How fast does your Internet connection need to be?

If you have a Crappy Internet connection you can stop reading now and give up on the Cloud (until your Internet options improve). Any Cloud Practice Management App (PM App) needs a reliable Internet connection with decent speed.

This is the most important part of your Cloud adventure. You are about to make your Internet Connection business critical. Get this part wrong and you are going to suffer immensely. For that reason I’ve spent a fair bit of time below getting into the details (sorry about the length but I think it will be worth your time).

Reliability of your Internet connection is paramount. If the Internet goes out for a few minutes each day (a.k.a. Flakey) this will drive you insane and dramatically impact your Practice. In my experience Practices that move to the Cloud often discover that their Internet connection has been Flakey without really knowing it. A traditional office uses its Internet connection in a spotty fashion – a download here, an upload there, but most of the time they don’t do anything that would notice a short, random momentary interruption of 10 seconds to even a minute or two. Even if you do notice it, people typically blow it off and just try again. If the connection is Flakey, in most cases a complaint to the ISP can usually resolve the issue once it’s spotted.

Some nomenclature: Internet speeds are discussed in Megabits per second (Mbps). Most Internet connections are asymmetrical, meaning the Upload and Download speeds are NOT equal. Download speeds are most often what are discussed, but your upload speed is important when you are capturing Photos or X-Rays and uploading them to the Cloud.

How much bandwidth do you need?

The first thing you should do is ask the Vendors you are considering. Most will tell you some things like these:

What you have now is probably enough
- This is wishful thinking, you need to delve deeper. They are just trying to not kill a potential sale by saying they aren’t sure.
Basic Cable Modem service is a good starting point
- Most Cable modem services start with speeds like 6 Mbps download speed and 1 Mbps upload speed (usually denoted as 6×1).
DSL service is borderline for anything but a smaller Practice
- DSL solutions typically struggle to be anywhere near as fast as Cable, so I would only use one if no other solution was available.
- Typical DSL speeds are less than 3×1, more often 2 x 0.768.
Fiber Optic based solutions are usually great
- Fiber solutions are built for speed, and lots of it. They will usually start at 10×3 for less than $99 per mo.
- Fiber isn’t in most places, but it’s worth checking.
Satellite based solutions are NOT going to work well enough
- If your data has to make a 20,000 mile journey to space and back, it introduces a huge amount of latency into every transaction. You click, and 2 seconds later the response comes back. It will drive you crazy.
- This is OK if all you are doing is web surfing (very little upload goes on when you are just browsing a website), so it might be OK if you live in a rural area, but not OK for a real-time Cloud PM App.
A 4G Cellular Link might be good enough
- Internet bandwidth on cellular networks has increased massively in past years. I’ve seen 20 Mbps links on cell phones.
- I wouldn’t choose this option unless my only other option was a too slow DSL.
- Reliability and consistency of speed of the 4G system is my concern.
- Might be a good choice for a failover solution (more about that in the next part of this article)
….and more bandwidth is better!
- All the vendors will suggest that it can’t hurt to get a little extra.

Be sure to check all your available options. Don’t just assume all that you can still get at your Practice is DSL (or whatever you use). Ask your peers and building neighbors. Call the Cable company. Google Search “Internet Providers in YourCityName”. Ask your IT person. Do a little research and you may end up finding a better service for less money.

OK, so how much is enough?

You’ll notice that they haven’t said exactly how fast your connection needs to be, and this is no oversight. There are more factors involved that are unique to your situation.

You need to consider how many sessions you will be running within an office. For example, a DSL connection might be just fine for a new or small Practice with just 3 or 4 PCs, but it might not be enough if you have 14 PCs. A rule of thumb I use is about 128 Kbps (0.128Mbps) download speed per session. There – I said it – someone actually making a solid suggestion. This was a metric we used back in the days of T1 lines, but it should be reasonable estimate in this situation too for almost all the vendors. This works out to approximately 8 users for each 1Mbps of download speed you have.

You also need to consider what else you will be using the Internet connection for. Imagine if you have a DSL connection that is 1.5Mbps download, you might conclude it should be fine for 12 sessions (ample for a mid-sized Practice). Not so. If even one other user uses the Internet for ANYTHING else, it will start to use up a share of the bandwidth, and a sizeable portion of the meager amount you have. A single Pandora radio stream can eat up 192 Kbps, and watching a video on YouTube or Netflix could use 1+ Mbps (all of it). The symptoms of this might be felt as inconsistent speeds of your Cloud PM App. You might incorrectly blame it on the vendor, but in reality it’s the staff member sneaking in a video on their break causing your pain. Other sources of bandwidth consumption could be Internet Backups, downloading Invisalign cases, really there are all sorts of things. You are going to want to have an excess of capacity. If you think you only need 1-2 Mbps of bandwidth for the Cloud, plan on 4 or more.

