The Remote Access Imperative in Modern Dentistry

The landscape of dental practice management has undergone a seismic shift. What was once a straightforward proposition—staff arrives at the office, accesses patient records, and goes home—has evolved into a complex web of remote consultations, multi-location DSO operations, cloud-based practice management systems, and after-hours charting. The question facing practice owners and IT decision-makers is no longer whether to implement secure remote access, but how to do so in a way that balances security, compliance, cost-effectiveness, and operational reliability.

According to recent industry data, 60% of businesses now use VPN technology to secure their operations, and healthcare organizations face unique pressures given the sensitive nature of protected health information (PHI) they handle daily. The average cost of a healthcare data breach reached $4.88 million in 2024—the highest ever recorded—making the stakes for dental practices of all sizes exceptionally high.

This analysis examines two primary approaches to securing remote access: commercial-grade VPN solutions deployed through on-site firewalls, and cloud-based remote access tools that have proliferated in recent years. Both approaches have legitimate use cases and can provide HIPAA-compliant remote access when properly implemented. However, when evaluating factors such as granular control, total cost of infrastructure, and long-term reliability, on-site firewall-based VPN solutions emerge as the more compelling choice for practices seeking maximum control over their security posture.

Understanding the Two Approaches

On-Site Firewall VPN: The Foundation of Network Control

A commercial-grade VPN deployed through an on-site firewall represents the traditional enterprise approach to secure remote access. In this configuration, a next-generation firewall (NGFW) appliance—such as those from Fortinet, Cisco, Palo Alto Networks, SonicWall, or Sophos—sits at the network perimeter of your dental practice. This physical or virtual appliance serves as both the gatekeeper for all network traffic and the termination point for encrypted VPN tunnels.

When a dentist needs to access patient records from home, their device establishes an encrypted tunnel directly to the practice's firewall. All traffic flows through this secure connection, allowing the remote user to access internal resources as if they were physically present in the office. The firewall simultaneously provides intrusion prevention, malware detection, content filtering, and detailed logging of all access attempts.

Key characteristics of on-site firewall VPN solutions include:

Complete data sovereignty: All traffic terminates at hardware you own and control, with no third-party data processing
Unified threat management: VPN, firewall, intrusion prevention, and content filtering in a single appliance
Granular policy control: Define exactly which users can access which resources, when, and from what devices
Site-to-site connectivity: Connect multiple practice locations seamlessly for DSO or multi-office configurations
Independence from vendor availability: Your network security doesn't depend on a cloud provider's uptime or business continuity

Cloud-Based Remote Access: The Modern Alternative

Cloud-based remote access solutions have gained significant traction, particularly among smaller practices and organizations seeking rapid deployment. These solutions—including services like NordLayer, Check Point SASE, Twingate, and Zero Trust Network Access (ZTNA) platforms—route traffic through the vendor's cloud infrastructure rather than through hardware at your physical location.

These platforms often employ Zero Trust principles, segmenting access to specific applications rather than providing full network access. When a user connects, their identity, device posture, and context are verified before granting access to individual resources. This approach can reduce the attack surface compared to traditional VPNs that grant broad network access upon connection.

Key characteristics of cloud-based solutions include:

Rapid deployment: Often operational within hours rather than days or weeks
No hardware required: Eliminates upfront capital expenditure for firewall appliances
Vendor-managed infrastructure: Updates, patches, and scaling handled by the provider
Geographic flexibility: Cloud points of presence distributed globally for performance optimization

The Case for On-Site Firewall VPN: Control, Cost, and Reliability

While cloud-based solutions offer convenience, dental practices seeking maximum control over their security infrastructure, predictable long-term costs, and independence from third-party availability will find on-site firewall VPN solutions more compelling. Here's why.

1. Complete Control Over Your Security Posture

With an on-site firewall, you maintain absolute control over how your network is secured. You decide which encryption protocols are used, how access policies are configured, which traffic is logged, and how long that data is retained. This level of control becomes particularly important when navigating the increasingly stringent requirements of HIPAA compliance.

The 2025 HIPAA Security Rule updates have introduced mandatory requirements including annual penetration testing, bi-annual vulnerability scans, MFA for all remote access, AES-256 encryption, network segmentation, complete asset inventories, and 72-hour disaster recovery capabilities. With an on-site firewall, you can configure each of these requirements precisely to your specifications, maintain comprehensive audit logs on your own systems, and demonstrate compliance without depending on third-party attestations.

Enterprise firewalls from vendors like Fortinet, Sophos, and Palo Alto offer "synchronized security" capabilities where the firewall communicates directly with endpoint protection software on workstations. If a device shows signs of compromise, the firewall can automatically isolate it from the network—a level of integration difficult to achieve with purely cloud-based solutions.

2. Total Cost of Ownership: The Long Game

Cloud-based solutions appear attractive initially due to their low upfront costs—often starting at $6-15 per user per month. However, these costs compound over time and include ongoing licensing fees that increase as you add users, features, or require premium support. For a practice with 15 staff members, cloud-based VPN solutions can easily exceed $2,000-3,000 annually, and that figure scales linearly as you grow.

On-site firewall solutions require a higher initial investment—entry-level next-generation firewalls like the Fortinet FortiGate 40F start around $450-550, while more capable units for larger practices range from $1,000-3,000. However, these appliances typically include licenses for multiple VPN users at no additional per-user cost. Annual support and threat intelligence subscriptions add $200-500 per year, but total five-year cost of ownership often proves substantially lower than equivalent cloud solutions.

