VoIP the right prescription for Melbourne medical chain

case study Voice over IP (VoIP) may provide cheaper calls for home customers, but for small businesses the road to VoIP is not always so easy. At Melbourne-based Medi 7, for one, the transition has taken several years -- and attempts -- before finally yielding a widely accepted telecommunications replacement that has cut costs by more than 50 percent.

With five clinics across inner and south-east Melbourne, Medi 7 has long dealt with expensive telecommunications for calls between sites and to the myriad other healthcare providers with which its doctors must collaborate. In the past, the company maintained 50 PSTN (public switched telephony network) lines at its sites and was spending over AU$4,000 per month on its phone calls.

Just as pressing as cost, however, was capacity: with doctors sharing the same lines as incoming callers, a busy day could see doctors waiting for lines or incoming callers unable to get through as doctors rang out.

Dr Nathan Pinskier, director of Medi 7 and a longtime observer of developments in the VoIP space, recognised early on that the emerging technology could solve some of the clinics' telecommunications issues.

"I've long been of the view that if you could disseminate information over the Internet effectively at low or no cost, why couldn't you do the same thing using voice?" he recalls. "When the first adapters became available, we jumped in to see how we could make them work for our business."

A first attempt, and a second
Around three years ago, Dr Pinskier installed a Netcomm V100 VoIP adaptor, which linked the company's clinics with a VoIP service from MyNetFone to provide low-cost telephone calls over the clinics' ADSL broadband links. Dedicated VoIP phones were made available for employees' use.

Despite best intentions, however, the V100s proved less than ideal for many employees. Mixed voice quality led many employees to refuse to use the VoIP phones, although ongoing work with MyNetFone -- and an overall increase in available bandwidth -- eventually improved the voice quality "dramatically", says Pinskier.

"Still, there was a major reluctance for staff to use it ... we had the problem that if it was easier for people to pick up a PSTN handset and dial, they would. It was quite a cultural process."

Over the course of several months, Pinskier and his technically astute son worked with MyNetFone to overcome another technical challenge: having more than one V100 live on the same network, at the same time. Although this approach worked, however, it introduced multiple points of failure and required a significant effort in management.

It became clear that a more integrated solution was required, and Pinskier found it in the form of the Netcomm TA612V. A step up from the V100, the TA612V added network port switching, a PSTN backup connection, and quality of service (QoS) capabilities that promised better call quality through prioritisation of VoIP traffic.

The devices were connected to several spare lines of the PABX units at the Medi 7 branches, allowing staff to elect to call out via MyNetFone's VoIP service simply by pushing one of the line selection buttons on their existing phones.

"This gave [VoIP] capacity to every room, every suite and every doctor," says Pinskier. "It became a more seamless process, and ramped up the number of outbound lines with no real cost to us. This started to change the culture."

Leaving PSTN behind
Although putting VoIP lines on the existing multi-line phones made it easier for staff to choose to use VoIP, the approach had done little to ease the competition for PSTN lines that had motivated Pinskier to pursue the technology in the first place. It was clear to the company that the best approach was to ban staff from making outgoing calls on the PSTN altogether, freeing up what was to be a shrinking number of PSTN lines for incoming calls.

This was, however, a potentially risky move if VoIP couldn't provide a seamless replacement. And with recurring echo and staccato problems plaguing the service, Medi 7 needed to make sure its new phone system was bulletproof.

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The answer finally came as Medi 7 installed new higher-end Cisco Systems routers and replaced the Netcomm V100 VoIP devices with Cisco Systems-Linksys Sipura 2100 equipment. This solution provided much better end-to-end control over QoS, and through continuous collaboration with MyNetFone has resulted in a much better performing VoIP system that has since become the only way for Medi 7 staff to dial out.

"It all comes down to adequate QoS, proper programming, and a good back end provider so you can quickly deal with problems as they arise," Pinskier says. "[Then you can] make it a seamless process whereby no matter which line someone picks up, they're dialling out through VoIP. That's where the real savings come in."

If VoIP only had a brain
Making VoIP reliable enough for everyday use proved to be a major cost saver for Medi 7, which with the new system in place has been able to get rid of half its PSTN lines -- only 25 remain -- and cut monthly phone bills to just AU$1,500.

In the long term, Pinskier expects that continued consolidation among the company's VoIP installation will further reduce the number of installed PSTN lines to just two at each site -- providing even further cost savings.

Consolidation wasn't the only end point for Medi 7, however: with the VoIP infrastructure in place, the company began looking for additional ways to improve efficiency of its call handling. Pinskier soon hit upon Asterisk, an increasingly popular open-source PABX system that offers what he calls "unbelievable" flexibility.

By implementing Asterisk to handle call routing among Medi 7's sites and 4-port Asterisk Digium B410P VoIP interface cards, the company was able to set up speed dialling numbers, redundant failover to alternate VoIP providers, and dialling rules that direct calls to alternate carriers if needed. This last feature proved invaluable earlier this year, when heavy rains disabled the company's phone lines but left the ADSL lines untouched. "VoIP was a lifesaver," he recalls.

This last feature proved especially valuable after Pinskier, intrigued by the idea of flat-fee mobile plans, snapped up three GSM gateways -- standalone devices that connect to the company phone network and use a mobile phone SIM card. By configuring Asterisk to detect and route all calls to mobiles through the GSM gateway, Medi 7 has been able to slash its calls-to-mobiles bill -- previously more than AU$600 per month -- significantly. Medi 7 now just buys three AU$49 prepaid cards, which each provide AU$239 worth of calls. At this rate, each GSM gateway will pay for itself within four months.

The introduction of new telecommunications and computing technologies into general practitioners' offices has been a mixed bag in the past, but Medi 7's success with VoIP heralds the considerable possibilities of the new technology. Although it has taken time, seizing control of the company's call routing, carrying interoffice calls at no cost and slashing the cost of external calls has freed up precious budget for completely new endeavours.