The document discusses how legacy practice management systems struggle to keep up with current demands for efficiency, real-time access, automation, and compliance. It argues that cloud-based systems address these challenges by providing a centralized database accessible in real-time from any location, automating workflows, handling upgrades and compliance, and reducing costs. Choosing the right technology partner is important for a practice to get customized solutions, remain competitive through future upgrades, and receive strong support.

1. Why Group Practices
should embrace the Cloud
to reach the Stars
www.carestack.com

2. 1. Executive Summary .............................................................................................................................
2. The Need for Efficiency
2.1 Factors affecting group practices today ......................................................................................
2.2 Challenges in IT ...........................................................................................................................
2.3 The need for focus on IT ................................................................................................................
3. Legacy Systems
3.1 What are ‘legacy systems’ and how are they constituted? .........................................................
3.2 How well can legacy systems keep up with the demands of today? .............................................
4. Cloud Based Systems
4.1 What are cloud based systems and how they are constituted? ...............................................
4.2 How well can cloud based systems keep up with demands of today ...........................................
4.3 Possibilities cloud based systems enable ...................................................................................
4.4 Advantages of cloud based systems ............................................................................................
5. Switching to Cloud Based Systems
5.1 Choosing the right technology partner for the practice .........................................................
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Cloud Based
Practice Management
Examining the impact of cloud based
technology in group practices
3

3. Executive Summary
The aim of this paper is to provide a practical
reference to help enterprise information
technology (IT) and business (i.e., administrative,
clinical, research and teaching) decision makers of
group practices in dentistry as they analyze and
consider the implications of cloud computing for
their organizations.
The paper initially discusses factors in the market
that influence this decision making process, and
shares insight into industry trends and how the
future is most likely to look.
The second section goes on to explain how most
legacy software systems operate and how well
they keep up with current industry demands. This
is contrasted with how the cloud based systems
operate and how well they fare against current
demands.
Cloud Based Practice Management 3
This is then followed by two short sections on what
additional benefits cloud computing can bring and
how to choose the best technology partner for the
practice.
When considering whether to use cloud
computing, practices and providers must have a
clear understanding of the unique benefits and
risks, relative to the purpose and scope of the
business: optimizing outcomes while maximizing
patient safety and the economy, efficiency and
effectiveness of care and treatment. Then, they
must establish appropriate contractual
relationships with the cloud-based practice
management service providers by means of
service level agreements (SLAs).

4. The Need for Efficiency
The US dental care market is quickly turning to a
race for consolidation, investments and M&As.
How can technology help the practice stay competitive?
1. Increased demand, reduced supply &
shrinking resources at demand side: According
to the WHO, global health spending totaled $7.5
trillion in 2013, growing at an average of 6 percent
each year since 1995 and 2 percent above the
growth of global GDP for the past four decades.
The trend reflects in dentistry and will continue
towards maintaining profitability, while adjusting
to the budget constraints, for every stakeholder.
2. Push for efficiency from payors: Despite the
increase in the number of Americans with health
insurance coverage and the recent multi-billion
dollar decrease in uncompensated care, many
healthcare providers and dental providers have
cited substantial financial struggles. This results
from newer payment methods from the payor to
the provider.
3. Misaligned incentives: In a market where
payment methods are changing fast and risk is
being transferred increasingly to the provider, a
principal question is, “How can the interests of the
dentist align with the practice?”. A large part of the
new reality has reimbursements being based on
value, instead of the services provided. This is
clearly shifting risk to the practice
Cloud Based Practice Management 4
4. Call for accountability: With costs for the patient
rising at a feverish rate, and consumers ever more
strapped for money, the demand for transparency,
when it comes to the nature and purpose of the costs
is growing. It's not just consumers, insurers and
other industry players are looking for details too. The
onus is now on providers to do the math, and
provide the answers.
5. Efficiency constraints on the provider side:
Healthcare, especially dentistry, is the only industry
that has not experienced an improvement in labor
productivity from technology and, in fact, labor
productivity in healthcare continues to worsen.
The focus on expert labor, without any technology
automation to improve labor efficiency, is a key
contributor to rising costs, and these escalating costs
do not necessarily translate into better outcomes for
patients.

