Please help: starting up a practice

[Doc4smile]

Hi,
After 7 years of associateship, I am finally doing a small start up by sharing (renting) a space with another office. As this is a particular arrangement, I would appreciate any advice on how to make this work. I have very limited budget since I have no real physical assets I may not be able to get a substantial loan. I read some blogs that said that OD is the most economical, will it meet my needs?
I want to start a paperless office with the following abilities:
1) digital xray and intraoral camera, extraoral photos linked in the patient chart (one place)
-please recommend the hardwares for all of the above that works seamless with each other and OD that is the most economical.
2)kiosk for patient information to eliminate need for data entry or scanning, maybe with a tablet?
3)since I am renting the space, I don't want to make any structural changes to the space (ie. No mounting dual monitors) does OP work with an IPad? Ifno, whichTablet do you recommend that is least expensive?
4)I am looking for hardware with the ease of transfer, in the case I want to build out my own space, I can move the hardware with me to my new office.
5) I would only have 2 ops to start with, do I still need a server? What is the best way to back up info? Has anyone heard of Curvedental? They are based on a cloud, will OD move towards that?
6)remote access with the iPhone
7)I am in Northern Virginia. does anyone know a computer tech that can help me with any necessary wiring on budget?
could I run everything on a laptop or should I just get one desktop and tablet? Do I need a server?
Thanks

[sprange]

I made the transition last year with a pretty tight budget as well. Be prepared for a -lot- of compromises.

1) There are quite a few inexpensive (relatively speaking) digital sensors out there that are supported by Apteryx or its branded versions. This isn't as convenient as having it managed completely by OD, but I'd rather Dr. Sparks focus on the practice management aspect of the software than radiograph filters/etc. Apteryx does image management quite well, at least in my opinion. With a very meager upfront cost and no (!) ongoing fees it's cheap. I have two intraoral cameras. One that I spent quite a lot on, and the other that replaced it when it stopped working after being dropped. I won't mention where I purchased the cheaper one...but I was shocked at what a <$100 piece of equipment could do.
2) OD can definitely support paperless data entry. I gave up on the tablet idea as a lot of my patients were as coordinated as a slug. Windows based tablets are more functional in this regard than an ipad.
3) noted above
4) Based on what you're describing, I imagine that you could get by with a few laptops. They're pretty much disposable now, and will be less than 0.00000001 of the rest of your expenses.
5) You could piggyback the server function onto one of the computers. Not exactly ideal but possible if you're careful (virtual machines may help here). I've seen curve in action. Being web (or so called 'cloud') based is no real benefit for me. but having a background in computer engineering I guess helps. I may be wrong, but curve seemed like a program geared towards 'dummies', but OD is easy enough and yet extremely customizable. In short, it saves me time and makes entering proper notes/etc no longer a chore. I've recently discovered how slick it's automation is too.
6) LogMeIn ignition. I use it for my android phones and it works well enough even to view radiographs/etc. You could even use the free browser based version. You were mentioning that you have a limited budget. Try pricing out remote access for other programs.
7) I am embarressed to mention it, but my operatory computers are on a wireless network. I'll be renovating my office sometime soon and didn't want to commit to wiring. This could be a good route for you too. Regarding the number of computers (laptops/desktops/servers/tablets) ...you need at LEAST two, and preferably three or more. Your front office needs a dedicated computer (preferably something with a full sized keyboard and easy to view).

Anyway hopefully a few others will chime in.

[jordansparks]

3. Windows tablet PC, not an iPad. But a scanner will still be cheaper and more flexible.
5. Super simple. Just designate one of your workstations as the "server". No need for virtual machines or anything else complicated. Curve is too expensive.
6. Yes, we have a simple mobile app.
Yes, you can run everything on a laptop. No, you don't need a server.

[Doc4smile]

Thank you for all your responses.

I will look into Apteryx. How is Kodak or Gendex?

The scanner idea sounds the least expensive option for capturing patient information, makes sense.


1. Sounds like I should get 1 desk top (designate it as server), scanner, printer/fax/copier for the business area. I read the system requirements, if I get the minimum requirements, will everything work without bugs and problems?
2. 2 notebooks for for the 2 ops and 1tablet. Will I be able to share 1 tablet between the two ops for showing X-rays, intraoral photos? What are the screen specifications for notebooks?
3. Logmein ignition sounds great. Will look into it. You mentioned for me to "Try pricing out remote access for other programs." I'm not sure what programs you are referring to.
4. Wireless route seems unreliable. Have you had problems getting access?

Thank you both for your help.

[drtech]

-XDR works great with OD, and it is simple. You can start out with just buying one #2 sensor...i think that with the software it would cost you about $6000 to so, much cheaper than gendex or kodak or shick, etc...(I just went through all that last year and we LOVE XDR...very reliable, GREAT image, and I think the best value.)
-Yes, just get a few laptops for now with an external wireless mouse and use one as the server
-logmein is great for remote access
-get a scanner (just like a simple sheet-fed scanner works great in our office and take up very little room) instead of a tablet if you want ease of people signing forms...if you want truly more "paperless" then get a windows tablet and they can sign the built in sheets in open dental and you won't have to scan hardly anything.
-Wireless will be fine if you set up an "N" based network for real easy setup and portability, but wired will certianly be faster and more secure. If you are going to run some cable, you just need a 6 port gigabit switch and cat 5e or cat 6 cable and your speed will be awesome.

[sprange]

I forgot about XDR...it's another great program. Regarding my comment about 'remote access fees'--some other programs charge quite a lot for so-called remote access. OD has a minimal fee for their mobile version, but I haven't tried it yet (logmein works well for me).

