Top lessons From a COO Who Switched 7 Locations to Cloud-Based Dental Software

Running a multi-location pediatric dental group is controlled chaos on a good day. Switching practice management solutions (PMS) in the middle of everything is another level entirely. 

Nicole Hartshorn has been COO of Pediatric Dental Group of Colorado for 13 years. She oversees seven locations, a team that includes staff with 36 years of tenure, and a clinical model built on personal relationships, precise scheduling, and tight operational consistency. 

After 15 years on Open Dental, she led the group's full transition to Dentrix Ascend and came out the other side with a clear-eyed perspective on what moving PMSs actually require. 

Here's what she learned. 

1. The reason to switch wasn't frustration. It was scale. 

Open Dental worked. That's the part of this story that's easy to miss. Pediatric Dental Group wasn't running a broken system. They were just running a system that couldn't see the whole picture. 

After 15 years, Nicole knew the platform well, but the server-based software made it so each location had to operate in its own data silo — no unified dashboard, group-level reporting, or way to see what was happening across the organization in real time. 

"It got to us that we really needed to be able to look at this practice as a whole unit and not as individualized locations. Open Dental just didn't have the ability to do that for us."

For a practice looking to add locations and team members, being able to make smarter decisions with the data they had access to became a ceiling that was stunting their growth. 

The lesson: the right time to evaluate your software isn't when it breaks. It's when your ambitions outgrow what it can do for you. 

2. The hardest part of the transition had nothing to do with features. 

Ask Nicole what broke first during the transition, and she'll tell you: A/R. All the ledger data stayed behind in Open Dental. Financial history didn't migrate. And within weeks, the team was losing track of what was owed. 

Her solution was methodical and unglamorous: pulling reports from both systems, building a master list, and creating a new SOP that walked the team through the process patient by patient. It took about six months to fully clear the curve. 

"About two months in, I was definitely questioning whether we made the right choice," said Hartshorn. 

She stayed the course because of the support behind the software. Trainers came on-site to every location, worked one-on-one with individual team members on their specific issues, and were present the day everything went live. 

"The day that we flipped the switch and saw patients for the first time with that new software, those trainers were on site with our staff, walking them through how to handle different scenarios and difficulties that would come up." 

Without that level of involvement, Nicole is candid about where things would have ended up. 

"If the support teams and software trainers weren't so hands-on and involved, we definitely would've been treading water and considered going back." 

The lesson: onboarding support isn't optional. For a multi-location group, it's the difference between a successful transition and a very expensive retreat. 

3. The front desk will struggle the most — and that's predictable. 

Nicole was direct about who the transition was hardest for: the front office.  

"The software we came from was very antiquated, very overly simplified. The new software was very AI-smart, very work-smarter-not-harder, and we weren't used to that,” said Hartshorn. “We were working twice as hard as we needed to in the beginning before we realized, 'Oh, this does this for us. We don't have to work like this anymore.'" 

Simple things caused real confusion, like appointments that felt saved but weren't, or a patient showing up with an appointment card for a visit that didn't exist in the system. Nicole's response wasn't frustration — it was grace. 

The lesson: prepare your front desk first, forgive them more than you think you should, and have written SOPs ready before they need them. 

4. Resistance often comes from habit. 

There's an assumption that longtime team members will be the hardest to bring along during a software transition. Nicole found the opposite to be true. 

"Our longtime team members struggled a little, but they were very open and easy to work with. Once you plant that seed — 'hey, this is here to make your job easier' — they were on board." 

The real friction came from those with the mindset of, "This is how we've always done it."  

Her approach was to redirect rather than argue. "You're right — this is how we've always done it. But let's explore something a little bit different and see if we can develop new systems for the next generations who come in behind us. You can help me plan that." 

The lesson: change management isn't about convincing people the old way was wrong. It's about getting them involved in building what comes next. 

5. Automating insurance verification freed up more than time. 

Before Ascend, one to two team members per location spent significant portions of their day on insurance verification. Hours on hold. Manual lookups. Phone tag with carriers. 

After the transition, that work largely disappeared from the daily workload. 

"We're probably saving about 16 to 20 hours per week on the phone. That's a part-time employee. Right now we have our team making baskets for referring offices — koozies, water bottles, things to take out into the community — whereas before they would have spent that time on hold with insurance companies." 

That reallocation isn't a small detail. It's the difference between a team that spends their day managing administrative tasks and a team that spends their day focusing on the patient relationships that actually drive retention and referrals. 

The lesson: the ROI of automation isn't just the hours saved. It's what your team can do with those hours instead. 

6. The metric most practices obsess over isn't the one that matters most. 

Nicole has a master's degree in statistics. She's also watched too many practices fixate on collections at the expense of the number that actually drives everything else. 

"Collections is important; that's what pays your bills. But if we're not increasing production, we're not going to see an increase in collection,” said Hartshorn. “You can collect 99% of production, but you can't collect 10% more for the year if you're not producing 10% more." 

The metric she watches more closely: patients who don't rebook at checkout. "Those patients that fall through the back door quietly destroy practices. You're seeing a drop of 10 to 15% of patients who just aren't returning." 

Her team targets a 95–96% reactivation rate before any patient reaches inactive status, using personalized text outreach that references details from the child's last visit. 

The lesson: production drives collections. Recall drives production. And patients return when they feel like your team actually knows them. 

Three years out — what Nicole says now 

When Nicole checks in with her team today — asking them to recall where they were two or three months into the transition, the response is unanimous. 

"We've come out on the other side. Everybody is just super grateful to have these systems in place and all of this support." 

The cloud-based infrastructure they moved to gives providers access from anywhere. Notes can be completed on a weekend emergency visit from home. Scheduling, insurance verification, and reporting all operate from a single platform. And the team that once spent hours each week on the phone with insurance companies is now out in the community, building the referral relationships that fill the schedule six months from now. 

If you're a practice owner evaluating the same decision Nicole faced — server-based and stable versus cloud-based and scalable — her advice is direct: 

"You can't go wrong with cloud-based, even if you are only one location, one provider. There are just so many things you can get done with a cloud-based PMS that you would have never even imagined." 

Check out the full episode of the Dental Marketer on their website or wherever you listen to podcasts.