Home Forums VOIP Autoattendant suggestions

I copied this from Bert's post in another section because I wanted to ask about Vendor particulars.
This is very inviting. Can you please tell us the name of the voip system you purchased?

Thanks

There are two basic ways to do Voice over IP. Host it yourself. Do NOT do that. Or have it hosted by a communications company. There are many companies which would do that. For us, it was the phone company we used, which has expanded into many areas of communication.

Just start with Google and look for companies which offer VoIP. You would possibly to set up a Auto Attendant type system using your existing digital phone system. VoIP isn't just to set up an auto attendant. It is a complete phone package utilizing your existing ethernet and Internet connection for your voice and not just your data.

One thing to mention, you have to look at this like having someone set up your entire network vs your doing it yourself using horrible equipment. This is an analogy. For instance, you can use OneBox or Grasshopper to expand your possibilities, but using a hosting company will allow you to have experts set up your algorithm.

Vicki,

I would also suggest going to Lauerdo's profile (just search for it). This is Adam, my best friend. Get his email from there. Email him (tell him I sent you) and ask him about his system. Ironically, we both went to VoIP at the same time. This is why it would give you perspective:

1. He went with a completely different company than I did. (two solutions in one small town of Brewer, Maine. In fact, we are two miles away.
2. He used OneBox for many months and can give you the difference between each.

Remember,

While hosted VoIP isn't necessarily cheap, it replaces your existing phone system, so in essence you can pretty much break even.

One of the cool things about VoIP is you can take your phone anywhere in the world, say to a conference, plug it into an ethernet jack and your phone is basically on your phone system.

One key thing, given that VoIP uses your network (although you would want likely want to use a switch with VLAN (I shouldn't go into the technicalities now), I wouldn't do it with wireless.

Thanks for all the suggestions Bert. When we do major changes to our system, we get a pro to help us. I saw one claled 8x 8 that looks interesting. I will contact Adam. I have corresponded with him in the past. Thanks Bert

What is 8 x 8? And do you have wired network?

I use a system called Accessline, through my Costco membership. But you do not need a Costco membership to buy the system.

I had a random question posed to me by a former HS friend of mine who actually can host VOIP. He said the lines on VOIP are not encrypted thus wondering if this is a hippa violation...any thoughts?

For those using it, are you using just VOIP for everything?

First, it is not the lines, it is the packets that must be encrypted. And, like anything else, it either is or it isn't. Our signaling is SIP based and is secured using TLS. The other packets used are the actual voice packets which generally use RTP. We use sRTP, which is the secure form.

This is where hosted VoIP (hosted by professionals and can monitor your setup 24/7 and know what the hell they are doing if they are capable of knowing what the hell they are doing) comes in handy. Most people are not capable of setting up a secure VoIP solution with QOS and proper VLANs or separte connections to the outside world. While you can run VoIP on the same subnet as your network (each phone being 192.168.1.x similar to your subnet of your network 192.168.1.x) you would be silly to do this.

This is where your research comes in. You want to ask your provider where the QOS is (at their end or in your switch), will they help design your networks, will they provide their own Internet connection (we got lucky and got it for free) and so on.

Remember, the good thing about VoIP is it can do SOOOOO many things that a regular, digital phone system over POTS lines can do. The downside is there are so many things it can be overwhelming. This is where paying for a hosted solution is beneficial. And, you stil basically break even once the phones are purchased. Remember, VoIP such as this, you pay for the "seat" not the line. So, 6 phones, you pay each month for 6 phones depending on the package for each.

As to the HIPAA, who cares. It is 100 times more likely that three people in your waiting room now knows that Patient A has scabies because your receptionist stated it, than for a hacker to intercept your phone call.

I remember a great quote from an extremely good networking person:

Is there someone out there that can hack into your network? Definitely

Is there someone out there that wants to hack into your network?
Doubtful.

No one but you is going to care whether your VoIP is HIPAA compliant or not.

Not sure what the question is. You basically must have voice and data in your office.

Voice can either be the traditional POTS (plain old telephone service) or VoIP, the V, hence Voice. Your data is your actual network of your computers, etc.

Disclaimer first, I have done multiple bouts in the VOIP business as an employee, mentor, integrator, and shareholder. Our services side also sells/installs/custom configures managed voice solutions.

Now let me say that I don't want any business - only to give some further suggestions about doing this, however you choose to do this.

You can take local POTS lines and connect that to an open-source PBX in your local network - requires some interfaces, but do-able. Managed Voice means that the calls will arrive at your office(s) as data traffic. While there are folks on the boards here who could run their own PBX, I'm guessing most won't.

