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


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 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 manage-ment 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 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, 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 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 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 plat-forms (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 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 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.


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.



1. Moore’s Moore’s Law or how overall processing power for computers will double every two years. Available at: 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: 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: Published June 18, 2013. Accessibility verified December 23, 2013.

5. Panzarino M., Steve Jobs’ obsession with the quality of the things unseen. Available at: 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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