Cloud Computing and other Interesting Technologies for the Orthodontist

with Steve McEvoy

April 16th_{, 2012}

Cloud Computing and other

Interesting Technologies for

the Orthodontist

Goals

• Educate you on The Cloud and some

of the issues related to it as they pertain to your Practice

• Talk will be available to you online so

Cloud Computing

Wikipedia says:

Cloud computing is the delivery of computing as a service rather than a product, whereby shared resources, software, and information are provided to computers and other devices as a metered service over a network (typically the Internet)

Cloud Computing

In-House Server

Firewall

Server

Databases Files/Images

Backups

Office Network

Hosted Computing

Office Network Firewall

Off‐Site Server

Cloud Computing

Office Network Firewall

Your Data

Hosted Computing

Office Network Firewall

Off‐Site Server

Private Cloud

The Cloud

• The industries current favorite Buzzword • Has Momentum

What’s in a Name?

“The Cloud”

– As in “My Backup is in the Cloud” “Cloud Computing”

– As in “We don’t have a Server, all that work

is done using Cloud Computing”

“Cloud Apps”

Pandora Radio

• Internet Radio

• ‘Tunes’ itself to your likes and dislikes • Free account (has a few ads)

• Paid account eliminates ads ($36 per

year)

• Works in a browser or with app (for paid

account)

Logitech SqueezeBox

• Media Player

• Can play music from your PC

• Can link to your Pandora Account

• Connects to your office music amplifier • Connect to your office network (cable or

WiFi)

• Touch Screen Control

• No more XM costs or staticky local radio • Costs about $300

Cloud Computing

The Hype is exciting, but does any of it really matter to the Orthodontist?

Technology …yum…

Classic Approaches

• Single Office Networks? • Multi Office?

• Thin Clients? • CBCT’s?

Single Office Network

Firewall

Server

Databases Files/Images

Office Network

Scanners Photos

2D X-ray TWAIN

Multi Office Network

Thin Client

Server

Main Office Network

Terminal Server

Remote Office Network

Cloud Similarities

Communication Links

• Internet Connections

– VPN Tunnels (Secure)

• Point to Point T1’s • Need to Consider

– Quality – Symmetry – Costs Main Remote T1 VPN

Communication Links

Communication Links

• Symmetry

– Is the Upload speed the same as the Download

speed?

– Most Internet Links are Asymmetric (download

is faster than upload)

– T1’s are most often Symmetric

• Why Does this Matter?

– Main Office Upload speed usually the bottleneck

for Remote Office performance

Multi Office Network

Communication Choices

• Point to Point T1

– Usually 1.5 Up/1.5 Down – Super Reliable

– Very Costly (~$300 per end)

• Varies by distance and carriers

– Your own dedicated, reliable pathway – Doesn’t scale well

• More speed means more T1s and more cost

Main Remote

Communication Choices

• Internet T1

– Links an office to the Internet, not Point to Point

dedicated connection. Just an alternative to DSL or Cable.

– Speeds vary but usually Symmetric and

consistent

– Probably more reliable than DSL or Cable – Often bundles with a Voice package

• 6 phone lines and 1/1 Internet for $275

Communication Choices

• DSL

– Delivered across a phone line

– Speeds haven’t kept up with Cable or Fiber – Typically 1.5 Down/0.786 Up

• Can be a little faster depending on situation

– Quality varies greatly

• Impacted by distance from Central Office

– Cheap $60

– Usually my last choice

Communication Choices

• Cable Modem

– Tremendous Speeds available now

• Starts about 6 Down/1 Up

• In some places 100 Down/20 Up

– Quality is pretty decent

• Not as good as a T1, but better than DSL

• Impacted by others on the Network (potentially)

– Cheap $50 for 6/1 or $200 for 100/20 – Usually my first choice

Communication Choices

• Fiber

– Not everywhere, but if available it is THE option

to pursue

– Tremendous Speeds available

• Varies, but packages usually include plenty of upload • 5/5, 10/5, 25/10 and up.

– Quality is very good

• Same as T1

– Can be Cheap $99 for 10/5 or $200 for 25/10 – Usually my first choice if available

LAN vs WAN

• LAN = Local Area Network

– The speed your cabling inside your office runs

• WAN = Wide Area Network

– The speed of your Inter-office or Internet

LAN Speeds

• LAN Speeds

– 10 Mbps Long time ago (1980’s) – 100 Mbps (1990’s)

– 1,000 Mbps or 1 Gbps (2000’s) – 10,000 Mbps or 10 Gbps (2010’s)

WAN Speeds

• WAN Speeds

– 100 Kbps or 0.1 Mbps Long time ago (1980’s) – 1 Mbps (DSL in the 1990’s)

– 10 Mbps (Cable in the 2000’s)

– 100 Mbps (maybe Cable or Fiber in 2010’s)

• Fast and getting faster

LAN vs WAN

• In comparison, WAN speed are averaging

1/100th _{of the available LAN speeds.}

0 200 400 600 800 1000

1980's 1990's 2000's 2010's

WAN LAN

LAN vs WAN

• Applications that are written for the LAN

typically don’t work well over a WAN link

Little b’s vs Big B’s

• Communication speeds are described in

‘bits per second’ or bps

• File sizes are described in Bytes

• For the sake of easier discussion lets use

1Byte = 10bits

Why Should You Care?