However you cut it, local network design/management is essential. VLANing the traffic is pretty much a minimum level to get acceptable performance. If you can physically segment the traffic, even better.

Next item is a edge device that supports QOS. A better organization will suggest/require an edge device that not only supports QOS, but also measures voice network traffic performance so that they can remotely monitor your voice network.

To be clear, SIP signaling is TCP/IP traffic, whereas the voice traffic is UDP, and UDP is much more sensitive to packet collisions, traffic congestion. The differences are a whole lesson in themselves, but VOIP doesn't not like burst traffic [like AC]. This I know from experience.

There are so many things that you can do with a well implemented VOIP system.

There are standard PBXs, Call Queues where calls are parked in order, and hybrid systems that have a front-side IVR, a call queue, as well as the means to exit the queue.

If anyone has more questions about VOIP, functionality, networking, or anything else - just post here, and I'll try and stop in multiple times this week.

If you are really itching to cook your own, just post that, and I'll dig up some starter links.

I actually have a whole course I wrote about implementing VOIP, but that was 11 years ago, so I'm sure there is better info now.

@Bert: Sorry I meant do some of you have a regular telephone line (one) in case internet is down? What are you doing when the Internet is down in the office i guess is the real question.

And second question is totally based on the fact that I don't know if we need encrypted phone lines or not for our medical practices because of hippa.

Indy, I should have studied your course before I started. I am sure a telecommunications guy would laugh at my system.

After some research, I went for a local solution in a very hybrid way. The design goals were redundancy, control, and separation of incoming, outgoing, and fax traffic. I have three Comcast rollover voice lines for incoming calls (some days maxed); one Qwest voice line, and two VOIP lines for outgoing. There is a separate Comcast fax line for outgoing faxes. The box is a Talkswitch. I looked at AccessLine switches but decided against them. I have VOIP phones for the heavy users (billing, MAs) and legacy analog 4-line phones wired in parallel for incoming. The box allows me to manage voice messages, menus, log calls, and switch lines (e.g. when Comcast went down). I have QoS for VOIP but not a separate LAN for VOIP phones. Performance seems ok even when all VOIP phones are in use.

I also have both Qwest and Comcast internet service, and am thinking of adding Verizon 4G for more redundancy. I use Accessline for virtual fax of admin stuff, and UpDox for clinical.

Jack,

Wow, I don't think I could keep up with all that. You are a better man than I.

I can't agree with Indy more.

First, understand that VoIP is a great solution, but it also is much more frail than your normal POTS. When was the last time you picked up your receiver and had no dial tone.

While it may cost more to have hosted, in my mind it is the only way to go. It's like doing your own brain surgery vs referring to a neurosurgeon.

It took seven months to set mine up, and I am still tweaking. All of the algorithm is done by a professional voice from Boston with music on hold. This is all that OTT Communications does. They know what they are doing. Just learning the phones is three-days task with a learning curve of two weeks (to know everything on it).

I got lucky because the wait was so long due to some glitches, I got free DSL and free phones. Given I have data on Roadrunner, there are two completely separate networks. Prior to that I split RR and had two separate networks. Most will set you up with a VLAN (Virtual Local Area Network) from your switch which divides them. You don't HAVE to be separate, but it is nice.

You need to have so much bandwidth up and so much bandwidth down. A lot of ISPs will provide 10Mbs down and maybe 512Mbs up (usually much higher). Cable can change depending on when Middle School and High School let out and the Facebooks kick in. DSL is nice as it is your own line and never changes.

QOS is thrown around so the explanation is Quality of Service. Whether you provide it or your host, it throttles the bandwidth so that voice always takes precedence. If your front desk person is watching the latest YouTube video while downloading an episode of Sex in the City from Hulu, these will be shut down if it is taking too much bandwidth.

A friend of mine who does a lot of networking and telecommunications was asking me why do I host my VoIP. What do they do that you can't do? As he listed off the simplicity, I started get nauseated. Then he happened to be here when my VoIP contact engineer showed up. And, he answered the question with we provide A, B, C, D, and E, plus F, and G. Oh, said my friend. I see. One thing they do besides full non-stop free support so when your phones go down in the middle of the day, I don't have to run out of a room and spend two hours trying to fix something I have no idea how to fix.

The service is monitored 24/7 so that if it goes down, calls automatically are routed to them where we then decide to take them on a digital phone, cell phone, wait it out and send to the service.

One great story. When they were setting this up using a separate network and Time-Warner, we used it temporarily to see how it worked. We called people (with call numbers restricted except for out main line). Sounded great. But, before we went live, the engineers came out and listed at the main switch. Nope. Dropping packets. The possibility of voice sounding like a cell phone on the other side of Lake Tahoe was there. So, they circumvented RR by giving us free DSLs. Perfect.

