By Dave Salciccioli, Co-Founder and CEO, Relay. This article was originally published on the Dentrix Ascend Catalyst blog by Henry Schein One on September 16, 2026, and is republished here with permission. Read the original.
Practice management software (PMS) is the heartbeat of every practice and DSO. The schedule lives there, and so do the clinical record, the ledger, and the reports leadership runs the business from; every other tool you buy has to connect to it. For a multi-location group it is also the platform that gets copied into every office you acquire or open for the next decade. And the decision carries more weight now than it did five years ago, because what a group can do with AI depends on how clean and how well structured its data is, and both are set by the PMS.
Even so, plenty of leaders still make a commitment this size because of a conference pitch, a recommendation in a Facebook group, or one ninety-minute demo. Here is what that looks like two years later.
The demo was technically flawless. The sales engineer glided from the schedule to the patient chart to the claims screen to the reporting dashboard without a wasted click. The owner of this group, more than fifty locations across several states, messaged his team and said "That's the one."
That was two years ago, and the deployment is not finished. Offices are still queued up on a conversion calendar that slips every quarter. Acquisitions stopped the day the rollout started, and so did every other initiative that depended on the same people. I have seen this movie before. The group did nothing dishonest or careless. They skipped steps in the process that would have saved them a year, and nobody told them the steps existed.
The rest of this article is those steps. Work through them about your own group before you look at a single platform.
Start with the organization you are becoming, not what you are right now
Evaluate for the footprint you will have, not the one you have today. A three-location group headed for fifteen needs different software than a three-location group that intends to stay at three. I watch owners and operators get this wrong all the time. They pick the easiest option for the practice in front of them instead of the right one for the organization they are trying to build.
Before the demo carousel starts, get clear on six things. I have put the one most groups skip first.
- The rest of your tech stack. Most groups never do this, and it is the most important item on the list. Map every application connected to your current PMS. A PMS change has downstream effects on all of them, and you cannot plan for effects you have not listed.
- Scale of footprint. Five years from now, how many locations will you run? If the honest answer is more than ten, you are an enterprise buyer today, no matter what your current count is.
- Growth strategy. How will you get there? Acquisitions come with someone else's software and a data conversion for each one. De novos start clean but demand a setup process you can repeat without thinking. The two paths put very different strain on a platform.
- Specialty requirements. Which specialties will you offer? Pediatrics, orthodontics, oral surgery, and periodontics each have their own charting and billing workflows. Some platforms support them out of the box. Others get there with workarounds you will not find out about until after go-live.
- Operating model. How centralized will you be? If billing, scheduling, and patient communication will run from a central office, you need a platform built for that. If each practice will handle its own administration, you need one that supports it without forcing everything through a support center.
- Customization versus standardization. How much do you actually need to customize? Be honest about whether your organization insists on tailoring every workflow to its habits or is willing to trade some customization for consistency across offices. Platforms sit at very different points on that spectrum.
Your answers become the lens the whole leadership team looks through. Without them, every good demo will pull you in a new direction.
Cloud vs. on-prem
For a growing multi-location group, cloud or hosted architecture is the right answer in nearly every case. A single practice or a small group with no plans to expand can reasonably stay on-premise. A group on a growth path can too, but it should be a deliberate choice, made with a clear view of what it costs in IT overhead and in the AI tools that will be harder to connect down the road.
The reason is data. Server-based platforms keep each office's data on its own machine, so a twenty-location group has twenty databases. A cloud platform keeps everything in a single database, so leadership sees every office in one view and a change gets made one time. Every AI tool a group adopts, for diagnostics, documentation, phones, revenue cycle, or analytics, is only as good as the data it can reach. A group with one clean, governed dataset can benchmark providers across offices, test scheduling strategies against its whole history, and stand up a new vendor in weeks. A group with twenty databases loses the first six months of every AI project to cleanup.
Choosing a PMS is choosing your data architecture.
Whichever way you lean, make the decision with your IT partner in the room. If yours is a local shop whose job is keeping servers alive and resetting passwords, you need a different one. Look for a firm with national reach, a client list of multi-location dental groups, and hosted and cloud environments already built for organizations your size. Finding that partner comes before the PMS decision, not after. The one thing cloud does not remove is the dependency on each office's internet connection, and your IT partner is who makes that reliable.