How do you catch this situation (where the performance problem is your connection or your staff’s usage of other Internet resources)? Many modern firewall routers offer a management interface that can show you in real-time what’s going through your Internet connection. You can see how fast it’s going, and who specifically is using it. A tool like this is awesome and helps narrow down the issue in moments rather than an extended guessing game. Here is what the tool looks like for a Watchguard brand firewall.

You can see the peak usage was 9.2 Mbps in the last 5 minutes and this isn’t a problem for the 10 Mbps connection we have. Imagine if we had a 5Mbps link, we’d know we were using all our bandwidth and need to speed it up or stop using it all.

Upload speeds matter too

If you are capturing a series of 8 digital photos that are 1 MegaByte each (notice I am saying Bytes, not bits) that is 8 MB of data. One Byte equals roughly 10 bits of transmitted data (they are NOT interchangeable). Those 8 photos equates to roughly 80 Megabits of data to transfer. So, our 1 Mbps upload speed for DSL would take about 80 seconds to upload these photos (that’s a notable amount of time). If your upload speed was 3 Mbps, it drops to just 26 seconds, more reasonable. Remember, you are used to this taking just a few seconds.

To make uploads go faster you can either reduce the size of the Photos (by adjusting the camera settings) or increase your upload speed with your ISP. To me, an ideal photo size for uploading would be a roughly 500 KB (0.5 MB), so turn those cameras down and make your life easier. You don’t need all those pixels! (And that will be another blog article someday)

Your upload speed should be at least 1 Mbps for any solution, and 3 Mbps or more is better.

Test your actual speed!

THIS IS SUPER IMPORTANT – don’t trust your ISP. Many, many times a Practice will be paying for something like 15×3, and when it’s tested find something like 5×1. It can be a sign of a mix-up on the ISP end (easily solved) or a more complicated solution replacing some faulty equipment.

The default answer from most every ISP when you call support to complain the speed isn’t what they promised is “Our equipment is fine, the problem is on your network” (personally I don’t even think they check, they just use this pat answer). It is possible that the problem could be your gear, so check it first to be prepared.

The best way to test is to temporarily hook a laptop directly cabled to the Cable/DSL modem (disconnecting the office firewall/router) and test the speed independently going to a site like www.speedtest.net. Don’t link your laptop to the modem by WiFi, you want to be using an Ethernet cable since the WiFi could be having the trouble. Preferably connect using the same Ethernet cable that was going to your firewall/router. This is deliberate, you want to cut off your existing network from the connection during the test since its possible something could be running amok and using all the bandwidth. If the result is notably below advertised, beat the ISP up, they will usually respond if this is your test scenario.

The first thing I always try when the Internet appear too slow is to restart the Cable/DSL modem and see if it is immediately better. This is often a quick cure.

If you discover that your connection tests fast when your laptop is directly connected to the modem, but slow when you connect it all back up to your firewall/router and your network, the problem is in your network. We’ve seen this many times too. Enlist your local IT person to sort the condition out.

Recommendations

Shoot for a middle tier Business class Cable modem service with 15Mbps download by 3 Mbps upload. In most regions this should cost you about $99-$129. If you have a large number of workstations (15+) perhaps consider the next step up in speed, usually something like 25×5.

One more recommendation: If you are lucky enough to have a Fiber Optic based solution available to you, get it. This is the future. The price should be about the same as cable modem, but the speeds will be able to scale to 100+ Mbps if you ever need it.

Is there such as a thing as too much speed? I think so. Most Cloud solutions won’t work any faster once you pass the ‘ample’ threshold. If all it ends up your situation needs is 15×3, getting a 50×10 won’t make it go any appreciably faster, so why waste the money. My advice is to make a moderately ample guess and start there.

In this multi-part series I am trying to help educate you to the issues surrounding the issues of Cloud based solutions offered by Dental Practice Management software companies. By arming you with the questions to ask and the context behind them you should be empowered to better evaluate the products and how they would benefit your Practice. You can find a link to all the Parts of the Series back on the Index in Part 1.

Up Next in Part 10 of the Series I will discuss “What happens when the Internet goes out?”

If you need a little help with your Practice, this is what MME Consulting does. Just give us a call at 866-419-1102 or check us out online at www.mmeconsulting.com.

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