How a Widely Distributed Dental Firm Protects Sensitive Data While Making It Highly Available

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How a Widely Distributed Dental Firm
Protects Sensitive Data While Making
It Highly Available
Transcript of a discussion on how a rapidly growing dental services company combined
hyperconverged infrastructure with advanced security products to efficiently gain data
availability, privacy, and security.
Listen to the podcast. Find it on iTunes. Download the transcript.
Sponsor: Bitdefender.
Dana Gardner: Welcome to the next edition of the BriefingsDirect podcast series. I’m
Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator.
Modern dentistry depends on more than good care. It also demands rapid access to
data and applications. For a rapidly growing dental services company -- consisting of
hundreds of dental offices spread across 10 American states -- the task of managing all
of its data availability, privacy, and security needs started out as complex and costly.
The next BriefingsDirect security innovations discussion examines how Great
Expressions Dental Centers found a solution by combining hyperconverged
infrastructure (HCI) with advanced security products.
Here to share the story of how to best balance data
compliance and availability requirements via modern IT
infrastructure is Kevin Schokora, Director of IT
Operations at Great Expressions Dental Centers in
Southfield, Michigan.
Welcome to BriefingsDirect, Kevin.
Kevin Schokora: Thank you, Dana.
Gardner: What makes Great Expressions Dental
Centers unique? How does that impact your ability to
deliver data wherever your dentists, staff and patients
need it with the required security?
Snowbird-driven software succeeds
Schokora: Our model is based on being dispersed in multiple states. Across those
sites, we have many software packages that we have to support on our infrastructure.
Schokora

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Based on those requirements, we were afforded an excellent opportunity to come up
with new solutions on how to meet our patients’, doctors’, and customers’ needs.
Gardner: You have been in business since 1982, but you have really expanded a lot in
the past few years. Tell me about what’s happened to your company recently.
Schokora: We found our model was ripe for success. So we have experienced
tremendous growth, expanding to 275 sites. And going forward, we expect to expand by
62 to 100 new sites every year. That is our goal. We can do that because of the unique
offerings we have, specifically around patient care and our unique software.
Gardner: Not only do you have many sites, but you allow your patients to pick and
choose different sites -- if they need to cross a state border or move around for any
reason, but that wide access requires you to support data mobility.
Schokora: It does. This all came about because, while we were founded in Michigan,
some of our customers go to Florida for the winter. Having had a dental office presence
in Florida, they were coming to our offices there and asking for the same dental care that
they had received in Michigan.
So, we expanded our software’s capabilities
so that when a patient has an appointment
in another state, the doctor there will have
access to that patient’s records. They can
treat them knowing everything in the
patient's history.
Gardner: Who knew that snowbirds were going to put you to the test in IT? But you
have come up with a solution.
Schokora: We did. And I think we did well. Our patients are extremely happy with us
because they have that flexibility.
Gardner: In developing your solution, you leveraged HCI that is integrated with security
software. The combination provides not only high availability and high efficiency, but also
increased management automation. And, of course, you’re able to therefore adhere to
the many privacy and other compliance rules that we have nowadays.
Tell us about your decision on infrastructure, because, it seems to me, that’s really had
an impact on the end solution.
Schokora: It did, and the goal was always to set ourselves up for success so that we
can have a model that would allow growth easily, without having huge upticks in cost.
When we first got here, growing so fast, we had a “duct tape solution” of putting
infrastructure in place and doing spot buys every year to just meet the demands and
accommodate the projected growth. We changed that approach by putting a resource
We expanded our software’s
capabilities so that when a patient
has an appointment in another
state, the doctor there will have
access to that patient’s records.

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plan together. We did a huge test and found that hyperconverged would work extremely
well for our environment.
Given that, we were able to go from five server racks in a co-location facility down to one
– all while providing a more consistent services delivery model. Our offices have been
able to grow so that the company can pursue its plans without having to check back and
ask, “Can the IT infrastructure support it?”
This is now a continuous model. It is part of our growth acquisition strategy. It's just one
more check-box where we don't have to worry about the IT side. We can focus on the
business side, and how that directly relates to the patients.
Gardner: Tell us about the variety of data and applications you are supporting for all 275
sites.
Aligning business, security and patient records
Schokora: We have the primary dentistry applications, and that includes x-rays, patient
records, treatment plans, and all of the various clinical applications that we need. But
then we also have cumbersome processes – in many cases still manual – for
coordinating that all of our patients’ insurance carriers are billed properly. We have to
ensure that they get their full benefits.
Anywhere we can, we are targeting for more provider-payer process automation, to
ensure that any time we bill for services or care, it is automatically processed. That level
of automatic payments eliminates the touch points that we would have to do manually or
through a patient.
And such automation allows us, as we scale and grow, to not have to add as many full-
time employees. Our processes can scale in many cases by leveraging the technology.
Gardner: Another big part of the service puzzle is addressing privacy and compliance
issues around patient information. You have to adhere to the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) and the Payment Card Industry Data
Security Standard (PCI DSS) nowadays. What were your concerns were when it came
to balancing the availability of data with these compliance requirements?
Schokora: We had to ensure from an
infrastructure perspective that we afford all of our
customers -- including the software applications
development team -- a platform that they can
have confidence in, and we had to earn their trust.
To that end, the HCI approach allowed us the
capability to use encryption at rest, which is a
huge component for compliance for HIPAA, PCI,
and things of that nature.
The HCI approach allowed us
the capability to use
encryption at rest, which is a
huge component for
compliance for HIPAA, PCI,
and things of that nature.

