Defining the Systems and the Pros and Cons of Each:

First business at hand, sorting the meaning of ‘Internet-based’ phones:

“Internet-based phone solutions mean different things to different people,” warns Scott Stevens, partner, Information Technology at Clifton Gunderson LLP, a nationwide firm of certified public accountants and consultants. In general, he says, these phone systems fall into two categories:

Dial-tone through the public Internet. Instead of utilizing the traditional local telephone companies, these providers deliver your voice channel through an Internet connection (referred to as “SIP” – Session Initiated Protocol), explains Stevens. This is the technology utilized by companies such as Vonage. The advantages include unlimited long distance for one flat rate, and low capital investment. The primary disadvantage is decreased reliability and voice quality cannot be ensured. Since this is newer technology, there are still numerous providers with varying levels of service fighting for market share.

IP Telephony System within the four walls of your company. With these solutions, an IP system replaces the traditional PBX system, and makes “voice” an application on your data network. The primary advantages are increased control, flexibility and functionality. The only disadvantage is the higher capital cost for the network infrastructure. Since this technology is mature, the return on investment is evident. “At this time, we believe this type of system offers the greatest benefit to physician practices,” says Stevens.

Quest and Verizon are two of the vendors offering this type of IP phone system. A Hosted IP Centrex system is another twist. “Much like traditional TDM-based Centrex service, Hosted IP Centrex service is designed for customers that want the features of a IP-PBX or PBX without the need to purchase or maintain their own system,” explains Lori Rudolph, manager of business VoIP services for Verizon. “Basically, all PBX functionality and routing intelligence resides in the service provider’s network, therefore, the customer has no phone system on premises to maintain.”

How Internet-Phones Can Be used Differently Than Traditional Phones

The beauty of Internet-based phone systems, the best of which are Voice over Internet Protocal (VoIP), is that they converge with your data systems to create incredibly efficient ways of communicating information. Calls can easily follow a physician so one number reaches you on any phone, anywhere and patients see only your office number, not your cell number, if you call them while away from your office. The real-time video component also aids physicians greatly with patient care.

Several doctors use Internet-based phones for a modern version of the House Call. New York-based plastic surgeon Dr. Spero Theodorou uses Skype’s video-conferencing capability to initially screen liposuction candidates who are too busy to visit the office or prefer the privacy of an at-home chat.

Dr. Loren Olsen, a psychiatrist in rural Iowa, uses Skype for brief follow-ups and for extensive clinical consultation for patients who live 50 miles or more from his practice.

“We use Skype to facilitate provider-to-provider communication between two Intensive Care Units,” explains Cheryl Kerr, MD, FAAP, a practicing pediatrician and a founder of ClickCare. “In our local hospital system, we have created real-time video telemedicine carts that connect the ICUs of our two local hospitals, which are about 10 miles way from each other. Staff shortages require that the two ICUs work together on a frequent basis.”

For the carts, says Dr. Kerr, the facilities use two higher-end IP cameras for the patient and the patient monitor. At the same time, for provider to provider communication, they are using Skype video calls with regular consumer web-cams. “Skype is free, easy to set up, secure, and the quality is fine—for unrecorded, real time provider-to-provider videoconferencing,” says Kerr. “Skype is really all you need.”

Dr Kerr also uses her company, ClickCare’s, store and forward approach to take care of situations when providers aren’t available at the same time, as well as to provide automatic archiving of all interactions and facilitating more complex collaborations with numerous providers and patient visits.

“The telemedicine community is starting to figure out that while real-time videoconferencing is exciting and essential in some situations, most medical collaboration is better served by store and forward solutions that allow busy providers to interact at their convenience…within a few hours, for example,” says Dr. Kerr. “Store and forward also creates much more cost savings for this reason.”

Valley Ear Nose & Throat is rolling out Mitel’s Dynamic Extension within its own facility, but will also use it to connect with doctors on Mercy Missions in Mexico. “This will essentially bring US connectivity to the Mercy Mission, without racking up long-distance charges on a cell phone or sacrificing communications altogether,” says Mitel spokesperson, Megan Lane.

Some physician offices use Internet-based phones so nurses can see patient wounds, symptoms, etc and make a better judgment about whether the patient needs to see the doctor, go to the emergency room, or merely continue at-home care after words of assurance from the nurse. Other physician offices use it to make chart notes while viewing diagnostics on the web and so it goes. The practical uses seem nearly endless.

Not A Magic Pill

Like all technologies, there is a down-side to IP-based telephony.

“For example, if there is a power outage, the VoIP service won’t work,” says Verizon’s Rudolph. “However, proper planning for battery back-up will avoid that situation.”

Another area of planning involves appropriate bandwidth sizing. With VoIP, the voice (phone) is combined on the same pipe with data (emails/files/images) transmissions. “Therefore, appropriate bandwidth sizing to accommodate both voice and bursty data traffic is critical,” explains Rudolph. “If bandwidth isn’t enough, voice quality will be jeopardized that is to say, distorted.”

“Also, an Internet connection can fail at any time and the phone system can be disabled,” adds Brodie MacLeod, systems engineer with Press 8 Communications. “With a hosted Internet-based phone system, calls can be rerouted in case of emergency to mobile phones and landlines so no calls are missed.”

The take-away: VoIP is a cost-beneficial addition to your practice but, only if you are prepared to handle its deficiencies.