Oral Health Group

Crystal Ball 2004: ‘Future Proof’ Computers

December 1, 2003
by Craig Wilson

Once upon a time, dental practices bought computers for a single purpose, which was to run a practice management application. In that simpler time, the installation of the practice management system was straightforward: you chose the software and then bought the software, hardware, installation and training services from the software manufacturer. They knew the software, and therefore knew best how to choose and install the hardware. Generally things worked well, and when they didn’t you had a single number to call where you found people who had a fighting chance of solving your problems.

Unfortunately, something went horribly wrong. History blames Apple for introducing the first really workable graphical interface in the early ’80s. Somehow, the fact that through this interface people could work with computers in a more intuitive and natural way, without needing to be reprogrammed to think like software developers, caused an explosion of new application ideas.


Previously when a new computer system was installed, the installers knew that the system would perform the same basic tasks on the date of install as it would five years later. As new application ideas started appearing with increasing frequency, it became impossible to know what sorts of things systems would be used to do/create/display/manage even 10 minutes later. The tasks that could be performed on a computer were now no longer limited by the imagination of the programmers, but were limited only by the collective imagination of the entire user base.

Today, very few systems run a single application or perform a single function. It’s much more likely that a computer system will be used to run multiple applications, possibly for practice management, imaging, finances, charting, communication, etc. There may also be specific pieces of dental hardware connected to the system, with their own software.

Obviously, the fact that we are able to do more things, with systems that are now in relative terms much less expensive, must be a good thing. However, the complexity of dental information technology installations has now necessitated that the decision-makers in a practice take a more active role in the rollout of any new computer technology. It is no longer practical to simply purchase all of your computer needs from a single source, since there is no longer a single player that can provide them all effectively. Instead the various elements involved must inter-relate, and that includes all software, hardware, and service elements.

Create a ‘Technology Plan’

When working with a new client, it’s often convenient to evaluate needs and plan installation requirements by working through a ‘technology plan’. Amazingly, there are many situations in which we begin working with a client to implement a particular set of technologies, but by the time we finish our planning process it makes more sense to start in an entirely different way.

We use a specific template to walk through the planning, but the goal is to get as much in writing as possible. Additionally, it’s important to approach the planning process from the point of view of: what are the goals, what should the patient experience be, and what do we want to be able to accomplish when we’re done. Don’t start by defining the gadgets and boxes that you want to buy and where they go. Let the gadgets and boxes be defined by the goals for the system.

By the time the ‘technology plan’ is completed, the practice should have a good understanding of what items need to be purchased and implemented now, but also what the longer range plans are.

Communicate All of the Requirements

With dental equipment, it is generally expected that a major purchase will include installation, training, ongoing support, and even the possibility of exchanging the unit if it does not suit the needs of the practice. Not so with computer equipment. Generally, the margins on these products are sufficient to cover the distribution of the device only. Any additional services are just that: additional.

For example, the purchase of 10 computers from a major retailer could compare in dollar value to the purchase of a dental chair from a major dental supplier. However, the end user would be responsible for the installation, and setup of the computers, any additional hardware or software requirements, integrating them with the rest of the system, and training the staff. The dental industry understands that it’s unreasonable to expect a dentist to install their own dental chair, and therefore generally has a service team available to perform that function. Conversely, the margin on the dental chair is sufficient to cover those service costs, as well as all of the costs associated with helping the practice make the decision to buy the chair. Even if the dental dealer charges a fee for the chair installation, you can be sure that there are some other costly added value items that the dealer is providing along the way. The margin on the computer equipment is sufficient to cover only the box coming into the store, and back out again. You can’t expect the same level of service on both kinds of products.

The simple point that must be stressed is that it’s important to understand that when you buy computer hardware you are generally getting just that: hardware. If you require installation services, or setup, or ongoing support, or training, you must specify those items. For example: the difference between plugging in a computer, and carefully drilling holes in cabinets, running cables through walls, and tying up and hiding anything extraneous can amount to several hours. If you have specific installation requirements make sure that they are communicated to the installers.

Buy your computer hardware

There are four types of vendors from whom you can purchase computer equipment. Notwithstanding the fact that everyone seems to know ‘a computer guy’ who can get them computer products, all vendors fall into one of these categories:

‘Big Box’ retailers and direct manufacturers

These are the outlets like ‘Best Buy’ and ‘Future Shop’, or ‘Radio Shack’, as well as the direct manufacturers like Dell and Gateway. Generally these are big name operations selling ‘brand-name’ products. Since you are dealing with large companies both for distribution and manufacturing, the return policies and warranties are always straightforward. Although onsite installation and warranty repair is usually available, these retailers are basically selling boxes not services.

Smaller resellers and retailers

Some small resellers are also authorized distributors for the ‘brand-name’ manufacturers, but many of them produce their own ‘whitebox’ machines. Generally these are computers that the resellers assemble from components. Some resellers have core expertise in particular areas and work in a specific niche market. Some also have fairly sophisticated support operations that can provide cabling, installation, support and training functions. It’s critical that you have references or a history with a particular vendor. Some are great. Some less so.

