2017 Winter Conference – Technology: Balancing Profit, Lifestyle & Patient Care

By Dr. Doug Depew

The 2017 AAO Winter Conference is quickly approaching. Our theme of this year’s meeting Technology: Balancing Profit, Lifestyle and Patient Care.  It promises to be a meeting filled with information for both newer and established practices to help make those tough decisions on what technology is important to use in our practices and when we may wish to invest in it.

The meeting will begin with keynote speaker Jack Shaw.   Mr. Shaw is a world- renowned technology futurist who will be discussing how cutting edge and disrupting technologies will change the way we do business and run our practices in the coming years.

IT guru Steve McEvoy will be answering some of those pesky questions we all have about computer hardware, effective and cost-efficient data backup, and security.   In the ever changing world of computers, what you hear at this meeting will certainly be different than what Mr. McEvoy would have talked about even a couple of years ago.

On Friday afternoon we’ll have a lively discussion by Drs. Greg Jorgensen and Neil Kravitz regarding building our practices through social media, websites, and Internet marketing. Their success in these areas has been paramount in growing their thriving practices.

Saturday morning will begin with Dr. Aaron Molen sharing his experience and thoughts on bringing emerging technology into our practices to help create more efficient and more comfortable patient care.

We’re excited to have Drs. Ed Lin and Christian Groth discussing how to integrate some of the latest technology hardware into our orthodontic practices. This includes workflows for using CBCT, Scanners and 3D Printing.

The conference will conclude with Chris Bentson and Charles Loretto with a discussion on how technology can affect the value and profitability in our practices. This should help answer the question about at what stage of practice a doctor might consider investing in advanced technology.

The location for the meeting is at the gorgeous Marriott Harbor Beach Resort and Spa in Ft. Lauderdale, Florida. The dates are February 10-11, 2017. The schedule is organized in a way to allow some time for afternoon recreation.

There will be plenty of time allotted for attendees to ask questions of the speakers to be sure all bases are covered.   To learn more and to register, visit https://www.aaoinfo.org/meetings/2017-winter-conference-technology-balancing-profit-lifestyle-patient-care

How Can Patients Contact You During an Office Relocation?

By Dr. Dan Grauer

member_on-phoneMoving your office to a new location is a tedious process involving many tasks and some headaches. A critical moment during the move is the transfer of your main phone number to the new location. Unfortunately not all numbers can be transferred to certain areas. Phone carriers have rules regarding the assignment of specific numbers to defined geographical areas that are beyond the purpose of this blog. Luckily there are solutions to this problem.

One way of transferring your number in an undetectable way is using a cell phone as a proxy. You will need to call your old office phone carrier a few days before the transfer and assign your old office number to a cell phone. This process could take from 3 to 5 days. Once your number has been assigned to a cell phone it automatically disconnects from the physical location of your old office. The last step is to forward your calls from the cell phone to the new office number. This is done through the setting menu of the cell phone, and it can be activated or deactivated on demand. The cost of this transaction will depend on the cell phone plan and the cell phone purchased. Advantages of this solution include that your patients will automatically reach the new office and you will maintain your old number regardless of your new geographical location.  Another advantage is that by deactivating the call forwarding function on the cell phone, it becomes an emergency phone for your new office.

You’re Missing Something Important… (…in your backup)

Steve McEvoy, Technology Consultant


The first thing I check when I start to work with a new Practice is their backup. Most Practices have something in place, but more often than not I find the single most important piece of data is being missed – the Practice Management Database. Imagine if your Server crashed and you had to use your backup to recover all your precious data, and at the end of the recovery your IT person explains “There you go, it’s all restored – oh – except for your Practice management data that is lost forever!” Your Practice would be severely impacted and the financial loss would be enormous. Taking 4 minutes to read the rest of this article and then pass it along to your IT person.

The Challenge
Most backup routines merely come along and make duplicate copies of files sitting on your hard drive. Imagine creating a Microsoft Word document. First create a new blank Word document and save it to your desktop. Open it, type a few new paragraphs, but you leave it open and don’t save it to the hard drive. If you run the backup right now, the backup will catch the new empty document that is saved and completely misses the newer data still in memory (but not saved to disk yet).

Many Practice Management programs (such as Dolphin, Orthotrac and Ortho2 for example – listed alphabetically) use a sophisticated database called Microsoft SQL Server. Backing up SQL Server needs a special technique. Just like in the Word document example, SQL Server is always open and keeps the latest changes to your information in memory or log files. If you just come along and ‘copy’ the database files you won’t have anything useful to recover with (bad news!). This is usually what I find is happening, people are running backups but aren’t realizing they need to take extra steps to backup the SQL database.