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The other benefit was to move our entire environment -- what I call a forklift of our entire
data center. That allowed us to then review what I would call the sins of our past to
ensure that any of that cobbled-together infrastructure is built with the security needed to
meet all of the requirements of the customer. We can now plan on a top-down basis.
We just completed this project and we have made a lot of changes to that model to
support a better and more secure infrastructure.
Gardner: Before you had a Swiss army knife approach to security. What was the
problem with that approach? And what kind of performance tax came with that?
HCI scalability adds value
Schokora: To meet the needs of the business at the time, the Swiss army knife
approach took us far. But as we ramped up our acquisition strategy and expanded Great
Expressions, we found that this was not scalable to achieve our new business needs.
We needed to look at a couple of key pieces. One was automation, and two was how we
revolutionized how we do things. Once we looked at HCI and saw the differences in how
we used to do things – it was an easy decision.
We put our new plan through a proof of concept (POC) test. I had some people who
were heavily invested in our former technology, but they begged for this new technology.
They wanted to use it. They saw how it translated into a value-add for the customers.
Gardner: What was the story behind the partners and technology you chose?
Schokora: We looked at three different vendors. We were an existing VMware
customer, so we looked at their solution. We looked at Hewlett Packard Enterprise
(HPE) SimpliVity, and we looked at Nutanix. They were all very similar in their approach,
they all had their strengths.
The one thing that really stood out for us with
Nutanix was their customer approach, their
engagement, and how they ensured that they are a
partner with us. They showcased this through the
POC process, throughout testing the equipment
and environment. They were there, hand-in-hand
with us, responding to our questions -- almost ad
nauseam. They ensured that customer experience
for us, just to make sure that we were comfortable
with it.
The one thing that really
stood out for us with Nutanix
was their customer
approach, their
engagement, and how they
ensured that they are a
partner with us.

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They also had their own hypervisor, what all their virtual machines rest on; same as
VMware has their own. There were some benefits in moving with that, and it also aligned
into our backup strategy, with the product we use called Rubrik.
So given all of this, as a complete package, we felt that this was an opportunity that
could not be passed up on. When we wrote the business case -- and this was almost the
easy part at that point, showcasing the benefits over five years -- this solution easily won
out from a cost perspective and aligned with the business requirements of growth. That
alignment supported our whole business, not just IT. That was also critical.
Gardner: How quickly were you able to do the migration? How did it go across 275 sites
and 4,000-plus workstations, laptops, and other client devices?
Well-managed migration
Schokora: This required a lot of testing. This was about us going through with
planning, with the test migrations, working with our users to have maintenance windows,
so that once we did move we could execute a fully developed test plan to ensure that
our customers also signed off on, “Okay, yes, this works for me, this meets my
requirements.” I thought that was key as well.
Going through it, we did experience some
hiccups, things that impacted project events,
and so we had to adjust our timelines. We still
finished it before we thought we would. We
were on a pace to beat our timelines by half.
Gardner: Wow.
Schokora: Yeah. It was great. We were moving at this rapid pace and then we
discovered that there were some issues or some errors happening in some of our virtual
servers and some of the ones that were rather big, and this kind of showcases that
support of Nutanix.
So we had Nutanix on the phone. They were with us every step of the way. They took
our logs and they evaluated them, and they quickly issued out patches to address some
of the things that they noticed that could be better within their migration tool. So we had
a positive effect on Nutanix as well, recognizing some of their opportunities and them
quickly addressing them.
Once we implemented this new tool that was provided to us, we were able to move
some of our extremely large systems over without impacting the customer outside of our
maintenance windows. And we are talking, not necessary petabytes, but very close to it,
with database servers and customer entry points into our dental software.
Going through it, we did
experience some hiccups, things
that impacted project events, and
so we had to adjust our timelines.

