Download Stability, longevity, and predictability in your practice

TECHNOLOGY
Stability, longevity, and predictability in your
practice management technology
Drs. Shalin R. Shah and Ryan K. Tamburrino discuss the benefits of a high-quality practice
management system
Introduction
Orthodontists have the wonderful ability —
and equally important responsibility — to
provide each patient with a lifelong healthy
smile. We achieve this goal through proper
diagnosis and treatment planning, thereby
affording the patient a smile that is stable,
long-term, and based upon predictable
treatment. We strive to achieve these three
pillars for everyone we see and treat; it can
be argued that our patients expect us to
deliver on all three as well.
Our ability to deliver that smile relies
upon an environment that also consistently
delivers. For example, the equipment we
use — including our bracket systems and
wires — must be reliable and accurate. Our
staff must be competent and dependable.
The same applies for the technology we
Shalin Raj Shah, DMD, MS, received his
Certificate of Orthodontics and Masters of
Science in Oral Biology from the University
of Pennsylvania and is a Diplomate of the
American Board of Orthodontics. He is also
a graduate of the University of Pennsylvania College
of Arts and Sciences and School of Dental Medicine.
Currently, Dr. Shah is Clinical Associate of Orthodontics
at the University of Pennsylvania and is in private
practice (Center for Orthodontic Excellence) in both
Princeton Junction, New Jersey, and Philadelphia,
Pennsylvania. Dr. Shah currently does not consult or
speak on behalf of tops Software. His involvement
with tops Software is limited to being their customer
and being an avid supporter of their team, vision, and
products/services. Dr. Shah has no financial interest in
the company.
Ryan K. Tamburrino, DMD, co-founder of
the Center for Orthodontic Excellence,
graduated from Duke University with a
double major in biomedical engineering and
mechanical engineering/materials science.
He attended the University of Pennsylvania for dental
school, as well as for specialty training in orthodontics.
Dr. Tamburrino is on faculty as an attending clinician
in the graduate orthodontic clinic at the University of
Pennsylvania. Additionally, he is on faculty and lectures
internationally/nationally with the Complete Clinical
Orthodontics (CCO) courses. His involvement with tops
Software is limited to being their customer and being
an avid supporter of their team, vision, and products/
services. Dr. Tamburrino has no financial interest in the
company.
44 Orthodontic practice
Figure 1: An easy-to-use user interface for essential data entry. The authors have significant experience with topsOrthoTM,
which possesses sound design and stability
employ in our offices. Each of these components builds a trustworthy and efficient
system, and that system must consistently
perform and meet expectations. This enables us to predictably execute our treatment and deliver those stable, long-term
results that patients expect.
In our extensive orthodontic education,
we are exposed to many concepts and
techniques. But many orthodontists would
agree that technology and business/
practice management education could be
stronger. Orthodontic residencies — and
education as a whole — are burdened with
the challenge of sharing and teaching an
ever-increasing amount of information in
a finite amount of time. This is in part due
to the growth of technology. Therefore,
when a practicing orthodontist chooses
a technology solution, that technology
must be reliable and require minimal
troubleshooting. It is even more beneficial
if our critical business and practice
management needs are integrated and
supported by the latest high-quality
technology and reliably delivered. This
is what topsOrtho™ and other practice
management software programs do —
and do well.
There are many high-quality practice
management software programs, but the
authors have routinely used topsOrtho
and have learned from experience that
this technology possesses all of the critical
attributes and more. This software will
serve as the model for this article.
Practice management technology
expectations
Orthodontists often see practice management software as somewhat of a digital
Rolodex for patient information, while also
maintaining the ability to electronically
annotate
treatment
provided
and
providing some statistical information
on the practice’s performance. These
are reasonable expectations and are the
essentials of any practice management
solution. However, in an age where data
is more than names and numbers, it
is important to expect more from your
“electronic Rolodex with notes.”
Data is king in the database world. Dr.