The Solution
The Practice Management companies know about the challenge and all of them have documented solutions for you to follow. The problem is who actually reads the manuals? This is a case where you (or your IT person) needs to. Ask your IT person directly “Are you properly backing up the Microsoft SQL Server database that my program uses?” If they don’t know for sure the answer is ‘yes’, the simple solution is to ask them to call the support team of your Practice Management Software company and ask for a little advice. They will have a solution:

  • Dolphin has a ‘Safe Backup’ solution that can run automatically as part of your end of day or end of month
  • Orthotrac has a database backup routine that can be set to run automatically and keeps copies of the database for each day of the week.
  • Ortho2 has a database backup application that can be setup to run as often as you like.

You’ll notice in my descriptions there are a lot of ‘cans’. You have to be sure these are setup and working. Make sure the backup files that these routines make are then swept up in your routine file copy backups. In a crisis, these backup files can be recovered from your regular backup and then the SQL database can be restored.

Final Thoughts
If you use a Cloud based Practice Management you don’t have to worry, they are doing it for you. If you use an Internet Backup the same problem can exist. Many Internet backup companies like Carbonite.com and Mozy.com don’t normally backup SQL databases, so you should check this out since your SQL database is your most important piece of data worth backing up. Personally I would recommend you take an extra step – make your own SQL database backup in addition to the one you configure with the Practice Management Software. Microsoft SQL Server includes the ability to schedule SQL backup jobs on its own, and I would recommend that you setup two backups (one at noon, one in the evening). Two backups are better than one!


A Simple but Costly Mistake: Part 2

By Steve McEvoy, Technology Consultant

Is Your UPS Connected Right?
If you have a ‘Server’ in your Practice (a computer that holds all your precious data), it’s probably protected by a device called an Uninterruptable Power Supply (UPS).  The UPS’s job is to keep the Server running for a short period of time in the event of a power failure.  They are essentially a small battery pack.  Servers shouldn’t just be switched off in a power failure else you run the risk of corrupting data that was in use at the time (like your Management software that runs your Practice).  You could even corrupt the entire Server operating system leaving it unusable.  A properly installed and configured UPS is your protection against this corruption.   I say ‘properly installed and configured’ because in many offices this is not the case.

In Part 1 of this article we covered watching out for Surge Only ports and linking the UPS to the Server with its Communication Cable properly.  Here are the final few issues that you should check on for your Practice.

You Get What You Pay For
A UPS is designed to generate AC power (Alternating Current – same as your building) when your power fails.  They do this using batteries contained within the UPS.  These batteries are like the battery in your car and they store DC (Direct Current) power.  All UPS’s generate AC power from its DC reserves, and this is done with an AC/DC power convertor.  The problem is not all power convertors are created equal, and lower quality units generate a ‘Stepped’ or modified sign wave rather than a pure sign wave that your Server prefers/needs.  They do this because it’s cheaper to make.  A simulated stepped sign wave can cause all sorts of odd problems for your Server.  I’ve seen Servers that don’t power up every time or run at all when on UPS battery power, some that reboot randomly, and other power related issues.  You may not even know you have this issue (yet – until the power goes out).  All of these issues can result in corruption of your data.  You should verify that your UPS is a true sign wave model by looking up the specifications online.  If you need a new UPS verify this prior to purchasing.

Figure 2 – Depiction of a Stepped Sign Wave DC to AC power conversion vs. a true Sign Wave

Figure 3- Specifications of a UPS with a true Sign Wave output

Figure 4 – Specifications of a UPS with a Stepped Sign Wave.  Note the listing of some Surge Only plugs

Batteries Wear Out
Just like your car battery, the batteries within a UPS have a limited lifespan.  I expect them to last 3 to 5 years at the most.  This means that they usually do not outlast the life of the Server.  If your UPS is more than 3 years old it might not be providing the protection you think it is.   In the worst cases, I’ve seen old batteries unable to keep the Server up for more than a handful of seconds, not enough time to allow an orderly shutdown.  If this was the case, you could be risking data corruption.  Many UPS’s have built in periodic self-tests to watch for this problem, and typically will turn on some form of LED saying ‘replace battery’ if it needs servicing.   Personally I recommend that you undertake a ‘calibration’ of the UPS once every six months.   A calibration will simulate a power failure and times how long the battery will last prior to depletion.   Since it’s an actual test, you can trust the result.  If the UPS has insufficient runtime when on battery it is time to do something about it.   Most UPS’s have replaceable batteries, and I would say this is a good option to follow if your UPS is properly installed and configured already as noted above (why have to go through all that setup with a new UPS if you can just rejuvenate your old one).  The battery won’t be cheap, but it will be less than the price of replacing the UPS.  Installing it is usually a fairly simple process, but be sure you do it with the Server OFF and follow the manufacturer’s instructions.   Be sure to recycle that old battery.

