Is now the time to move your dental imaging solution to the cloud? While 90% to 95% of 2D and 3D image files are still stored on locally hosted servers the cloud is undoubtedly gaining traction in dentistry. In the coming years, many practices are likely to consider whether it’s time to retire that image file server in the back office. To help answer the question of whether to make the move from on-premise to the cloud I’ll attempt to provide a non-biased comparison of each solution.
Apteryx is uniquely positioned to provide a fair comparison because imaging software has been our main focus for 25 years and we offer both on-premise and cloud-based solutions. We have a very large installed user base on XrayVision®, our on-premise product. We also have a growing number of practices on our newer cloud offerings that were launched in 2016 under the brand names XVWeb® and XVWeb™ 3D. Whether you select one of our solutions, or find that a competitive offering is a better fit, we’re happy to provide our perspective and then back off and let you decide which path is best for your practice.
Cloud Versus On-Premise: A Simple Definition
Unless you’re a computer geek like me your first awareness of cloud computing probably came when Apple told you to set up this thing called an iCloud account in 2011. Since then “the cloud” has moved into our common dictionary but there’s still a lot of clever marketing and neat names being used in the dental industry. To be clear not everything claiming to be “cloud” is the real thing.
A favorite analogy comes from my own experience. In college I had a summer job building houses. One day my boss was showing off his new Ford work van at lunch time. He was excitedly explaining to us that the grill was titanium. Even at 19 years old I knew there was no way the grill was made from titanium which is a precious metal. It turns out the grill was coated titanium colored paint. Likewise, an IT consultant can move an on-premise imaging solution like XrayVision to a virtual server like Microsoft Azure or AWS, provide remote access with a VPN (virtual private network), and call it “cloud.” Going back to my analogy this is the technological equivalent of mistaking titanium for titanium paint. A “true cloud” application is designed to provide a fast-seamless user experience to any internet connected device. This is fundamentally different than accessing an on-premise solution from a remote desktop environment.
Here are three very simple concepts that define a “true cloud” solution:
- No on-premise server hardware – you don’t have to buy, or no longer need, that blinking computer in the backroom
- No systems maintenance – backups, updates, security, and troubleshooting are not your issue. Establishing internet connectivity to your practice is about where your IT responsibilities end
- Browser access – true cloud software is device agnostic. Whether you use a phone, a tablet, a Mac, or a PC makes no difference
This article compares on-premise solutions like XrayVison to true cloud imaging software like XVWeb and XVWeb 3D.
Comparing Cloud-Based and On-Premise Dental Imaging Solutions
Before comparing on-premise (also known as locally hosted) to true cloud imaging let’s establish working definitions for each.
On-Premise: Software is installed and running on a computer internal to your physical location. Image file data is also stored internally. A local network is required so that workstations in different operatories and the front office can access the program and the image files. No internet connection is required for daily operation of the software.
Cloud-Based: Software and data are stored external to your practice location typically in data centers with multiple redundant servers. A local network is not required as each individual device or workstation can access the imaging program independently via an internet connection (wireless devices may use a common Wi-Fi connection to access the internet – that’s different than the local area network required by an on-premise system with multiple access points in the practice). Access is gained via an internet browser making cloud solutions device or hardware agnostic.
The following table summarizes many of the features of on-premise versus cloud-based dental imaging solutions:
|Server Location and Storage||– Internal to the physical practice location||– External to the practice. Typically, in multi-computer data centers|
|On-Premise Access||– Via a computer or device connect to local area network||– Via any internet connected device|
|Off-Premise Access||– Requires separate remote connectivity software or VPN||– Via any internet connected device anywhere. Off premise interface and user experience is the same regardless of location|
|Data Backups||– Initiated by you or your IT expert at regular intervals||– Happen automatically and in real time|
|Data Security||– Provided by separate software or utilities. Configured and updated by you or your IT expert||– Provided as a function of the data center utilized. Updates occur automatically and deploy as they are rolled out|
|Updates||– Initiated by you or your IT expert||– Deployed automatically as they are released|
|Purchase Cost||– One-time upfront license purchase. After that you own that version of the software||– Recurring cost (typically a monthly subscription). If you stop paying you lose access|
|Associated C osts(1)||– Initial Set Up Fees(2)
– Image file server
– IT consulting fees
– Security Software
– Support fees
– Upgrade fees
|– Initial Set Up Fees(2)
|Scalability||– Best suited for a single location||– Accommodates multiple locations seamlessly|
(1) Excludes workstations or other devices to access the imaging data. On-premise and cloud costs should be comparable.