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Gardner: And this is for 2,400 employees, but you only have an IT staff of approximately
30 or so people?
Schokora: Correct. And you will hear the A word a lot: Automation. While we had some
late nights, given the tools and some of the automation techniques that the vendors use,
specifically Nutanix, we were able to get this done with limited staff and with the result of
our board of directors personally thanking us, which was great.
Gardner: Not only did you consolidate and modernize your infrastructure, but you in a
sense consolidated and modernized your approach to security, too. How did the tag
team between Nutanix and your security vendor help?
A secure solution
Schokora: From a security perspective, we chose -- after a lengthy process of
evaluation -- a Bitdefender solution. We wanted to attack our endpoints and make sure
that they were protected, as well as our servers. In addition to having a standardized
methodology of delivering patches to both endpoints and to servers, we wanted an
organization that integrated with Nutanix. Bitdefender checked off all of those boxes for
us.
So far the results have been fairly positive to overwhelmingly positive. One thing that
was a positive -- and was a showstopper with our last vendor -- was that our file server
was so big. We needed to resolve that. We couldn’t run our antivirus or anti-malware
security software on our file server because it made it too slow. It would bog down, and
even as we worked with the vendor at the time we could not get it passed to “green.”
With Bitdefender, during our POC, we put
it on the [file server] just to test it and our
users had no impact. There were no
impacting events, and we were now
protected against our biggest threats on
our file server. That was one of the clear
highlights of moving to a Bitdefender
solution.
Gardner: And how important was Bitdefender’s integration and certification with
Nutanix?
Schokora: It was one of the strengths listed on the business case. That integration
between Nutanix and Bitdefender was not a key decision point, but it was one of those
decision points that if it was close between two vendors it would have put Bitdefender
ahead. It just so happened, based on the key decision points, that Bitdefender was
already ahead. This was just another nice thing to have.
There were no impacting events,
and we were now protected
against our biggest threats on our
file server.

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Gardner: By deploying Bitdefender, you also gained full-disk encryption. And you
extended it to your Windows 10 endpoints. How easy or difficult was it?
Schokora: Leveraging encryption at rest was a huge win for us from a compliance
standpoint. The other thing about the workstations and endpoints was that our current
solution was unable to successfully encrypt Windows 10 devices, specifically the mobile
ones, which we wanted to target as soon as possible.
The Bitdefender solution worked right out of the box. And I was able to have my desktop
support team run that project, instead of my network operations team, which was hugely
critical for me in leveraging labor and resources. One team is more designed for that
kind of “keep the lights on” activity, and not necessarily project-based. So I was able to
leverage the project-based resources in a more efficient and valuable way.
Gardner: It sounds like you have accomplished a lot in a short amount of time. Let’s
look at some of the paybacks, the things that allowed you to get the congratulations from
your board of directors. What were the top metrics of success?
Timing is everything
Schokora: The metrics were definitely based on timing. We wanted to be wrapped up
by the end of June [2018] in support of our new enterprise resource planning (ERP)
system. Our new ERP system was going through testing and development, and it was
concluding at the end of June. We were going for a full roll-out for our Michigan region at
that time. The timing was critical.
We also wanted to make sure there were
no customer-impacting events. We
wanted to ensure that all of our offices
were going to be able to provide patient
care without impact from the project that
was only going to be deployed during
scheduled maintenance hours.
We were able to achieve the June timeframe. Everything was up and running on our
new Nutanix solution by the third week of June. So we even came in a week early, and I
thought that was great.
We had no large customer-impacting events. The one thing we will own up to is that
during our IT deployment and maintenance window, the applications development team
had some nightly processes that were impacted -- but they recovered. All cards on the
table, we did impact them from a nightly standpoint. Luckily, we did not impact the
offices or our patients when they wanted to receive care.
We wanted to ensure that all of
our offices were going to be able
to provide patient care without
impact from the project that was
only going to be deployed during
scheduled maintenance hours.

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Gardner: Now that you have accomplished this major migration, are there any ongoing
operational paybacks that you can point to? How does this shakeout so far on
operational efficiency measurements?
Schokora: We now have almost two months of
measurements, and the greatest success story
that we’ve had on this new solution has been a
66 percent cut in the time it takes to identify and
resolve incidents when they happen.
If we have slow server performance, or an impacting event for one of our applications,
this new infrastructure affords us the information we need to quickly troubleshoot and get
to the root cause so we can resolve it and ensure our customers are no longer impacted.
That has occurred at least five times that I can recall, where the information provided by
this hyperconverged solution and Bitdefender have given us the ability to get our
customers back on track sooner than we could on our old systems.
Gardner: And this is doing it all with fewer physical racks and fewer virtual servers?
Schokora: Yes. We went from five racks to one, saving $4,000 a month. And for us
that’s real money. We also do not have to expand personnel on my network operations
team, which is also part of infrastructure support piece.
Now, as we’re preparing for even more expansion in 2019, I’m not going to have to ask
for any additional IT personnel resources. We are now attacking things on our to-do lists
that had always been pushed back. Before the “keep the lights on” activities always took
priority. Now, we have time back in our days to proactively go after those things that our
customers request from us.
Gardner: Because you have moved from that Swiss army knife approach, are there
benefits from having a single pane of glass for management?
Know who and what’s needed, when
Schokora: Based on having that single pane of glass, we are able to do better
resource evaluations and forecasting. We are better able to forecast availability.
So when the business comes back with projects -- such as improved document
management, which is what’s currently being discussed, and such as a new learning
management system from our training department -- we are able to forecast what they
will demand from our systems and give them a better cost model.
From an automation standpoint, we are now looking at how to get new virtualized
servers up within seconds, whereas it used to take days. From a support of legacy
systems standpoint, now that we have a window into more metrics, we are in a better
The greatest success story
… has been a 66 percent cut
in the time it takes to identify
and resolve incidents.