Figure 5 – Typical UPS Replacement Battery

Pull the Plug
Once you think you have all these issues in order, you might consider a real life test to be absolutely sure you have it all configured right.   Pull the plug (the main power cord to the UPS) to make the power fail, and watch ALL the results until the Server has shut down properly.  Plug the cord back in and see if it all starts back up.   Make sure that everything that ‘should’ happen actually does.  Do this when the Practice is closed and shutting down the Server won’t be a disruption.  Not the most exciting way to spend 20-30 minutes of your life, but taking the time now to be sure the entire system is working right can give you some peace of mind.

But I Thought I Was Backing Up My Stuff!

Author: Steve McEvoy, Technology Consultant

For 3 years Michelle had worried about the office backup.  Each day she would bring in the oldest off-site tape from home in a special case.  She would swap it for the one that backed up last night, and then carefully label it with the date and place it back in the case and carry home that night. She slept well knowing her backup was done.

I was hired to take over the network maintenance, and the first thing I did was ask about the backup.  She explained her process to me and I was impressed.  Standing at the server I asked “What software do you use?”  A quizzical look appeared on her face, and I knew there was trouble. Two minutes of checking revealed that there was NO backup software, and EVERY tape she ever changed, labeled and took home were completely blank.  She turned grey.

I have seen this story repeat many times in all sorts of variations.  The result is still the same, a Practice without a backup of their precious data.
If you stop and think about it, do you have a nagging feeling about your backup?   Are you 100% certain it’s working?   Are you certain it contains ALL your Practices data?
Let me jump to my recommendation now:  Proceed on the assumption you have NO backup until proven otherwise.
Be sure All your Data is on the Backup
You probably have most of your data in one place – usually the ‘Server’.  Backup the Server and you have everything right?  Not usually.  Often your Practice Management database has special backup needs.  Users have terrible habits of saving documents to their Desktops or My Documents folders.  2D and 3D CBCT X-ray system save their data to the PC you use to run the machine unless you adjusted it otherwise.    Applications like Invisalign, OrthoCAD and Geodigm save their downloaded data to the local PC by default.
How are you supposed to know where the data is?  You aren’t expected to, but you should press your IT person to find out and know for sure.   Your job it to tell your person what programs you use, and ask them to specifically determine what needs to be backed up for each and how.  It might take them an hour or two to figure it all out, but that will be time well spent.  Push your IT person to really, really think about your data and make sure it’s all backed up.
Verify your Backup is working by doing a Routine Restore
So once you think you have it all backed up, you can’t trust the backups are working reliably.  Too many times I have gone to use a backup only to find it’s corrupt or incomplete.  The cure to this is to periodically test your backup by going through the process of actually restoring a few critical pieces of data each month.  This tests the software, backup media, and that someone knows the steps for recovery.   I’m not talking about using the ‘Verify’ function most backup software has built in, I am suggesting doing an actual restore of your data to an alternate location.  I don’t usually restore all the data, but a few of the most important pieces (maybe your Practice Management database and Quickbooks data file).
Ask your IT person to do this on a routine schedule, and then show you the restored data to prove to you the system is working.  It won’t take long and is well worth the trouble to know it’s working.
Monitor the Backup on a Daily Basis
Even with doing a test restore Monthly, what if the backup malfunctions the day after?  You could be surprised with losing 29 days of data should a disaster strike.
Most modern backup software programs have the ability to email you a status update each day.  They will tell you if they worked, were incomplete or failed.  Regardless of what they tell you, it’s good information to have.
I recommend that you assign the duty of checking this email to one of your responsible staff members and make it clear that it is a VERY important job responsibility and must be reviewed each day.  It will take 15 seconds on most days when things are working, and on days when it doesn’t they should be given the authority to contact the IT person to remedy the situation.   Usually this is the person also tasked with carrying out the off-site backup (you have an off-site backup right?).
You should be worried about your backup.  Without one, your Practice is at risk.  Imagine what it would be like to lose all your data.  Could you ever completely recover?
Assume you don’t have one and call your IT person now.  I bet they find something that needs improved.