PBX for the Medical Office

Bruce gave me a hard time about the Switchvox review (yeh .. I’ll finish it) because there was no good introduction to exactly what the system is – and why I would want it.

 Here’s an intro paragraph:

Asterisk is an open-source phone system.  It replaces the Nortel or NEC or Siemens Or whatever system that you have in your office.

Why would you want to replace your current system?  Well .. because it’s old and hard to change settings and/or maybe it is just time to upgrage and you are shopping around.  In our case – it’s that the old system (a perfectly functional Nortel Meridian Sytem with Voicemail and ~10 extensions) didn’t do some thing that we wanted – and we’re tired of struggling with configuration changes that take either a long time to learn & memorize – or $90/hr to pay the local phone guys to come and help when we are over our heads.

Asterisk is great and has many features.  It does all of the things that your current phone system does .. like answer the phone .. route calls to extensions, manage voicemial, etc.  There are two things that make Asterisk different from most systems: 

  1. It usues VOIP
  2. It is free

The difference between a VOIP system and an analog system is that the voice is moved from the server to the phones over computer wires just like the signals from one computer to another.  Yes – it will work over WiFi too.  So of course the phones are not regular $9.99 phones you can pick up at Kmart .. they are actually little computers themselves – since they need to decode the bunches of data that represent the voice and make it into something that the person hears.  It all sounds like it would be too hard and too slow to do all of this encoding of data .. moving it and then decoding it .. but the technology has gotten pretty good.  Trust me – it works. Yes – you can even use the $9.99 phone from Kmart if you buy an ATA – which is a little adapter thing that costs about $60 and does the comptuer work for you.

Why would you want to use VOIP indtead of an analog system?  Using a computer to set-up the system and route the calls makes more sense than remembering (or reading) a bunch of codes and punching them into a telephone.  VOIP also means that the phones keep their setup information wherever they are.  So if you unplug the phone from the office and plug it back in at home (so long as you have an Internet connection) — the phone will work the same as it did at the office.  Dial a "local" extension for the person who was one office away and it will ring there just as if you had been back at work.

This makes it easy to have remote workers.  One of our nurses will be working from home to help us triage calls when we get too busy.  

Hardware and infrastructure needs.  To install a VOIP system – you really don’t need much.  Asterisk can run on an old PC with not-too much RAM.   The load on the server is proportional to the number of concurrent calls.  For home or small business – a reasonably capcable desktop PC would be fine.  Big companies can run hundreds fo concurrent calls through a moderately sized server.

The system needs to get calls .. and make calls – just like any phone system. 

If you want to use it at home, you could set it us with straight VIOP and pay for calls either monthly (unlimited minutes) or by the minute with Broadvoice or one of the other VOIP providers.  Google "Asterisk VOIP" and you’ll find lots.  You’ve heard of Vonage?  Well think of an Asterisk system as your own little Vonage.  Each extension you create in the system is like one of Vonage’s customers.

For a medical practice – VOIP may work for some things (we’re going to have a few lines on VOIP for overflow) but it’s better to connect the system to a T1 or partial T1 that is provided by your local phone company.  This will replace the analog lines that are plugged into your current system and will provide from 9 to 18 (depending on what you buy) lines.  The T1 connects to the Asterisk system (you have to buy a T1 card that goes into the computer for this – about $600), and Now Asterisk can "see " the lines from the phone company.  Calls from inside the system got out to the phone company .. and calls from outside come in.  You can set up rules for how calls are handled, set up "IVR trees" to help callers find what they want .. etc etc.

Still with me?

Ok .. so why use Switchvox instead of plain (free) asterisk?  Because The setup and management of Asterisk is not plug-and play.  I can do it ( I set up two Asterisk servers at home) and most nerds can – but I want something that our office manager can set up and manage without any technical help.  Switchvox is a commercial product that puts a plug-and-play user interface on top of Asterisk.  While there are other UI enhancements to Asterisk from competing vendors and open-source collaboratives, We selected Switchvox for the reasons I discuss in the review.  Switchvox costs about $1500.  Add the phones and you are probably talking about $3000 for the whole nine yards.  Compare that to a $10,000 or $20,000 phone system that does less.  Hmm .. hard choice — eh?

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