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place as we migrate off. We are not having lingering issues when we are moving to our
new ERP system.
All of these things have been the benefits that we have reaped, and that’s just been in
two months.
Gardner: Looking to the future, with a welcome change in emphasis away from IT
firefighting to being more proactive, what do you see coming next?
Schokora: This is going to directly translate into our improved disaster recovery (DR)
and business continuity (BC) strategies. With our older ERP system and that Swiss army
knife approach, we had DR, but it was very cumbersome. If we ever had a high-impact
event, it would have been a mad scramble.
This new solution allows us to be able to
promise our customers a set schedule,
that everything will be up in a certain
number of days or hours, and that all
critical systems will be online to meet
their requirements. We never really had
that before. It was hopes and prayers
without concrete data behind how long
we would need to get back up.
From a business continuity standpoint, the hyperconverged solution affords us the
flexibility to leverage a hybrid cloud, or a secondary data center, in a way that my
technicians feel, based on their testing, will be easier than our older approach.
Now, we haven’t done this yet. This is more for the future, but it is something that they
are excited about, and they feel is going to directly translate into a better customer
experience.
Being able to have Bitdefender provide us that single pane of glass for patching and to
get critical patches out quickly also affords us the confidence in our compliance. For the
latest assessment we had, we passed with flying colors.
There are some gaps we have to address, but there are significantly fewer gaps than
last year. And other than some policies and procedures, the only thing we changed was
Bitdefender. So that is where that value-add was.
Gardner: Any words of advice now that you have been through a really significant
transition -- a wholesale migration of your infrastructure, security, encryption, new ERP
system, and moving to a better DR posture. What words of advice do you have for other
folks who are thinking of biting off so much at once?
Smooth transition tips
This new solution allows us to be
able to promise our customers a set
schedule, that everything will be up
in a certain number of days or hours,
and that all systems will be online to
meet their requirements.

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Schokora: Pick your partners carefully.
Engage in a test, in a POC, or a test plan.
Ensure that your technicians are allowed to see,
hear, touch and feel every bit of the technology
in advance.
Do yourself a favor and evaluate at least three different solutions or vendors, just so that
you can see what else is out there.
Also, have a good relationship with your business and the business representation.
Understand the requirements, how they want to accomplish things, and how you can
enable them – because, at the end of the day, we can come up with the best technical
solutions and the most secure. But if we don’t have that business buy-in, IT will only fail.
Gardner: I’m afraid we will have to leave it there. You’ve been listening to a sponsored
BriefingsDirect discussion on how Great Expression Dental Centers combined
hyperconverged data centers with advanced security products to solve their security and
data-availability needs.
And we’ve learned how balancing compliance and availability requirements with new
modern IT infrastructure can provide for greater automation, IT staff productivity, and
allow for broad improvements in a very short amount of time.
Please join me in thanking our guest, Kevin Schokora, Director of IT Operations at Great
Expressions Dental Centers in Southfield, Michigan. Thank you so much, Kevin.
Schokora: Thank you.
Gardner: I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and
moderator for this ongoing series of BriefingsDirect discussions.
Do follow me please on Twitter @Dana_Gardner and find more security focused
podcasts at briefingsdirect.com.
A big thank you also to our sponsor, Bitdefender, for supporting these presentations. A
big thank you as well to our audience for joining. Please pass this on to your IT
community, and do come back next time.
Listen to the podcast. Find it on iTunes. Get the mobile app. Download the
transcript. Sponsor: Bitdefender.
Transcript of a discussion on how a rapidly growing dental services company combined
hyperconverged infrastructure with advanced security products to efficiently gain data
availability, privacy, and security. Copyright Interarbor Solutions, LLC, 2005-2018. All
rights reserved.
Ensure that your technicians
are allowed to see, hear,
touch and feel every bit of the
technology in advance.

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