A third option sits between the two: server-based software running on a hosting provider's infrastructure, reached through a virtual desktop. You keep the platform you know and the integrations you have built, and you get rid of the on-site hardware and the office-by-office patching. For a group that is not ready for a full conversion, that is a reasonable path. But unless the vendor's enterprise edition consolidates the databases, you still have one per office and every new tool still connects location by location. Ask before you call it cloud.
The rating rubric: score every platform on the same seven criteria
With the strategic questions answered, put every platform through the same seven criteria, weighted for your operating model. A simple spreadsheet and a 1-to-5 score on each line is all it takes. Have three or four people score independently, including someone from the front desk and someone from clinical, and then argue about the lines where the scores disagree. The disagreements are where the real information is.
One more rule before the scoring starts: write the demo script yourself. Give every vendor the same list of tasks from your team's actual day, such as a new-patient call, an eligibility check and estimate, a hygiene visit with a perio update, a claim with an attachment, a denial and its resolution, and a month-end production report by provider and office. Make them run it in that order. A vendor that controls the demo shows you strengths. A vendor running your script shows you the platform.
1. Multi-location architecture
Find out whether the platform was built for multiple sites from the start or modified later to support them. The giveaway is whether a single patient record, a single set of fee schedules and templates, and a single consolidated production report work across every office without exporting anything.
2. Workflow depth
On paper, every vendor's feature list reads the same. Depth is whether the platform takes a task from start to finish the way your team actually works, with no workaround in the middle. Evaluate three areas separately, because a platform can be deep in one and shallow in the others. Your current PMS may have some or none of what follows.
A. Revenue cycle workflows. Trace a single claim through the system, from the day the patient books to the day her balance hits zero.
- Eligibility and coverage. Before the patient arrives, does the platform pull real benefit detail, such as remaining annual maximum, deductible met, and frequency limits, or does it only confirm the policy is active?
- Treatment estimates. When the dentist builds a treatment plan, can the system price it against the patient's actual coverage and produce an out-of-pocket estimate before she leaves the chair?
- Claim generation and scrubbing. Are narratives and radiographs attached to the claim in the same step, and does the system flag a claim the payer is likely to reject before it goes out?
- Denial management. When a claim is denied, how fast does a person see it, and can it be fixed and resent without re-keying the data?
- Payment posting and reconciliation. Are electronic payments posted and reconciled automatically, with a clear process for exceptions?
- Patient balances. Can the patient pay by text, and does that payment land in the ledger without anyone touching it?
A group that centralizes billing also needs one queue a central team can work every office's claims and denials from. An office that has to track its denials in a spreadsheet is an office that will eventually stop tracking them.
B. Clinical workflows. Clinical tools used to mean charting and perio. Today they are the layer where most of the coming AI investment will land, and it is where platforms differ the most. Evaluate four areas:
- Imaging and AI diagnostics. Which sensors and imaging software connect natively? Does a radiograph open inside the patient's chart or in a separate program? If the platform includes or integrates AI image analysis, do the findings flow into the treatment plan and into what the patient sees on the screen?
- Clinical documentation. Is there ambient or voice-driven charting? Does it produce the perio chart and treatment plan along with the progress note? Can the provider review and sign without leaving the record?
- Standardization. Are odontograms, perio forms, and treatment templates managed centrally and consistent across specialties? Can leadership set diagnostic criteria so two dentists looking at the same film reach the same recommendation?
- Structured data. Do clinical findings land in structured, searchable fields rather than free text and image files? A platform that only reaches the clinical layer through a third party will be slower to pick up each new capability, and clinical AI is where new capabilities are showing up fastest.
C. Patient engagement workflows. Most of what a patient experiences now happens outside the operatory. The question is how much of it the PMS handles on its own and how much it hands off to bolt-on tools, each of which is one more integration to maintain and one more place the record can drift.
- Online scheduling and intake. Can patients book against live provider availability under rules the office controls, or do they land in a request queue someone has to confirm? Do intake and consent forms write directly into the chart, or arrive as a PDF someone re-keys?
- Two-way communication. Does a patient's text reply update the schedule? Can a coordinator text from inside the chart and see the full conversation?
- Recall and payments. Does the system identify patients overdue for recall or carrying unscheduled treatment and run the outreach, or only print a list? Can patients view their treatment estimate and pay online without calling?
- Multi-site administration. Can every engagement rule be configured centrally and reported across all offices from one view?