• If you have a 10 MB sized file and a 1 Mbps

Internet connection, how long would it take to transfer?

– 1 Second? – 10 Seconds? – 100 Seconds?

• 100 Seconds (1 minute 40 seconds)

– 1 Mbps = approx 0.1 MBps

• Consider this when thinking about photo

Dropbox

• Personal Cloud Storage Folder • Add-on to

– Windows – Mac

– iStuff (iPad, iPhone, iTouch) – Android (Droid, etc)

• Accessible from the Dropbox Website

– You are always near your files, even without

Dropbox

• Great way to shuffle data between

diverse platforms (like PC and iPad)

• Great way to sync files between multiple

devices (Images at home and work)

• Acting a bit like an Internet Backup

Dropbox

Internet

Office PC

Data File Home PC

Laptop

Web Browser

iPhone, iPad, Android

Dropbox

Costs

• 2GB Account is Free!

– Enough for most peoples basic

needs

• Pro 50 Account

– $10 per month, or $100 per year

Where are We So Far?

• When looking at Cloud services you need to

consider these factors and how they apply to your individual situation

– Is your Application made for LAN or WAN? – Link Types (T1, DSL, Cable, Fiber)

Cloud Vulnerabilities

• What are some of the weakness’s of Cloud

Services?

– Reliance on your Link

• What happens when it’s down?

– The Company providing the Service

• What happens if they go under?

– Backup of your Information

• Where is your Data?

– You have to move with their Development path

Link Vulnerabilities

Same liability as your own multioffice scenario: OFF = BLIND

• Use a Dual connection to indemnify

– Main Link (Cable Modem $100)

– Backup Link from a different carrier

• DSL ($50)

• 4G Wireless ($50)

– Need a Dual WAN Capable Router

Link Vulnerabilities

Speed too Slow?

• Investigate the options you have, get the

fastest one you can afford.

• Only Crappy DSL available? Might need to

wait on the Cloud until your connectivity improves.

Link Vulnerabilities

Link Saturation

– One of the staff is using 100% of your

bandwidth watching NetFlix while you are trying to work.

• Have a router that can show you

who/what’s using the connection in real-time

• Prioritize the traffic to give your important

Company Vulnerability

• Consider the viability of any company you

select

– How long have they been around? – Are they growing?

– Are they responsible? – What’s their reputation?

• What if you choose to leave – Will they give

you your Data?

Backup Vulnerability

• Ask where your Data is • Is it being backed up?

– How often?

– How many versions are retained?

• Likely they will be doing it MUCH better

than you would be

• Ask if you can have a local backup just in

What can The Cloud do in your

Ortho Practice Today?

• Backup

– Carbonite, Mozy, Oaktree Storage

• eMail

– Gmail, Office 365

• Music

– Pandora

• File Portability

– Cloud based USB Key - Dropbox

Cloud Based Practice

Management

How might this change your practice?

• No Servers to Own or Maintain

– (Can you really have no Server at all?)

• Equal Performance in each office

– All offices are the main office

What Questions to Ask

• Bandwidth requirements (Up and Down) for

the number of computers you have

• Requirements for the local Hardware

– Will it work with what I own now?

What Questions to Ask

• How will “Imaging” work?

– Can I keep using my current application? – How will Photos be captured?

– How are Documents Scanned and stored? – How are 2D X-Rays captured?

– Is there integration for my CBCT?

– Are files captured locally then sync’d to the

What Questions to Ask

• How will Printing work?

– Will it work with my existing printers?

– What about labels and appointment slips?

• Integration with 3rd party services:

– Patient Communication like HouseCalls and

Sesame

What Questions to Ask

• Can I Host my own data in-house?

– Could be a way to minimize the effect of the

Internet connection and have your own copy of the data

• How does support work?

• How would you get through a day in the

Dark?

• How would you get your data back if it all

What Questions to Ask

• What are ALL the costs?

– How much up front for:

• Software • Conversion • Installation • Training

• Support

– How much ongoing for:

• Hosting • Support

MME’s Blog

Thank You!

steve@mmeconsulting.com Presentation Online at

www.mmeconsulting.com/presentations