5. The tools in yesterday’s world are unsuitable to manage
the new reality of today. This is a top challenge.
Hiring and maintaining skilled personnel becomes a
challenging task. However, there is an increasing demand
for updating technology, applying customization and even
development due to:
a) Changes in payment models,
b) Increased compliance requirements and
c) The need to increase operating efficiency.
Add to this, the exponential rate at which
technology evolves, making any technology
developed outdated in the span of few months.
New technology comes out frequently, and they
not only improve operating efficiency, but they
also spread in the population before industries
can adapt to it. This poses a continuous demand
for adoption of new technology from the
customer’s side.
Fig 1.1: Utilization of the latest technology becomes a mandatory requirement to improve almost every aspect
that affects the profitability of a practice.
Challenges in IT
The Need for Focus on IT
Increase
Profitability
Increase
Revenue
Increase
Scale
Increase
Patients
Increase
Efficiency
Re-negotiate
Contract
Reduce
Expenditure
Manage
Receivables
Better
Integration
with
Insurance
Better
Analytics
Constant
Need for Better
Technology
Cloud Based Practice Management 5

6. Cloud Based Practice Management 6
Upgrades
& Updates
Virus
Protection
Maintenance
& Support
Scheduled
Scheduled; once
in 24 hours
3rd-party Analytics,
Backup & Practice
Optimization Provider
Practice Location 1
Practice HQ
Upgrades &
Updates
Virus
Protection
Maintenance
& Support
Practice Location 2
Upgrades &
Updates
Virus
Protection
Maintenance
& Support
Practice Location 3
Data Backup
Internet
Monthly paid services
for data consolidation
and reporting to practice
HQ
Single time high
capital cost purchases
Core operations of the
practice
Components of
Legacy Systems
Compliance
& Security
Location 1 Local Network Server
Location 2 Local Network Server
Location 3 Local Network Server
Compliance
& Security
Compliance
& Security
Scheduled
Scheduled

7. Legacy Systems
Most practices still use locally installed
software and legacy systems to manage operations.
How do they fare with the demands today?
1. Control of operations: Legacy architecture does
not support real-time control for optimized use of
resources. A legacy system utilizes stand-alone
software installed either on a desktop or a server
shared across multiple desktops in the same
location. A 3rd party practice optimization system
fetches the data from these systems based on a
schedule, often once in 24 hrs.
2. Streamlining and optimization between
locations: Due to the lack of a central database
where every action has a discrete identity, it is
impossible to streamline operations between
locations. Such streamlining adds heavily to the
efficiency and utilization of skilled resources.
3. Automation of work-flows: Automation of
mundane and repetitive tasks free up time for
resources, improving productivity. Technology has
developed to automate simple algorithms, detailed
work-flows and even decision support. However, the
fundamental requirement for this is a single
centralized database, which legacy infrastructure
does not provide.
Cloud Based Practice Management 7
Legacy systems are incompatible with current demands, because of:
a) Installation on local machines and local servers
b) Lack of a single database
c) Need for a 3rd-party service that reports data to consolidate information; which is almost never
real-time.
4. Costs: The legacy infrastructure incurs a lot of direct
costs in servers and other hardware, security of data,
virus protections, IT personnel, backup systems,
software costs for both OS and the program, as well as
the need to engage with 3rd party companies for
analytics and consolidation of data.
5. Compliance: Data standards, procedure codes, and
security standards are being updated regularly.
Complying and updating to the latest processes requires
constant involvement of development personnel.
6. Security: As the recent ransom-ware attacks teach
us, security is a prime concern and constant updating of
systems becomes a necessity to keep-up. The data that
institutions hold is extremely valuable and will continue
to be a target.
7. Management time: The time taken up by constant
requirements in managing IT takes quite a toll on the
senior management’s time. Time and effort required to
authorize change and to train personnel with every
requirement is disproportionate to the benefit.

8. Practice HQ
Practice Location 1
Practice Location 2
Practice Location 3
Upgrades & Updates
Server Hardware +
Software
Compliance
Data Security
Virus Protection
Data Backup
Real-Time
Real-Time
Real-Time
Real-Time
Cloud Based Practice Management 8
All a practice needs to do is to use the cloud-based PMS.
Everything else is taken care of.
Internet
Cloud Based Service Provider
Technical Support

