Tech Tips: Should You Switch to VoIP?

MDNG NeurologyApril 2008
Volume 9
Issue 2

There are several ways to employ an IP-PBX, depending on the size of your organization, the number of branch offices, and the number of phones needed.

Using VoIP (Voice over Internet Protocol) enables you to take advantage of the Internet to both save money with your office’s phone system as well as add new features that are just not possible using POTS (plain old telephone systems). VoIP actually refers to the specific protocol used by computers to transform analog voice data into compressed and encrypted data packets that can be sent via the Internet. This concept was introduced in 1995, but it wasn’t until recently that the technology matured to a point that the reliability and quality of voice transmission equals or exceeds what we expect in telephone service. Visit for further technical information.

In most offices, the phone system is controlled by a private branch exchange (PBX). This is usually a box in some closet that functions as the old-time telephone operator, but doing so in an automatic fashion. Communicating between phones within your office, as well as directing calls from outside sources to the appropriate office phone, is controlled by your PBX.

An IP-PBX does all of the switching and connecting of conventional systems, but is capable of doing much more. There are several ways to employ an IP-PBX, depending on the size of your organization, the number of branch offices, and the number of phones needed. Large, complex organizations would typically purchase the IPPBX for thousands of dollars and employ an IT staff to maintain a technologically complicated IP-PBX system. Fortunately for us small fries, many companies now provide an IP-PBX service. These companies essentially host your PBX system on their servers, which you access and control via an Internet interface. This approach has numerous advantages—no need for expensive equipment, no need for specialized technical know-how, and the system is readily expandable as needs change. For most neurology offi ces, the hosted PBX approach is really the only practical option.

So, why should you be interested in this technology? It can save you money. For my five-line system, I have been paying about $350 per month in phone charges. With an IP-PBX service, I can have much greater functionality for $189 a month. All long-distance calls are free. Other features that would typically cost extra with a standard PBX, but which are usually standard for a hosted PBX, include:

  • Automated attendant—the phone tree despised by many patients
  • Call menus, allowing for more flexible handling of calls with the ability to program rules based on time of day or information from caller ID
  • MAC (moving, adding, changing lines) is vastly simplified
  • Voicemail boxes on computers (or voice mail to e-mail) enables simplifi cation of message pick up
  • Automatic call forwarding
  • Call hold with selectable music and programmable options
  • Branch office support—the more offices in a practice and the farther apart they are increases the savings and justifi cation to change to an IP-PBX
  • Conference calling
  • Possible integration with Outlook or your contact manager

There are several important considerations when deciding whether your offi ce could benefi t from VoIP. Foremost is available bandwidth. Each phone conversation uses about 70KB of bandwidth (increasing to about 280KB during peak times). To insure simultaneous Internet usage, at least 360KB would be required. There is a handy tool to test your current bandwidth availability as well as quality of transmission at

The initial costs of converting to a VoIP service also depend on whether you can use your existing phones or will have to purchase Internet telephones. Some IP-PBX service providers allow you to use your current phones with an ATA adapter, but there may be some reduction of voice quality with this approach. Most others, however, recommend the use of an IP phone (about $160 each).

It is important to note that faxing capabilities are substandard via the VoIP protocol. Similarly, the POTS analog line is still needed for modems to use credit card services. Some vendors resolve the faxing diffi culty by off ering an eFax-type solution, which may actually be an advantage if you use an EMR. Th e faxed images from radiology and lab reports can be electronically fi led without having to scan the documents.

Visit to review the services off ered by the various vendors in this fi eld. Th e site will prompt you to specify your telephone requirements and select which vendors you would like to contact you ( and also offer similar comparison services). You will also find several comparative tables that list prices and features, allowing you to narrow down the fi eld of potential vendors.

I know everyone is curious to see hear how this VoIP implementation has aff ected my practice and patient care, but you will have to wait until the next issue of MDNG to find out because the system has not yet been installed.

Dr. Zuckerman is an MDNG Healthcare IT Advisory Board member, and the Chief of Neurology and Medical Information Officer at Baton Rouge General Hospital in Louisiana.

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