The Tech Doctor: Buying a New Phone System?

September 1, 2008

It’s a whole new world of telephonic choices, and it can get confusing. Don’t complete that telephone upgrade without reading our primer.


You need a new phone system.

The reasons are numerous: Your practice just broke up and you’ve rented new office space; or you and your med school friends are hanging up your first shingle to practice; or you are starting to hear staff comment that they are certain the Flintstones had a more current phone system than yours.

Regardless, buying a new phone system can be daunting. The acronyms and technical jargon seem endless, and you might feel like you are at the mercy of those who understand such technobabble. So, before you pay too much, let’s take a look at the options.

Most good systems are “scalable,” meaning they can be expanded over time. However, system vendors often offer a few different types to cover different-sized organizations.

For instance, a vendor may offer one system that is scalable from four to 25 handsets, with capacity for two to six lines for inbound/outbound dialing. That same vendor may also offer a system that is scalable from 25 to 400 handsets, with the capacity for up to 60+ lines for inbound/outbound dialing.

Fundamentally, a phone system, large or small, ends up being priced on a few key values:

  • Number of handsets: This is (obviously) the actual number of telephone handsets - often called “stations” or “stationsets” - you require in your office. Document how many stations you need, and the role of the staff using each station. You can save money by only buying higher-end stations for areas that need the additional functionality. Be sure to count fax machines and credit card machines as stations, as well as any wireless phones you may need.


  • Trunklines (aka phone lines): Most phone systems require additional modules of hardware for every so many additional inbound/outbound phone lines you buy from your local phone company. A small office with only two employees, two physicians, and one fax machine can often get away with approximately four lines, while larger offices may need more lines. You need enough capacity to support the maximum number of simultaneous phone calls you want to allow in/out of your practice at any given time.

  • Maintenance agreement: If you are a larger office and expect to make modifications to your system often, you may wish to explore a “guaranteed hours” agreement. Smaller offices may opt for basic coverage and a “per-call hourly rate” for repair work instead. Always require that your vendor provide (in writing) its guaranteed time to respond and time to repair. Be sure to ask if damage to wiring and stationsets are covered in your maintenance agreement.

  • Wiring: This hidden cost often surprises buyers. Although your building may already have wires and jacks, it is possible that a complete rewiring, partial rewiring, or simply a new type of jack might still be necessary. Avoid an unpleasant surprise by asking your vendor to include all wiring costs in its proposal.

  • Additional features: More advanced systems come with a lengthy list of à la carte add-ons that you can buy. These range from “call accounting packages” that help you report your phone usage statistics, to overhead announcement/paging systems, to “fail-over systems” that provide a limited backup solution in case your primary system fails.

Some useful terminology

PBX: Usually short for “Private Branch Exchange,” this is the core component that all handsets are connected back to via direct wiring (except in VoIP applications). PBXs should always be connected to a backup power source that also provides protection from power surges, brownouts, or other electrical fluctuations. They should also always be installed in a dry, secure, temperature-controlled location.

Key system: Usually refers to the smaller, common phone systems familiar to most people. Key systems usually have a button, or “key,” associated with each line. You can see if a line is in use if the key is lit/flashing/etc. Applicable for small practices and sometimes available as used/refurbished for a reasonable price.

Analog vs. digital: Stationsets are often referred to as either analog or digital. Analog stations are similar to your home phone, and in most cases are limited to basic features like hold, transfer, etc. Digital sets communicate in a more advanced way with a core PBX, and often have advanced features such as digital displays, touch screens, menu options, and programmable buttons.

VoIP (Voice over Internet Protocol): Used to describe phone systems that operate over existing computer networks, VoIPs are usually deployed in medium to large environments. While eliminating the need for dedicated wiring, the fact that VoIP systems share their pipes with other data (such as e-mail) on your network can require advanced setup both for the phone system and your computer networking hardware (routers and switches).

POTS (Plain Old Telephone Service): POTS lines are what most of us have in our homes. When buying smaller phone systems, sites often simply buy a few POTS lines.

PRI (Primary Rate Interface): The PRI is a special line that is the equivalent of 23 voice channel POTS, but is usually cheaper. If your practice is so large that it requires more than 15 to 20 inbound/outbound lines, consider moving up to a PRI instead of using POTS lines. Using a PRI requires your PBX to have a PRI module installed (not all systems support PRI use).


LEC/CLEC (Local Exchange Carrier, Competitive Local Exchange Carrier): These refer to your local phone companies. The LEC is usually the oldest phone company in your area, and is likely providing service to your home. CLECs are newer competitors and often offer very competitive pricing on POTS/PRI lines.

As with any purchase, you should require written proposals/estimates and a signed contract before you allow system installation to begin. Establish a required completion date for installation and a timeframe post-installation (usually 30-60 days) that allows you to have the vendor return if necessary. Do your homework, and you will end up with a phone system you can truly use.

Jonathan McCallister is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via abeckel@physicianspractice.com.

This article originally appeared in the September 2008 issue of Physicians Practice.