John H. Holmes, a clinical epidemiology
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TECHNOLOGY
Figure 2: Database queries and report generation are essential tools in data analytics. Proper database design allows a host of data compilation
possibilities
Figure 3: Data reports evolve with time, and with the needs of a practice and the profession. Practice management systems should be able to generate new
reports easily and effectively, especially in an era when new technology advancements necessitate different types of data interpretation
professor at the University of Pennsylvania,
told his students in the introductory class,
“You will never view data the same … and
you will learn the difference between data,
information, knowledge, and wisdom.” Data
goes beyond regurgitating information on
demand; it is the source of what we know,
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helps derive understanding in what we see,
and serves as a cog in the sprocket of
more complex thoughts and hypotheses.
A practice management system is a
carefully planned collection of data and is
appropriately called a database.
Databases are created from well-
thought-out models and based upon
entities and the entities’ attributes. The
technology’s realization and usability is
derived from its competent engineers
and architects, as much as it is from
the repeated end-user satisfaction and
success. Of course, most of its success is
Orthodontic practice 45
TECHNOLOGY
Figure 4: With technology advancements, our methods of interaction with data are constantly changing. Ubiquitous data
access across multiple platforms enables the orthodontist, practice, and patient to benefit from timely solutions
predicated upon seamless and uneventful
data entry and retrieval (Figure 1). However,
database stability and robustness, as well
as queries and report generation (Figure 2),
are equally essential. When evaluating the
right practice management system, these
all are important factors to consider.
Database stability provides a reliable
interface to access your data, which is
important in a thriving and demanding
orthodontic setting with multiple users.
Database robustness allows scalability
of the model as future needs arise and
technology evolves. Robustness is
important in an age when platforms and
our daily needs are changing. Queries and
report generation are equally important, if
not more so. They enable us to analyze our
data with regard to practice performance
and efficiency. A database that is properly
structured also allows different reports to
be generated and tailored to the needs of
the orthodontic practice (Figure 3).
These are some of the critical elements
that you should expect from your practice
management software.
Demand more
The concept of Moore’s Law originated
around 1970. The simplified version of
this law states that “processor speeds, or
overall processing power for computers will
double every two years. To break down the
law even further, it specifically states that
the number of transistors on an affordable
46 Orthodontic practice
CPU will double every two years.”1 At the
time, critics said that was not possible or
likely, but nowadays the rate is doubling
almost every year. Similarly, practice
management software and technology
should be growing with the times and with
the rapid changes in platform software
and hardware capabilities. Part of today’s
practice management growth begins with
data being ubiquitous.
Data accessibility across multiple platforms (for example, laptops, smartphones,
tablets, and so on) enables the orthodontist
to quickly access and comprehensively
review necessary background on a
patient or situation, then provide informed
solutions (Figure 4). In turn, this allows the
patient to have shorter turnaround times
and allows the orthodontist to address
matters promptly. Prompt service is
always a positive contributor to growth
and is essential in the equation of good
business practices. There are multiple
mechanisms by which data can be made
globally accessible, but we are going to
briefly focus on two of the more commonly
discussed ones.
Public or private clouds? Dr. Mark
Sanchez, orthodontist and founder of tops
Software™, has extensively researched
this topic and has live data points over
the last decade that illustrate the strength
of private clouds in our profession. To
begin the framework of this discussion,
it is important to understand the concept
Figure 5: topsEcho effectively implements the efficiency
and data security of private clouds
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TECHNOLOGY
of elasticity, an important facet of public
clouds. National Institute on Science
and Technology defines rapid elasticity
this way: Capabilities can be elastically
provisioned and released, in some cases
automatically, to scale rapidly outward and
inward commensurate with demand.2 In
the evaluation of an orthodontic practice,
it is evident that the workload is relatively
constant.
An article in Wired published in
August 2013 features an entrepreneur by
the name of Eric Frenkiel, who founded
MemSQL, a tech startup. In the interview,
Frenkiel discusses his company’s use of
Amazon’s cloud (public cloud) and delves
into analytics on the pros and cons of
private clouds. He reveals that, as the
company adds more servers, MemSQL’s
server costs “won’t come anywhere
close to the fees it was paying Amazon.
Frenkiel estimates that, had the company
stuck with Amazon, it would have spent
$900,000 over the next 3 years. But with
physical servers, the cost will be closer to
$200,000. ‘The hardware will pay for itself
in about 4 months,’ he says.”3
This is only one example presented,
but it delineates some important points.
