Alan Halls DMD
Alan Halls DMD
As a dentist and software developer, I often get asked technical questions regarding how technology can help an office overcome certain challenges, as well as advice regarding hardware and software for their office. Enjoy and comment on what you need
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ajhalls
ajhalls

Practice Management Software, the Good the Bad and the Ugly - Part 3

9/14/2018 10:27:51 AM   |   Comments: 0   |   Views: 19

This is the big one to me, really it is the reason for the series. First let me break down which PMS systems use which database engines. You can think of an engine as the difference between choosing Microsoft Word over Corel Wordperfect, or FrameMaker – They all do the same job, some better than others. Some are popular and still maintained, others abandoned soon after launch.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                    

 

                       
                                    

Database Engine

                       
                                    

Release Date of Database Used

                       
                                    

Database currently supported by manufacturer?

                       
                                    

Developer Tools Available

                       
                                    

OpenDental

                       
                                    

MySQL

                       
                                    

2010

                       
                                    

Yes

                       
                                    

Yes – Free

                       
                                    

Dentrix

                       
                                    

FairCom C-Tree Ace

                       
                                    

2013

                       
                                    

Yes

                       
                                    

Yes

                       
                                    

Eaglesoft

                       
                                    

Sybase SQL Anywhere

                       
                                    

2013

                       
                                    

Yes

                       
                                    

Yes

                       
                                    

Softdent

                       
                                    

Faircom C-Tree Plus

                       
                                    

1998

                       
                                    

No

                       
                                    

No

                       
                                    

Dentrix Enterprise

                       
                                    

Microsoft SQL Server

                       
                                    

 

                       
                                    

Yes

                       
                                    

Yes – Free

                       
                                    

Dentimax

                       
                                    

ElevateDB

                       
                                    

 

                       
                                    

Yes

                       
                                    

Yes

                       
                                    

PracticeWorks

                       
                                    

Pervasive

                       
                                    

 

                       
                                    

Yes

                       
                                    

Yes

                       

 

Softdent was the interesting one to deal with. First I tried contacting Kodak, everyone I talked to was clueless about how to possibly connect to the database. By that I mean, they didn’t even know if there was a department or person in the company for me to talk with. When I asked how companies like SolutionReach connected, I was told “They probably hired a programmer that figured it out… No we don’t have any documentation or support for that” Cool, we can work with that I suppose.

I next called Faircom, the database vendor to purchase the developer kit only to be told it was a discontinued platform, the kit was unavailable, and no support would be offered to anyone for it. Not me, not Kodak…

I later learned some interesting things about the old C-Tree Plus server. From what I understand, the 1998 server operates at incredible speeds for inserts, because it is inserting raw data into a table that has no idea what is contained in that table. There are no separators between columns, it doesn’t even store numbers as numbers, but as pure binary. It operates at such a “low level” that the server just puts it’s head down and says “I have a job to do, don’t talk to me” and does it’s work.

Trouble with that is, it also operates in a similar way that some malicious code may operate. By working at such a low level, from what I learned, as Microsoft fixes security flaws in Windows, or identifies new ways that programs exploit your computer by working at low levels, it is vulnerable to being inadvertently identified as malicious.

Imagine coming to work, launching Softdent and finding it can’t connect to the database because Windows automatic updates installed a new security patch. You could call Softdent, along with every other office in the country. They can’t help you, Faircom won’t help you, and depending on the update, you may not be able to uninstall it. The only solutions may be to either get a new server, reinstall Windows, but not the newest updates, disable automatic updates – forever. Of course you, and everyone else will be calling Kodak for a new activation code, but all in all you are working on paper for 2-3 days, or in a rush try to move to a new PMS and hope they can convert your data quickly.

Will it happen? Maybe. Could it happen? Yes.

Now I don’t know why developers choose one database engine over another. Maybe it seemed like a good idea at the time, the new engine seemed to have a lot to offer. Maybe that was the one the CTO / software engineer used in his last company and so recommended it, but I have really been surprised by how many different ones are used by these PMS systems. As I said, they all do pretty much the same thing, in the same way, using with very minor changes the same SQL queries (such as “SELECT * FROM patients WHERE last_name = “Halls”). 

Some will operate faster than others, and newer versions will outperform older versions. That is of debatable importance in a small dental practice. If you can insert 20,000 rows per second vs 40,000, does it really matter? I have noticed some queries that do complex accounting that could take 10 minutes on MySQL 5.5 completing in 10-20 seconds on version 5.8. That is because they have optimized some internal math functions along with maybe taking advantage of new CPU instruction sets designed by Intel and other things. It is a nice thing, but in a small practice, not the biggest deal.

My personal favorite is MySQL, which is used at some small places like YouTube, Netflix, NASA (https://www.mysql.com/customers/). It has been around since 1995, is owned by Oracle and is free. Because of that, it also has one of the largest customer bases in the world, which means when you need help, there are more people to help you with MySQL that practically any other system on the planet – slight exaggeration. Other excellent free options are MariaDB (written by the original author of MySQL), PostgreSQL. All of which are free, work on every operating system, and have lots of support.

Because they all work the same way, they could also, with minor modifications, upgrade to one of those, or another on this list: 
https://en.wikipedia.org/wiki/Comparison_of_relational_database_management_systems

Like I said, I don’t know why these companies are all choosing to use other databases, because commercial ones like Faircom, Sybase, and others may cost them for every customer they get, which cost is passed on to you, but ultimately raises the price tag of their solution compared to others that choose the open source options.They also then can't upgrade their DB without either footing the bill themselves for every user, or charging an additional fee.

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