Software providers

There are very few software vendors left that also sell computer equipment. As described above, when the computer hardware is used solely to run a specific application it makes sense for the software vendor to be involved with the hardware purchase. When multiple applications from various vendors will be employed, who should be responsible for the hardware? Clearly the dental practice should be responsible for its own hardware, and the software vendors should adhere to industry standards to ensure that their software is compatible with as wide a variety of hardware and other software as possible. Purchasing hardware from the software vendor may make sense when the system is used ONLY to drive a single application.

Dental dealers

Most dealers that have made attempts to sell computer hardware have discovered that this is not a market that they want to be in and have abandoned the idea. The margins are very low in comparison to their other prod
ucts, the complexity is very high, and the likelihood of winding up with a dissatisfied client is significant. Dental dealers rely on ongoing repeat business from their clients, and it’s imperative that they not have any potentially ‘relationship altering’ problems. It is critical however that the dealer rep be involved in the planning processes since it’s likely that there will be dental products (digital radiography, cameras, etc.) that will be used with the system either now or in the future. Some dealers and/or reps have a great understanding of computer requirements, and can be an excellent resource to either plan part or all of your installation.

Dental industry specific vendors

As discussed, many dealers and reps have made a concerted effort to put as much distance between themselves and the computer equipment in a dental practice as possible. However, ‘nature abhors a vacuum’, and in most geographies there are computer hardware vendors that specialize in dental installations. Dental dealers sometimes refer their clients to these vendors. Sometimes these vendors are well known among a particular group of dentists where they have provided good quality service. You will probably pay equivalent or slightly higher prices for the computer hardware from these vendors, but there is an opportunity to get service from technicians who are familiar with the industry. If hardware costs seem to be significantly higher than a competitors, it’s likely because different components are being quoted based on the experience of the vendor. Services will either be built into the cost of the hardware products or itemized separately depending on the company or the specific project.

Should you buy a ‘brand-name’ computer?

‘Brand-name’ equipment is hardware manufactured by one of the ‘big’ computer vendors such as Dell, IBM, Compaq, Gateway, HP, etc. Barring an unfortunate design or manufacturing problem, when you buy a ‘brand-name’ box you know exactly what you are getting, and an engineering department has worked hard to ensure that the box works the way they expect. Additionally, feature for feature, a brand-name box is often very reasonably priced since the manufacturer can use their design resources and manufacturing capabilities to put a large number of components onto a single board and save costs compared to a competitor who needs to buy a variety of components to achieve the same functionality.

‘Whitebox’ equipment on the other hand refers to a set of hardware components assembled together to build a computer. The name comes from the fact that most vendors once used nearly identical cases to assemble their machines, and they were off-white in colour. (Although possibly more appropriate, the term ‘beige-box’ apparently didn’t catch on.) The quality of a ‘whitebox’ unit is dependent entirely on the quality of the parts. Each vendor has their own ideas vis–vis the components that they choose to use, and each is driven to a greater or lesser degree to include inexpensive components based on their client mix.

The bottom line is that although you can buy an IBM model from two different sources and be guaranteed that the contents of the units are nearly identical, it is not possible to do the same thing with ‘whitebox’ hardware. If you were to buy a ‘whitebox’ unit from two different sources, where each had identical basic specifications, it is guaranteed that at least some of the components inside would be different. Additionally, since you are dealing with small resellers, it’s possible that there may be potential issues with warranties, returns, etc.

So, if there are so many reasons to buy ‘brand-name’ and avoid ‘whitebox’ why would anyone not choose to buy the big name equipment at the lowest possible price from the big-box stores?

Two reasons: compatibility and interchangeability

It is VERY common to discover that a particular sensor or capture card has very specific requirements regarding hardware and software compatibility. If you purchase a ‘brand-name’ computer and discover that there is a hardware incompatibility between your unit and a piece of dental hardware that you want to attach, you will likely need to replace the entire computer. If you own a ‘whitebox’ unit, it’s likely that you will only need to replace a single component, such as a sound or video card. Also, due to the integrated nature of most ‘brand-name’ computers, it is much more common that you’ll experience compatibility issues than with a ‘whitebox’.

The second reason to consider using ‘whitebox’ equipment is that replacement components are much more readily available. ‘Brand-name’ equipment is reassuring because we know that the company that produced the device will be around for the next few years in the event that there’s a problem. This sense of security may be short-lived in the event of a hardware problem since the ‘real’ cost of a hardware problem will be the downtime involved in fixing it. If you can run to the corner (or have your vendor do the running) to get a replacement part and be up and functioning quickly, this might be better than waiting for an overnight part delivery from a large manufacturer, then an onsite technician, and finally for your vendor who needs to redo the configuration.

Generally a good guideline to follow is: choose your hardware vendor carefully, and then follow their advice. A good hardware vendor will insist on good quality components since they will also be on the hook to repair anything that goes wrong.

Revisit your technology plan

Your computer system will never be ‘finished’, any more than your continuing education will be finished, or your practice improvement ideas are finished. Revisit your technology plan regularly, and maintain a feel for your long-term and short-term plans. A well-designed system will accommodate new ideas that were not even on the horizon when the hardware was installed. Occasionally, there will be items that need to be changed and/or discarded, and items that are added. There should be no reason to ‘start again’ if the system was planned correctly from the beginning.

Craig Wilson is CEO of Compudent Systems Inc., an IT company specializing in customized computer installations for dental offices.

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