LANs vs. IPD
By Charles A. Lewis
Originally Written July 2006; Updated June 2009
The June 2006 issue of Orthodontic Products contained Part 1 of a two-part article titled ‘The Computer Room; The new center of your office’ that can be found on pages 40-44 of the magazine. The article was written by Marc S. Lemchen, DMD, a board-certified orthodontist practicing in New York City who is also the founder of Dolphin Imaging and Management Solutions. The article, including Part 2 (and references) can also be read at http://www.orthodonticproductsonline.com/article.php?s=ORP/2006/06&p=8. The purpose of this informational report is to allow you to read Dr. Lemchen's article and then compare his remarks on operating paperless local area networks (‘LANs’) (which he uses and his company, Dolphin, provides) with the Internet Program Delivery (‘IPD’) services provided by my company, Advanced Ortho Systems, LLC (‘AOS’) for paperless practices.
I congratulate Dr. Lemchen on doing a good job of defining the problems orthodontists face in operating a sophisticated paperless practice using a LAN. He points out many of the difficulties (and the high costs) involved in operating these networks with all the appropriate systems and safeguards in place. He is also to be commended for honestly admitting that ‘I will likely never have that “dream computer room” I envision.’ That is because few (if any) orthodontic offices could ever afford to implement the systems and safeguards listed in his article and he didn’t even cover all the issues! A majority of offices with practice management programs confront the problems he discussed, since all the orthodontic software vendors (except AOS) offer their software only for LANs using an office-based server. Dr. Lemchen’s article gave no indication that Dolphin has anything ‘in the works’ to resolve these issues and I haven’t seen any of the other vendors offering solutions either.
This document addresses the issues mentioned by Dr. Lemchen (plus some additional important ones) and describes existing, proven cost-effective solutions for all of them. And the exciting part is that implementing and using these solutions actually costs less than what most orthodontists are now spending to operate local area networks without these safeguards and systems in place! To make it easier to compare this report with Dr. Lemchen’s article, I am listing the headings he used and then providing my responses under them. However, I am omitting individual responses to the subject matter contained under the following headings:
The reason for this omission is that the alternative solutions described in this document are based on the IPD services offered by AOS from its Los Angeles-based datacenter and those services make all the above (except cabling for office workstations) unnecessary. However, my summary will mention how those concerns are addressed by the AOS datacenter.
The FOO Factor
Dr. Lemchen calls the doctors’ fear of obsolescence the ‘FOO factor.’ In this section he points out that doctors should not be naive enough to think that they can install one system and one program that will serve their needs for the next several years. And for the most part, he is correct. For instance, the LAN is already obsolete and I believe that will be borne out by comparing the accurate LAN information in Dr. Lemchen’s article, with the factual IPD data provided in this document. However, where my attitude differs somewhat is in regard to purchasing practice management software. In my opinion, when a doctor invests in an expensive management program he/she should fully expect that software to be consistently maintained and enhanced (for a fee) so it is always on the ‘cutting edge’ of technology, no matter how advanced the changes become. I also believe that this same expectation should be applied to software delivery systems and all related services. This philosophy is demonstrated by my company’s continuous actions . . . it is not hyperbole.
Because the practice management software used for paperless operations must effectively control or manage all the various systems referred to in Dr. Lemchen’s article, the point will soon be reached where a need to change management software will cause a far more severe disruption in the practice than it does now. Therefore, in order to avoid having to switch, doctors should do a thorough ‘due diligence’ investigation before committing themselves to a particular company, software and/or delivery system!
Data-Center Location and Design
It is unnecessary (and impractical) to build a datacenter in the orthodontic office! My significant reasons for this belief are noted throughout this document. However, in the event that you do have an in-office data center, the issue I want to address here is the suggested fire protection mentioned by Dr. Lemchen.
Having fire extinguishers handy would certainly be one reasonable precaution (and required by most fire codes). However: What fire protection is provided during all those hours and days (a majority of the time) when the office is closed? I didn’t see any suggestion of a need for a security/fire alarm connected to a central dispatch system and/or to the fire department. And even if the office does have this warning system, the response/reaction times of the alarm company’s dispatch system and the fire department would be critical. In the event of fire, the server and its data could be destroyed within minutes.
Compare that scenario with the fire protection provided with the IPD service offered by AOS from its datacenter. The datacenter's multi-zoned, dry-pipe fire suppression system is monitored 24x7 by onsite personnel.
Another subject that I did not see brought up in the article was protecting patient records in the datacenter from theft. Not even a security alarm connected to a central dispatch system and/or to the police department was mentioned. But even if the office did have this safeguard, the response/reaction times of the alarm company’s dispatch system and the police department would be critical. Once inside, the theft of a file server containing all the patient records can take just minutes. And if the patient data had not been regularly backed up at the end of each business day and then removed from the premises to a safe location (and the backup is actually usable), the practice would have a potential disaster on its hands.
Again, compare that with the protection provided by AOS’ datacenter. Onsite personnel provide around the clock security; security cameras are located throughout the datacenter and monitored 24x7. Entry requires a pass and visitors are escorted by authorized personnel only after they have first been cleared at the guard station outside the datacenter. As a result, the possible theft of data from our datacenter is not a relevant issue.