3. Reliability and Independence

Cloud-based remote access solutions introduce a dependency on the vendor's infrastructure. If NordLayer, Check Point's cloud services, or any other provider experiences an outage, your team cannot access practice resources remotely until service is restored. Recent years have seen numerous high-profile cloud service outages affecting millions of users simultaneously.

An on-site firewall's availability depends solely on your own infrastructure: your internet connection, your power supply, and your hardware. While these can fail, you maintain complete control over redundancy and failover. Many practices implement dual internet connections (cable and fiber, or fiber and 5G backup) to ensure continuous availability. If your primary ISP fails, traffic automatically routes through the backup—something impossible to configure with a cloud-dependent solution.

Additionally, on-site solutions eliminate concerns about vendor longevity. The enterprise firewall market features established players with decades of history. Cloud-based remote access startups, while innovative, may be acquired, pivot their business model, or cease operations—any of which could force a practice to rapidly migrate to alternative solutions.

When Cloud-Based Solutions Make Sense

Despite the advantages of on-site firewall VPN, cloud-based remote access solutions have legitimate use cases where they may prove more appropriate:

Practices without IT expertise: If your practice lacks internal IT resources or a managed IT provider, cloud solutions' turnkey deployment may outweigh their drawbacks
Highly distributed workforces: Organizations where most workers operate remotely from diverse locations globally may benefit from cloud solutions' distributed points of presence
Third-party contractor access: Cloud-based ZTNA solutions excel at providing temporary, application-specific access to contractors or partners without requiring VPN client installation
Rapid scaling requirements: Practices experiencing rapid growth or DSOs acquiring new locations may appreciate the speed with which cloud solutions can accommodate new users and sites

Many organizations find value in hybrid approaches, using on-site firewalls for core practice connectivity while supplementing with cloud-based solutions for specific use cases like third-party access or temporary project-based remote work.

Implementation Considerations for Dental Practices

Regardless of which approach you choose, certain best practices apply to securing remote access for dental practices:

Multi-Factor Authentication Is Non-Negotiable

The 2025 HIPAA Security Rule updates mandate MFA for all remote access to electronic protected health information (ePHI). Both on-site firewalls and cloud solutions support MFA integration—typically through authenticator apps, hardware tokens, or SMS verification. A recent survey found that while 98% of small healthcare practices believe they're HIPAA compliant, many lack basic controls like MFA. Ensure your remote access solution enforces MFA for every connection, every time.

Network Segmentation Protects Against Lateral Movement

Whether using traditional VPN or Zero Trust approaches, segmenting your network limits damage from compromised credentials. If a user's login is stolen, proper segmentation ensures attackers can only access resources that user legitimately needs—not your entire network. On-site firewalls excel at implementing sophisticated segmentation policies, though cloud-based ZTNA solutions achieve similar results through application-specific access controls.

Regular Security Assessments Are Essential

HIPAA now requires annual penetration testing and bi-annual vulnerability scans. Whether your firewall sits on-site or your remote access flows through the cloud, regular security assessments identify vulnerabilities before attackers exploit them. Work with qualified cybersecurity professionals who understand healthcare compliance requirements and can provide the documentation auditors expect.

Staff Training Remains the First Line of Defense

The most sophisticated firewall cannot prevent a staff member from clicking a phishing link or sharing credentials. Regular cybersecurity training—including phishing simulations and secure remote work practices—complements technical controls. Dental practices that combine strong infrastructure with comprehensive staff education dramatically reduce their breach risk.

Recommended Enterprise Firewall Solutions for Dental Practices

For practices choosing the on-site firewall approach, several vendors offer solutions particularly well-suited to healthcare environments:

Fortinet FortiGate Series

Entry-level models ideal for solo practices
Advanced threat protection with FortiGuard subscriptions
Excellent price-to-performance ratio

Cisco Meraki MX Series

Cloud-managed but on-premise hardware
Excellent for multi-location DSO deployments
Simplified management dashboard

SonicWall TZ Series

Purpose-built for small to medium businesses
Comprehensive VPN capabilities included
Strong HIPAA compliance documentation

Sophos XGS Series

Synchronized security with endpoint protection
Intuitive management interface
Excellent threat intelligence

Conclusion: Building a Foundation for Secure Practice Operations

The choice between on-site firewall VPN and cloud-based remote access tools ultimately depends on your practice's specific circumstances, technical resources, and strategic priorities. Both approaches can deliver HIPAA-compliant remote access when properly implemented.

However, for practices prioritizing maximum control over their security infrastructure, predictable long-term costs, and independence from third-party service availability, on-site firewall VPN solutions offer compelling advantages. You own the hardware, you control the policies, and your network security doesn't depend on a cloud provider's uptime or business decisions.

As the dental industry continues its digital transformation—with practices adopting cloud-based practice management systems, AI diagnostic tools, and telehealth consultations—the importance of robust, reliable remote access will only grow. Investing in a solid security foundation today positions your practice for whatever innovations tomorrow brings.

Whether you choose an on-site firewall, a cloud solution, or a hybrid approach, the most important step is taking action. In an era where dental practices face increasing cyber threats and regulatory requirements, the only unacceptable option is inaction.

This article is part of DDSMag's Practice Technology series, providing dental professionals with actionable insights on infrastructure, security, and digital transformation.