I agree that you don't -need- a virtual machine, but it does come in handy, especially when using software like Apteryx. The benefit for me is that if the computer running the virtual server goes down, I can run the image on any of my other computers with almost no downtime. When I purchased my office, I had the 'server' on my reception computer. That worked well until the power supply fried. While it didn't take too long to move OD to another computer, Apteryx wouldn't run on the other computer without a new registration code, and being 3 hours behind they were closed. On a different note, I was able to run mysql on a crappy dlink 323 and in testing it was okay as a server too, but it was definitely slower than running it on windows.

[Doc4smile]

Thank you everyone for all your advice! This information will surely help.

[stjames70]

Since your initial hardware requirements seem to be so little (we operate one main MacPro computer with the OpenDental SQL database, 8 iMacs and four Dells), may I suggest you get a nice MacPro which will give you good service for many years, and two iMacs which take very little counter space all connected with a wireless Airport Extreme Base station. I also suggest you buy DEXIS.

Here are the reasons:

1) You are a dentist, not an IT manager -- you want hardware that is built right and it is not going to crap out on you in two years time (Dell anyone?)
2) Airport Extreme and Apple computers use all the same hardware, so wireless compatibility is assured -- our wireless network has failed once in six years, requiring only a simple reboot of the wireless router
3) VM Ware Fusion which you will need to run OD on Macs runs circles around our native Dells when running OD -- ridiculous in my opinion, but just goes to show you how well integrated hardware runs
4) Dexis because it comes with the one thing all others sensors don't -- a service contract which prevents you from having to pay full price for a sensor when one of your assistants smashes it by running it over with an assistant's chair

Finally, this is not a plug for CDW, but get a credit line from them, 24-month lease your equipment with $1.00 option to buy in the end, and you will not require any large upfront capital costs. This setup will give you the opportunity to expand when you are ready, and as you add computers (as long as they Apple), all you have to do is to clone the virtual machine from one of your existing computers to the new computers. Cloning (or copying VMs from one machine to another) is fast, does not require you to reload all the programs once again, and if you infect one of your VMs, you can just toss that VM in the trash since the Mac side of the computer will remain uncorrupted from the Windows side.

Of course, if you enjoy rebuilding your computer after a virus infestation or have your computer run like a snail because of virus protection, by all means, save money on the initial capital costs, and waste it in the back end fixing the aforementioned problems. Your time is more valuable than anything, and having to deal with the issues I described previously will cost you dearly in time and money spent.

[stjames70]

I also forgot to mention that with the Back to My Mac function built-in on every single Mac computer, you can log into any of your Mac computers from another Mac computer as long as you have a MobileMe account.

Thus, I use my home computer to log into my office computer, check the schedule, and look up patients when they call me during after hours. It is simple and easy, and I believe this function will actually become free when Apple revamps iCloud this coming fall.

BTW, the iMac form factor is great. All monitor and one single power cord. No funky cords hanging from anywhere. The monitor is also beautiful, so you can look at your digital pictures without straining your eyes. Your patients will also appreciate it if you try to show them anything on the screen.

[Doc4smile]

Stjames70,
I am also a mac and dexis fan, I will look into the financing option you mentioned. It would come handy, since cost is the main prohibiting factor for me. Thank you.

[sprange]

If the cost of the equipment is even moderately important, I would not be buying any Apple computers (especially a Pro), and for the cost of the Dexis sensors and their ongoing fees you'll feel like running them over with a chair. I always get a chuckle when I read about having to spend 'hours' getting rid of virus infections, hardware problems/etc. Maybe with Windows 95, but Windows 7 is pretty damned stable. Any modern Intel CPU will have no problem with antivirus software for the record. Anyway it's your money.

[drtech]

You will have paid for 2 1/2 XDR sensors buying one Dexis...and that replacement plan means high monthly fees. Not a good deal in my opinion.

[Doc4smile]

I will have to research the cost/benefit of these options. I appreciate eveyone's input. Thank you.

[cdcdent]

-XDR works great with OD, and it is simple. You can start out with just buying one #2 sensor...i think that with the software it would cost you about $6000 to so, much cheaper than gendex or kodak or shick, etc...(I just went through all that last year and we LOVE XDR...very reliable, GREAT image, and I think the best value.)
-Yes, just get a few laptops for now with an external wireless mouse and use one as the server
-logmein is great for remote access
-get a scanner (just like a simple sheet-fed scanner works great in our office and take up very little room) instead of a tablet if you want ease of people signing forms...if you want truly more "paperless" then get a windows tablet and they can sign the built in sheets in open dental and you won't have to scan hardly anything.
-Wireless will be fine if you set up an "N" based network for real easy setup and portability, but wired will certianly be faster and more secure. If you are going to run some cable, you just need a 6 port gigabit switch and cat 5e or cat 6 cable and your speed will be awesome.

I am in Australia and have done three cheap startups

I still buy Dells at auction for 90 to 120 dollars

They don't all work but the duds are a source of spare parts

Right now you need a good start point for an expansion path

I still don't have digital, as film is cheaper, and most of the time you can wait for an XRay while the local numbs up the patient toothache.

Now I have two screen in each op but if starting again I'd opt for a laptop on a wall mount with a second screen by its side

I run a server with Wndows 2000 and most of my workstations are 7 to 10 years old OR Dell running Windows XP

If I re-equipped now I would probably go with Apple as discussed eleswhere in this post

Remember you can buy out of date computers (as new) 6 months after initial release for about half listed release price

I am typing on a laptop that was listed at $5500 new that I bought as new at auction 6 months after it was obsolete as far as new sales were concerned for $1890

Most computers are far and away more than powerful enough for dental software programs so old computers will run your office until you can afford something more upmarket.

Jeremy Rourke





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