Our profession’s needs align better with
the benefits of the private cloud, and
practice management solutions employing
this technology and that thought process
can transfer cost savings to the end users.
Another important aspect of cloud
computing is data security. Wired features
another article that states the concerns
about security in public clouds. “The truth
of the matter is that many enterprises
and government agencies still question
the privacy and security of public cloud
services. ‘This level of control is very
important in regulated industries: financial
services, and healthcare,’ says Michael R.
Overly, a lawyer with the international firm
Foley & Lardner LLP.”4
Privately owned servers that support
private clouds demonstrate an ideal fit for
the orthodontic profession, while serving
the needs of ubiquitous data and our
increasing demands. topsOrtho employs
private clouds and has successfully
implemented data access across multiple
platforms in a stable and efficient manner
(Figure 5). The topsOrtho team has also
been able to interface this private cloud with
other technologies, such as web patient
portals, thereby enhancing the strengths
and offerings of the practice management
software. Ultimately, data accessibility
48 Orthodontic practice
When a practicing orthodontist chooses a technology
solution, that technology must be reliable and require
minimal troubleshooting. It is even more beneficial if
our critical business and practice management needs
are integrated and supported by the latest high-quality
technology and reliably delivered.
across multiple platforms enables the
orthodontist to properly prepare for
emergencies, schedule changes, and
so on at a moment’s notice. In turn, this
enables a more efficient system that begins
with you, the orthodontist.
The rate limiting factor
Software can only be as dependable as
the platform on which it runs. This article
will not serve as the forum for the pros
and cons of different operating systems.
However, it is noteworthy to discuss that
a strong practice management software
can only deliver on a functioning operating
system. If the operating system fails to
achieve consistency and maintain stability,
the potential and great deliverables of the
practice management technology will be
compromised.
Key points
In Walter Isaacson’s biography of Steve
Jobs, he includes an interesting story
about Jobs’ adoptive father.
“I thought my dad’s sense of design
was pretty good,” Jobs told Isaacson,
“because he knew how to build
anything. If we needed a cabinet,
he would build it. When he built our
fence, he gave me a hammer so I
could work with him…” He said that
his father refused to use poor wood
for the back of cabinets, or to build
a fence that wasn’t constructed
as well on the backside as it was
the front. Jobs likened it to using a
piece of plywood on the back of a
beautiful chest of drawers. “For you
to sleep well at night, the esthetic, the
quality, has to be carried all the way
through.5,6”
A high-quality practice management
system needs to possess the same
characteristic: The usability, esthetic(s),
and quality has to be carried all the
way through. This results in practice
management technology that maintains a
stable environment with predictable actions
and allows longevity of data entry, retrieval,
and scalability. In turn, we can focus on
the smiles and smile because our practice
management technology and team have
the right focus.
Acknowledgments
The authors thank and acknowledge the
continued efforts of Dr. Mark Sanchez,
Kirsten Lambert, and the tops Software
team. They were instrumental in providing
the necessary graphics and openly
discussed any and all questions on their
product and services.
REFERENCES
1. Moore’s Law.org. Moore’s Law or how overall
processing power for computers will double
every two years. Available at: http://www.
mooreslaw.org/. Accessibility verified December
23, 2013.
2. Mell P, Grance T. US Department of
Commerce. The NIST Definition of Cloud
Computing. Recommendations of the National
Institute of Standards and Technology. NIST
Special Publication 800-145. Published
September 2011.
3. Metz C. Why some startups say the cloud
is a waste of money. Available at: http://www.
wired.com/wiredenterprise/2013/08/memsqland-amazon/. Published August 15, 2013.
Accessibility verified December 23, 2013.
4. Metz C. Amazon’s invasion of the CIA is a
seismic shift in cloud computing. Available at:
http://www.wired.com/wiredenterprise/2013/06/
amazon-cia/. Published June 18, 2013.
Accessibility verified December 23, 2013.
5. Panzarino M., Steve Jobs’ obsession with
the quality of the things unseen. Available at:
http://thenextweb.com/apple/2011/10/24/
steve-jobs-obsession-with-the-quality-of-thethings-unseen/. Published October 24, 2011.
Accessibility verified December 23, 2013.
6. Isaacson W. Steve Jobs. New York, NY: Simon
& Schuster; September 2013.
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