3. Data access and custom reporting
Standard reports come with every PMS. What matters is whether you can build the ones you actually run the business on and get raw data out through a warehouse connection, the API, or a bulk export. If getting your data out is hard, you do not really own it.
4. Integration and API access
Begin with imaging, since imaging connections are the most common technical failure in any PMS deployment. Then widen out to the partner ecosystem. Every tool you add later, whether AI radiograph analysis, a virtual receptionist, automated claims processing, or a business-intelligence dashboard, exchanges data with your PMS through an API, the interface the vendor publishes for that purpose. Open, well-documented APIs let you add capability without replacing the core. A closed platform turns every addition into an expensive integration project.
5. Data security
The PMS holds the most sensitive information a dental group has, protected health records and payment details, and dental organizations have become a real target for attackers. Ask to see the vendor's SOC 2 report, which is an independent audit of its security controls. Make sure the platform requires multi-factor authentication, so a stolen password by itself does not open the door. Check for role-based access, so a front-desk coordinator does not see what a billing manager sees. Confirm there is an audit log of who looked at what, that data is encrypted both in transit and at rest, and that the vendor can tell you how long a restore from backup actually takes.
6. Vendor fit and enterprise support
A vendor that is excellent with single-site practices can be out of its depth at forty locations. Find out how many clients they support at your scale. Ask what enterprise support looks like in practice: named contacts, a clear escalation path, and committed response times. If you are growing by acquisition, ask whether they can run several data conversions at once. Then ask for three references of similar size, make the calls yourself, and ask each one what went wrong.
7. Five-year cost
Look at total cost of ownership across five years, not at the license fee. Include subscription fees, data conversion, training, any infrastructure or network upgrades, third-party connector fees, the add-on modules you will eventually need, and your own staff's time during implementation. Ask specifically how the vendor plans to price AI features and whether usage-based token fees are coming. Then set the whole number against what standing still costs you in lost revenue and IT upkeep.
Prioritize implementation and adoption
A good platform implemented well will beat a better platform implemented badly. Every single time.
Set the timeline from readiness, not from a target date: a few weeks for a single location, twelve to twenty-four for five to ten practices, a year for ten or more. Phase the rollout to protect cash, moving billing and claims first, patient records once billing is stable, and imaging last, because clinical care stops when a provider cannot see an X-ray. Convert one or two offices first, fix what breaks, and only then go wider. Taking dozens of locations live at once does not work.
The vendor installs the software and shows your people where the buttons are. Adoption belongs to you, or to a service partner you bring in specifically for it. It takes role-specific training, internal super-users at each office, leadership that visibly owns the rollout, and support that continues after go-live. Measure success by whether the work is actually being done in the system, complete digital charting and timely billing, rather than by whether the software was turned on.
This is the part of the project we spend most of our time on at Relay, and it is the part that decides whether the business case ever shows up. The pattern is consistent: the vendor declares go-live, the training webinar is over, and ninety days later half the offices are running the new system the old way. Set a short list of adoption measures before go-live, such as eligibility verified before every appointment, claims out within twenty-four hours, and an estimate presented with every treatment plan. Track them by office for the first ninety days, and send someone to the offices that fall behind. The site still charting on paper in week ten will still be charting on paper in month ten unless someone stands next to them.
The one choice you cannot take back
The group from the opening is still in the middle of its migration. They will get there, because there is no way back, and they will end up on a working system at a very high price. The software was never the problem. The steps in this article were, because none of them happened. That work takes a few months. It is the cheapest phase of the whole project, and it is the only one you cannot go back and do later. Spend the time here so you can move fast everywhere else.
Dave Salciccioli is the Co-Founder and CEO of Relay, a deployment partner that closes the gap between technology purchased and technology that actually works. This article first appeared on the Dentrix Ascend Catalyst blog.
Sources
- Ekim IT, "How to Choose Practice Management Software for a DSO" (May 2026). ekimit.com
- Dental Practice Insider, "Dental Practice Management Software Switching Cost (2026)" (June 2026). dentalpracticeinsider.org
- MyBCAT, "Dental Software Integrations: DSO Multi-Location Guide" (April 2026). mybcat.com
- Group Dentistry Now, "Why 2026 Will Expose Which DSOs Took Cybersecurity Seriously and Which Didn't" (January 2026). groupdentistrynow.com
- Ntiva, "Top 5 Technology Trends from the 2026 Empower & Grow Conference" (March 2026). ntiva.com
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