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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.
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ajhalls
ajhalls

So you want to build your own Cloud PMS

5/6/2020 9:04:35 AM   |   Comments: 0   |   Views: 180
This topic came up on Facebook and after a few days and over 100 comments, I was asked to weigh in. Some people thought you would need $10 million, others $40k. Here are my thoughts.

 Here would be my basic gameplan that ignores financial considerations since different companies or individuals have different burn rates. 
 
 Using a combination of WebAssembly and C++ to avascript using Emscripten, develop your imaging section. Gimp is an open source Windows image editor that could be migrated to the cloud with the above tools. Otherwise you could find an HTML5 one like https://ui.toast.com/tui-image-editor/
 
 https://www.opensourceimaging.org has some tools for doing MRI's and CBCT online. Otherwise look for HTML5 DICOM Viewer. Talk to Justin Shafer about connecting to the X-Ray sensors. He is the closest thing to an expert in medical imaging I know of that isn't part of an existing PMS.
 
 Try to integrate it with existing OpenDental installations first. Use revenue from that to fund future development. I consider imaging to be the #1 obstacle in development of a successful cloud PMS. 
 
 Even when you have it working, you need to make it fast enough that offices on DSL can pull up images fast, and those on cable with a capped upload speed can capture reliably. Reliably also means that when you take the X-ray, there is a local copy saved immediately in case the upload fails so they don't have to ask the patient to do that again.
 
 Use the database layout of OpenDental (https://www.opendental.com/OpenDentalDocumentation20-2.xml) as the basis for your cloud PMS. They have the most advanced DB structure of any PMS I am familiar with. Every column is important, while also not being too extreme in abstracting the data to avoid any repetition. Minimal changes would be needed to make it usable for hundreds of offices rather than just one, or multi clinic for a single company. Using it will save hundreds of thousands in self discovery and mistakes where you later realize that you needed to include that data too.
 
 Since Open Dental is also open source and written in C#, there is a good chance you could reuse much of the back end code and just build a new "front end" that was web enabled. 
 
 FullCalendar.js would be what I use for the schedule. While the core of it is free, you would need the scheduler plugin which is $480 for a SaaS service. No you can't develop it in house for less.
 
 Bootstrap HTML templates will save tons of time and make it mobile friendly. I think you could do the tooth chart and perio charting pretty easily using it as well. Patient charting, accounting, forms, notes and all are idiot proof.
 
 Find out a little about connecting to an insurance clearing house. Setup costs and monthly minimums can make it hard to get some things off the ground. Some things aren't just technical challenges.
 
 Once you have all that done, you now need a way to get data into your database. Standardizing data from Dentrix, Eaglesoft, PracticeWorks, Dolphin is a pain, but possible using their ODBC connections. EzDental and SoftDent that use Faircom's cTree database requires months and months of time to crack (ask me how I know). If I could have paid a flat rate of $100,000 for the database structures and ability to connect to the top 10, it would have been a bargain.
 
 Nearly every PMS uses not just a different database layout, but also a different database engine, which means learning new commands to do all the stuff you already knew how to do in the past. So far I have had to deal with MSSQL, MySQL, cTree Plus, cTreeACE, Pervasive, Sybase. Then to pull in outside cloud data, deal with API sourced data.
 
 Starting off with just Open Dental support will work as a proof of concept, and there are tons of Open Dental customers, but you have to compete with Open Dental directly, which is one of my favorite companies in terms of support, pricing, features. Their customer loyalty is amazing, so while it is easy to build, it will be hard to entice customers away. You might be better off with a good solid conversion from a popular but horrible PMS like SoftDent.
 
 Start with imaging, make it a value add to existing systems. Once you build your customer base adding features little by little till you are ready. Learning Computer Vision (CV) would help in doing IA Canal detection and things in the X-rays. Much of the big CV libraries are written in Python, but it is starting to appear in other languages as well.
 
 As others have said, marketing is a big deal. It is not enough to simply produce a another version of the same stuff that everyone else does. There is a significant investment in asking an office to change, and saving money alone isn’t enough, it has to be better as well. 
 
 Even when your product is better, and cheaper, it is still hard to break into the market. Ask me how I know... It is easy for offices to keep doing what they’ve been doing. Even if their old solution is expensive and isn’t great, it is working, and their staff knows how to do it. 
 
 So all of your initial investment in utilizing open source technology to create a competitive product is now worthless until you invest in solving problems that no one else has solved yet and making their life better. That takes time and money. The sooner you want to get to market, the more it’s going to cost. If you’re OK adding a feature at a time, little by little, you will have minimal manpower waste and can create a phenomenal product with very little overhead. 
 
 Personally I cringe at the thought of these big companies with hundreds of employees. It is like having 15 people doing dishes, sure they are all "working", but most are waiting for someone else to get out of their way so they can work. A perfect example is the difference between DOMO and Grow which provide nearly identical services. DOMO has multiple large buildings, hundreds of employees, spends TONS on advertising and from what I understand, has a base price of $20,000 per month. Grow was started by 3 people, provides nearly identical services and starts at $300 per month. I was introduced to Grow by its founder's brother when I interviewed him for a job with us. He and his brother had been building Grow on the side keeping his overhead low. 
 
 Larger companies can solve bigger problems faster, generally at a much higher price. Smaller companies can solve the same exact problems, for a fraction of the costs, but it takes longer. 
 
 The good news is that many of the PMS systems like Easy Dental, Dentrix and SoftDent haven't changed much in the last 15 years other than minor cosmetic or security changes. So even if it takes you a few years working on it at night, you aren't hitting a moving target as much as you would have been 20 years ago. 
 
 
 Finally, Good Luck!
Category: Practice Management, HR and Accounting
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