9. Cloud Based Systems
Cloud based technology shifts the responsibility for IT management,
security and compliance away from the practice almost entirely.
How do they fare with the demands discussed on Page 5?
1.Control of operations: In cloud-based system,
everyone in the practice, from the practice locations
to the head quarters, access the same installation
using the same database. This allows for real time
observation, control and correction.
2. Streamlining & optimization between locations:
The utilization of a single database updated in real
time makes streamlining operations and resources
between locations a simple task.
3. Automation of work-flows: Cloud technology
allows a practice to automate various work-flows
and paperwork, and frees up time of resources at all
levels. Upgrading such automation to include the
technologies of tomorrow, like decision support and
machine learning, becomes simple and affordable
because the development is done on top of the
system customized to specific requirements of the
practice and is handled by the cloud service vendor.
4. Costs: A single cost covers all. Cloud services
usually bill a single amount monthly that includes
hardware (server-side) and software costs,
maintenance and support, customization and
integration, development of new features, data
security, virus protection and compliance.
Cloud Based Practice Management 9
What is ‘cloud based’ technology?
Cloud computing is the delivery of computing services—servers, storage, databases, networking, software,
analytics, security and more—over the internet.
5. Compliance: Data standards, procedure codes,
and security standards are updated regularly by the
cloud service vendor.
6. Security: Security updates to the system are done
without involving time of the practice and are
covered in the subscription cost. Any potential
attack is taken seriously and dedicated personnel
readily take care of any problems.
7. Management time: Except in the initial phases,
the management’s time is not needed. Any further
upgrades are above the existing framework at the
cloud service provider’s end and so, training costs
and time are significantly reduced.

10. Advantages of Cloud Based Systems
Cloud based systems offer a wide variety of advantages in
various departments within the practice. The info-graphic
in the following page illustrates some of these.
1. Future ready: Technology evolves at an exponential pace
and the life cycles are only reducing in duration. Cloud based
technology gives the practice the benefit of their power as a
customer. Being a subscription based model, the cloud
service companies must stay competitive and they always
ensure the best of features are delivered to the practice in a
manner that is convenient. This ensures that the systems
their practice operates on will always be future ready and
possibly the best in the practice’s competitive landscape.
2. Analytics and business intelligence: Cloud service
companies deploy highly skilled resources to find out the best
parameters to follow to improve efficiency in the practice.
This is also presented to the practice on a dashboard, that is
convenient and designed based on management’s priorities.
3. Customer friendly: Cloud based technology makes it
easier for the practices to maintain relationships with their
customers. Integration with mail and telephonic campaigns,
and storage of unique patient and potential lead data ensure
the practice is constantly in touch with its patients. Some
companies also allow the patient to access their reports and
medical records through a patient portal. Constant and
personalized information on the patients ensures fewer
missed appointments and considerably lower attrition rates.
4. Costs: Overall cost vs. benefit is highly skewed towards
cloud based systems, especially when the costs of risk
mitigation and crisis management are also considered.
5. Insurance integration: Some cloud based providers
enable seamless integration with insurance companies,
eliminating the need for considerable time and effort of the
administration personnel. This also enables better cash flow
predictability for the practice and helps them manage their
pay-outs better.
Cloud Based Practice Management 10

11. Predictable cash flow
Higher profit
Centralized management
Streamlined operations
Reduced manpower
Increased efficiency for
providers
Better interaction with
patients
Higher patient satisfaction
Single simple upgrade
Always state-of-the-art
Centralized real-time insurance
checking and claims processing
Centralized real-time cash flow
predictability
Negligible set-up cost
Expenditure savings in support
staff and IT personnel
Simpler implementation
Analytics on operating
performance for all locations
mapped to resources
Automated multi-location
work-flows
Streamlining multi-location
operations real-time
Dedicated IT team not required
Centralized control allows better
delegation of human resources
Streamlined and automated
operations allows better
time-utilization of skilled employees
Better scheduling for patient
Increased mobility allows better
communication with patient
Patients feel welcome and recognized
at all locations of the practice
No effort for future upgrades
No effort and cost to scale-up
No downtime
Can use any device
Cloud Based Practice Management 11

12. How to Choose the
Right Technology Partner?
Choosing the ‘right partner’ is crucial since the practice
should rely on the company for the foreseeable future for
its technology requirements.
Cloud Based Practice Management 12
1. Customization: Partners who listen to the practice and can customize and adapt to specific
processes and systems that the practice is used to, enable better utilization of the systems and
relatively effort-less integration.
2. Forward-looking: The right partner should always be concerned with providing the practice
state-of-the-art technology, and not make the practice a victim of their “cash-cow” product. This
ensures the practice maintains competitiveness well into the future.
3. Employee strength: This is a crucial factor in technology companies, as the features and
customizations the practice gets are a direct output of ‘man-hours’. The more employees a
company has per customer, the better it is likely to be for the practice.
4. Compliance and security: The company must ensure compliance with all the latest HIPAA
and other mandates and security with the highest standards possible.
5. Service and support: The company should show concern for the practice's issues and open
a simple channel for the practice to communicate if any problems arise.

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July 2017
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