It just isn't as easy as it sounds. This isn't Vonage. And, we are still setting up the call algorithm.

Lastly, VoIP can do many things. The auto-attendant can route calls ANYWHERE you want. Combine it with Google Voice and you will soon be on your way to no answering service at all. But, if I had to decide between the advantages of audex and routing calls here and there and having a Queue, which means a different type of autoattendant, I would go with a Queue.

This means NEVER ever missing a call. To the patient it means never getting a busy signal. It means if they want to call your office, and it is 5 pm, they know they will have a person on the phone by 5:03 pm.

Well I answered the second one already. You have to put things in perspective. Do the best you can do. If you are walking to your car with a chart and you are mugged and someone grabbed the chart, is that a violation? What would HIPAA say? You need a body guard at all times. Or you need to write your progress notes in lemon juice and heat them with a flame later.

The nice thing of having two separate lines for Internet is if DSL goes down, I simply move the cable to a network line and reboot the phone. Or have an employee take a phone home and take calls from there, assuming it can make it to OTT.

I guess I am just a control freak and want to host my own hardware. Same with AC versus cloud solutions, I guess.

Actually what started me down that road was that 3 original lines coming in was not enough, and too many incoming calls had to drop to voicemail. I also was very frustrated trying to get stand-alone music on hold to work properly (the voltage drop on Comcast lines do not trigger music on hold properly). I have used the VOIP-anywhere capability a few times when we had to leave the clinic with no receptionist.

If the Talkswitch box goes down, we will still have incoming lines pass through and routed correctly to the analog phones, just no VOIP, internal voicemail, or music on hold.

I have so much to learn. I thought I voip was just for an autoattendant.

Of course VOIP brings its own headaches. Yesterday Comcast rerouted our modem because DrFirst secure servers were not coming up. It solved the routing problem, but we lost our external IP address we had for three years. We could not use the VOIP lines because their servers only accepted packets from our old IP address. After we figured it out, took 15 minutes to re-propagate and we were up again. Other services used our DynDNS name and were correctly rerouted.

Vicki,

If you want just an auto-attendant, albeit not extremely robust but very functional, use onebox.com or grasshopper.com.

look at www.3cx.com as they are VERY affordable and windows based (will even run on a virtual instance!). Our docs love these! They do EVERYTHING you want including the ability to manually record calls to insurance companies!

Checked it out. Prett cool twisted. Good call.

We're using 3CX. No complaints.

I too use a 3CX system. After a few bumps early on, it has been smooth sailing the past couple years.
The things you can do with a VOIP system are remarkable.
Some feature I like include: pulling up a virtual phone on my tablet as I'm in a room and need to call a pharmacy for questions etc ... can do right with the patient. There is also an iPhone/iPod app for the 3CX... can turn it into another phone extension.
You can monitor your lines in action with the 3CX MyPhone program (review call histories, active calls, etc) and transfer calls with a click and drag of the mouse/pointer.

All the QOS, VLAN, etc. issues make VOIP seem overwhelming. We've found the hardware simple, and the management of the lines a little more complex, but mostly because of all the call routing and messaging options.

We have 4 people in our office, plus two remote workers (an RN and a CMA) We use RingCentral's digital lines system. We have 8 digital lines dedicated to 4 desk VOIP phones and 2 wireless VOIP phones, and 2 computer based soft phones (for the remote workers). Plus we use RingCentral's Android App after hours (let's you call from your cellphone with the office Caller ID shown), and their fax service. Lovin' it for about 3 years now.

We decided we would just hook the phones up to the office LAN, and worry about QOS issues later. So far, we're still just running them through our LAN, without any issues. We have a 10mb cable internet connection, 1gb switches, and 100mb NetGear Firewall/Router. The voice quality is as good or better than POTS.

Maybe we're just lucky that we haven't had to tweak the LAN, do VLANs, etc. If so, hoping we stay that way.

Wow, RingCentral sure has increased their business since I used them for Internet Fax seven years ago.

QoS is nice, but if you have 10Mb of bandwidth, I don't think you are going to need it. Especially, if that is upload speed. Just no downloading of Justin Bieber songs, and you should be OK.

In many cases QoS becomes an issue outside of your private network; often called mid-route congestion.

If you are trying to implement VOIP over DSL, the problem will often be at the local facility where all of the DSL connections typically run through a device called a concentrator - that is where your VOIP quality goes in the ditch.

The other thing to watch for is high latency/packet loss from your Internet providers' network routers - you can fire up ping-plotter and trace your traffic to your VOIP provider to check your network route.