, and supplied by the Curve Dental, you would think it is a "no brainer" right?

Peter Parker's quote comes back again to our conversation. We have to consider the cost of technology:
1) Benefits and rewards
2) Responsibilities (including Disaster Plan and Politics)
3) Process

Benefits and Rewards:
I do not see any issue since it eliminates the need to purchase, maintain, and upgrade software. Also, if the cloud provider does what is expected, your data should be protected in case of disaster. There is a lot of pluses there

Responsibilities:
1) Various State, Federal, and International Laws:
Why I address this dictates how compliance are being met by Curve Dental (or their subcontractors). Since clouds are to meet compliance laws depending upon operation location and use. How are prevailing compliance laws implemented and mandated. Like I stated, is the data stored outside the USA? How are the data being backed up and security compliance in who has access to your data?

2) How does the Imaging Software works in correspondence to Practice Management Software (PMS)?

There is a terminology in the dental world called "Seamless Technology". This means does the PMS work bi-directional with the Imaging Software. Both software utilize the database(s) to perform various functions that otherwise would not when they bridge database or are standalone. Meaning, the patient name and their corresponding relations could work from PMS to Imaging or Imaging to PMS (Compare to Standalone, you need to have to separate databases that has no relations. Bridge has few relations and usually one directional; from PMS to Imaging.)

As Curve Dental stated:
"Because our imaging software is ‘native’ to our practice management software, it is more efficient and more stable than an integrated or bridged solution,” said Dorey. “‘Integrated’ or ‘bridged’ solutions equate to separate databases, separate sources for technical support and two applications that may work and look differently from each other.”

Meaning:
To have seamless integration, you need to switch out your PMS to their software. There is a cost in data conversion (let alone training and process changes to practice operations). This is a hidden cost to working the way you want it to work. Note, this has the same question and concern in terms of process

3) (Since we are talking about Imaging Software,) What Equipments will work?
They state they are compatible with many digital equipments but they do not list all equipments. When switching, we have to truly see and verify your digital equipments will work (and work the way the equipments are suppose to work.. This is a big emphasis on intraoral cameras and their buttons to capture/retake/save). TWAIN drivers are a solution but not all equipments are TWAIN capable. Again, with the industry taking sides, what type of relationships does Curve Dental have with the various vendors (and will they be willing to work with them in the future).

Emerging in the Dental Industry is the acquisition of 3-D Images (especially for oral surgeons) which utilizes manufacturers' software and drivers (in some case, their own acquisition machine and their own proprietary image format). How does the software handle these acquisition brings the question of going to the cloud completely or not. Note, we address the size of data later.


3-D Image Acquisition of Patient (Courtesy of Imaging Science iCAT)


Software Analysis 3-D of Patient Face (Courtesy of Imaging Science iCAT)


4) Security and Standards including Internet Data Transfer & Data Size
The important question is how are they are compliant to various health standards (HIPAA, Red Flag) and how are data secured over the Internet (Encryption, VPN, etc). That is a big and obvious question. Even if they answered the question, how are they managing user rights and security for each employee in an employer as well as guidelines when Internet goes down. When you take an x-ray, does it get saved on the machine locally and then to the Internet (process of the software)? Or if you lose connection, you lose the data image and have to retake? How much data compression do you have especially when 3-D Image (if possible to send) could be anywhere between 50MB to 100MB?

To Hit the point: How does the office function when the Internet is down? What is the contingency plan?

5) Cost of the Software
Since it is a subscription based, you are going to pay monthly. How much do you save (short and long term) in comparison to owning your own equipment and data? Subscription based on data size (images will add up and accumulate over time)? Data Conversion (what part of the data stays the same? Primarily accounting and ledger in correspondence to transactions) and its price? Support Cost included with the subscription?

The main point here is to look at the Doctor's vision and see if Cloud is really advantageous (especially if their Internet connection is sporadic or down.. T1 Lines needed and how much more for guarantee High-Availability)? Does owning the equipments consider cheaper comparing to "renting" the equipments?

Process:
How does your office function with the changes are involved. There are no distinct things to look at but general points to consider:

Is the learning curve and training easier?
What does the software allow me to take care (than the previous software did not) and not take care? (This deals with software interaction with the staff)
How are updates notified to the office?
Does the software work with other 3rd party vendor software (like electronic claims)


At the end, patient records are the dentists' livelihood. As a consultant, I want the doctor weigh the good and bad. Technology has many promises but it all deals with my sense of trust with the vendor and how the vendor deliver disaster recovery successfully and promptly. Also, I let it become more standardized and jump on board when all questions are answered to the expectations that my doctor and I desire (Never believe in the promises but the delivery)

How does this technology affect me? It gives another flavor of how to do business for the dentists. Practically, off-site data backup to the cloud seems very logical in terms of service. Also, cloud shows my company a directive to approaching our clients with value add and expertise in looking at the return of investment. Technology has grown in this industry faster than most people think. But technology is allowing the work of dentist (as well as my livelihood) to go faster to the speed of life..