(2) May include location set up fee, data conversion, data bridge, and staff training
On-Premise or Cloud Dental Imaging: Technological Considerations
I promised an unbiased comparison which I’ve hopefully provided so far. Since I lead software development here at Apteryx, staying completely neutral is challenging. The fact that we launched the XVWeb cloud-platform in 2016 followed by XVWeb 3D in 2019 is an indication that we think there’s something important and compelling about cloud technology for dental imaging. I’ll simply provide the disclaimer that what follows is potentially biased by my view of where I see technology headed. My intention is to inform — not to sell one solution over the other.
Dental Imaging in the Cloud: A Natural Use Case
You’ll see cloud solutions being touted today for many industries and dentistry is no exception. For example, cloud based dental practice management companies are advertising heavily and are finally beginning to gain meaningful traction. And the benefits of the cloud for practice management have much in common with the benefits for dental imaging (no server cost, automatic backups and updates, enhanced security, etc.).
If the use case for dental practices to move non-image data to the cloud is good, the use case for cloud imaging is that much better based on one key factor — file size. After 10 years in practice your accounting and scheduling data might grow to 500 megabytes. Over that same time frame imaging data could require 10 terabytes of storage or more. Furthermore, those images are patient records that must legally be maintained for seven years. Keeping that amount of information secure, for that long, without breaking the bank for additional servers to store that data, is just a natural value proposition for the cloud. The greater adoption of high-resolution 3D cone beam images will simply accelerate and amplify the value proposition to have your imaging in the cloud.
Scaling your imaging solution for multi-locations is also much easier in the cloud. On-premise imaging solutions simply aren’t designed to accommodate the needs of DSO’s and multi-location group practices. We have a terrific white paper on this issue at Apteryx.com about American Dental Partners, a DSO that opted for the cloud when faced with replacing and maintaining 340 on-premise imaging servers.
Data Center Quality
Cloud providers host their applications in remote facilities with hundreds of interconnected powerful computers or servers. A high-quality data center provides security and redundancy that you’ll never be able to match in an on-premise installation. The biggest cloud services like Amazon (AWS) or Microsoft (Azure) don’t kid around when it comes to their data centers. They operate from hardened facilities, with backup power, superfast networks, redundant failover, armed guards, and barbed wire fences.
For cloud application providers like Apteryx choosing to host on these elite platforms is not inexpensive. But beware the cloud provider that cuts costs in selecting their data center. Before you trust your valuable practice data to any cloud-provider ask them where they’re hosted. Look for well know names like AWS, Azure, Google, or IBM. If they won’t tell you who provides their data center services that’s usually a bad sign.
Another consideration is where your imaging software provider will focus their development. Technology companies are constantly forced to choose between investing in on-going maintenance and upgrades to older products and platforms versus improving performance and functionality on new platforms. With the cloud gaining momentum it will likely be the priority platform for new features and functionality in imaging and other dental practice applications.
Specific Use Cases
While we’ve talked about DSO and group practices being great use cases for adopting cloud-based imaging there are a still a few specific use cases where on-premise is a necessity. In highly regulated industries, or for organizations working on top secret research, security protocols may prohibit using an external connection to the internet. Or if reliable internet connections are not available, on-premise may be the only option. For example, Apteryx serves dentists that provide care to remote Alaskan villages from laptops. These very specific use cases don’t apply to the majority of dental practices so both on-premise and cloud-based imaging solutions are viable choices for most.
Which is the Better Choice?
Whether an on-premise or cloud-based imaging solution is a better fit for your practice really depends. A start-up practice, or one that you’ll continue to operate for 10 years or more, is likely to benefit from the easy and unlimited storage expansion offered by the cloud as well as the increased investment to add advanced features. If expanding to multiple locations is in your future, you’ll probably want to investigate the cloud. If you’re facing an imminent file server upgrade, you might prefer to avoid that upfront hardware investment and reduce IT support expenses. If you’re planning to sell your practice in the next five years, not running into storage capacity issues, and have good IT support, an on-premise solution may continue to be a great option.
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