Number of Servers
With IPD, no server whatsoever is required in the orthodontic office! Obviously, this also means avoiding the costs of creating a datacenter area with its expensive power and HVAC requirements. The practice management software and patient data (including images) are stored on powerful multi-processor servers in the AOS datacenter and delivered to office workstations via the Internet. Workstations can consist of PCs, thin client terminals, or Macs and the office network can use cabling, be wireless, or a combination thereof. And because all data processing is done on the datacenter’s servers, the PC workstations can be minimally equipped; fast processors, loads of RAM, and large hard drives are unnecessary, which means lower costs. (In Dr. Lemchen’s office, as he described it, IPD would eliminate 4 servers and a probable investment in the range of $25,000!)
Even if the practice has multiple offices, it still does not need a server. Workstations can connect to our servers from any location in the world, at any time, as long as a broadband connection is available. And all the workstations, no matter where they are located, work on the same patient database in real time, just as they would in an office LAN.
Backup
The hassle of daily system backups in the office is a thing of the past with IPD. Patient data is continuously backed up on multiple servers, storage devices, and media in the AOS datacenter; it is also backed up in offsite locations. In addition, at the beginning of each month AOS archives a copy of patient data for the previous month on a separate storage server for access whenever the client wants it. A second copy is archived by AOS at a location other than the datacenter.
What If …?
Dr. Lemchen listed several hypothetical situations and risks under this heading; he also mentioned one actual disaster: Hurricane Katrina.1 Yet every single one of these events is either completely dealt with by using IPD, or the risk is eliminated. Your data is available from the datacenter whenever you need it - no matter what happens at your location - and you don’t have to wait for it to be restored to a server somewhere. All you need is a PC, thin client terminal, or Mac and a broadband connection. And if you have been operating in paperless mode, all your data is instantly ready for use, including images.
Reality
Dr. Lemchen says, “To be sure, advising is easy; implementation is not” before making his comment about it being unlikely that he will ever have the ‘dream computer room’ he envisions in the article. In regard to operating LANs he is totally correct!
Implementing IPD operations is easy and, as long as you have suitable broadband available, IPD can be provided, with all its safeguards and security measures, no matter what type of building you are in. One absolute reality is that health records will soon have to be maintained in electronic form under requirement of Federal Law 2, 3 and LANs are already technologically obsolete because they do not allow the easy transmission, access, exchange, collation and/or aggregation of electronic records by patients’ multiple healthcare providers. A second reality is also made clear by reading Dr. Lemchen’s article: Doctors cannot afford to furnish all the safeguards and security measures required to fully protect these electronic health records!
Given these realities, why would a doctor want to make, or continue making, a large financial investment in an obsolete LAN when a completely superior method of program delivery is available with all the safeguards and security measures, and at a substantially lower cost?
Summary
AOS is in its 7th year of providing the described IPD services to clients located throughout the United States. Everything mentioned as safeguards in Dr. Lemchen’s article, and much, much more, is included with IPD services.
In addition to what has already been described, the following is provided by our datacenter:
As Dr. Lemchen’s article indicated, individual orthodontic offices probably won’t ever be able to provide all the safeguards he recommends for a LAN due to costs, and limitations in their office space. Yet these are the security measures that can eliminate an orthodontist’s anxieties about protecting his/her patients’ records. But Advanced Ortho’s IPD clients benefit from all these security measures because they are provided by our datacenter. And what is really remarkable is that compared to using a similar sized LAN without the safeguards, the total savings from using IPD over a period of 5-7 years can be as much as 50-60%!
In concluding, I want to refer to something Dr. Lemchen said in his opening paragraph: “We are now obligated to become, or hire, information technology (IT) experts to design, install, and maintain an ever-changing mountain of servers and switches and routers and hubs, webs of wires and cables, and a myriad of vital backup devices to deal with our new paperless digital practices—or risk the consequences of not doing so.” For LAN users that is an absolutely true statement, however: Advanced Ortho’s IPD services provide all that for the doctor!
1 Lewis, Charles A.: Could a Natural Disaster Ruin Your Practice? September 2005
http://www.advanced-ortho.net/articles/disaster.asp
2 Lewis, Charles A.: The Cutting Edge: The Advantages of Paperless Operation, Journal of Clinical Orthodontics, Pp. 299-305, May 2006.
3 Consider these two provisions from the Economic Stimulus Bill signed into law by the President on February 17, 2009: “The National Coordinator shall perform the duties…consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…facilitates health and clinical research…” and “The utilization of an electronic health record for each person in the United States by 2014.” From article, Economic Stimulus Bill Mandates Electronic Health Records for Every Citizen without Opt-out or Patient Consent Provisions.
About the Author: Charles A. Lewis is the Chairman and CEO of CPI Technologies Corporation and CEO of its subsidiary companies; Advanced Ortho Systems, LLC and Advanced Dental Systems, LLC. He has many published articles on paperless operations and practice automation. Charles lectures at seminars and colleges on increasing practice efficiency through paperless operation and on Internet-based delivery of management software. Orthodontists can contact him at 877.803.4412.