Just What the Doctor Ordered: A New Phone System

Paul Shenenberger, CIO, Summit Medical Group of New Jersey
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Paul Shenenberger, CIO, Summit Medical Group of New Jersey

It’s difficult to imagine a field where reliable, efficient phone service is more important than in healthcare. But the rapid expansion at the multi-campus Summit Medical Group in New Jersey added another wrinkle when it came to updating phone service. 

"When evaluating vendors, strong preference should be given to vendors that support generic handsets that work on multiple systems"

As the doctors group based in Berkeley Heights grew from 34 to 70 locations in 18 months, it inherited multiple disparate phone systems from the smaller physician groups it welcomed into the fold. Unlike phone systems in traditional call centers or enterprises, healthcare is similar to a retail model where calls are distributed across multiple sites and workflow variation leads to additional challenges in creating a standard platform. 

The existing phone system used a mix of landlines, legacy PBX infrastructure and multiple Voice over IP (VoIP) providers. One particular problem was the maintenance cost for the complex infrastructure, escalating cost structure and managing multiple vendors. Employee skill set and available vendors complicated the challenge as the industry continues to shift from legacy telecom infrastructure to network based solutions. 

Rather than try to bring some consistency to the current system piece by piece, it was decided that the best option would be for the Group to replace the mix of different landline systems with a Hosted VoIP

Business Requirements

When evaluating options for the consolidation and the replacement of the phone system there were several key considerations:

• Redundancy and High Availability
• Single experience for phone system users and customers 
• Capital investment was as flexible as possible
• Return on Investment Analysis
• Expandable platform to support new technologies and integration in the future
• Consistent and predictable monthly billing with minimal variation

Redundancy and High Availability

In 2012 the Summit service area was damaged by Super Storm Sandy, which impacted power, phone service and data lines at many of Summit’s facilities. Located in the northeast, winter weather and snow also has an impact on service availability and staffing models for services that are rapidly expanding beyond traditional business hours. When making an investment in a new service it was critical redundancy was at the center of any new purchase. As Summit’s organizational footprint grows, regional disasters will be a decreasing factor in the decision to close. 

When comparing traditional on premise systems to hosted platforms, there were significant advantages to moving service to a highly redundant provider. By making this migration phones continue to ring no matter what local site issues exist and allow calls to be routed anywhere in the health system to make sure patients can reach their doctor no matter what environmental events are occurring. 

Capital Investment 

As we move away from traditional telecom infrastructure, the model is shifting from hardware investments to software. As a result depreciation models are changing, innovation is occurring at a faster rate, and we are seeing increased competition and consolidation of the market place as new business models are tested. The largest capital investment in a phone deployment is typically the handsets. When evaluating vendors, strong preference should be given to vendors that support generic handsets that work on multiple systems. In the event that your vendor experiences service delivery challenges, market disruption or consolidation, there is flexibility to preserve your capital investment and shift to another service provider without the outlay of additional capital. 

Return on Investment 

One of the biggest challenges, compared to traditional PBX systems is a change in the cost structure. When purchasing premise based systems you have a large capital outlay and ongoing maintenance costs. With hosted platforms you shift to an operating model and avoid those costs. When calculating the return on investment for a hosted service it is critical to look at the five year or greater ROI. Hosting models are very attractive in the short term, but have outsize impact at the end of the depreciation. Examine all cost elements, including the data network, redundancy cost, long distance charges, and staffing models as they may change when eliminating on site hardware. 

Results of ROI analysis were a major part of the contract negotiations, and allowed us to hold the vendor accountable, not just to the IT metrics, but to our business transformation efforts. 

Workflow, Workflow, Workflow 

Like any transformational project, changing the phone system is a major IT initiative. Focusing solely on the technology change or attempting to replicate the existing functionality will not maximize the business value of your transition. A key objective was ensuring the organizational paradigm shifted in how the phone system was utilized. There were opportunities to standardize workflow across multiple facilities, focus on the patient experience when calling an office, and other workflow changes that resulted in a transformational project that delivered business value not just a new phone system. Do not be afraid to experiment, it was a very iterative process in finding the ideal workflow for each office, and understanding what the appropriate standard should be. 

Defining your business objectives up front is crucial and allows you to tie your vendor’s success not just to uptime SLA or traditional SLA but to your business objectives. 

Changing Operating Cost Model 

Hosted platforms typically employ a cost per handset model, with all services inclusive. This has allowed us to reduce the variability we receive in the bill and simplifies the monthly review of invoices when not policing the traditional fees added by legacy carriers. It also created a business opportunity for the organization to perform more effective charge back to departments and police there usage because the new model is an inclusive handset per month model. This has allowed us to control cost, reduce frivolous requests, and identify phones that have low usage and can be eliminated reducing our costs. 

Reporting is one of the largest benefits of the investment. A key deciding factor in our final vendor selection was the strength of the analytics platform. Through analytics we can change organizational staffing models based on a rapidly evolving business landscape.   

New Company Must Be a Good Fit 

With phone service being such a vital part of daily operations at Summit Medical Group that the relationship with the vendor goes well beyond technical considerations. It’s important to make sure the company is a good cultural fit, and will be a good extension of your organization. As services continue to evolve the convergence of traditional telecom and unified communications are accelerating. Your partner should have a strong road map with clear direction on adding new functionality and integration with other unified communication components like web and audio conferencing, instant messaging and mobility. 

Success beyond the Traditional 

By migrating from a premise based solution we achieved multiple objectives. We got improved redundancy that allowed us to create business rules for call coverage in the event of a disaster. We improved our internal charge back practice and gained better control of costs. We were able to transform the staffing model to focus on delivering value to the organization instead of supporting a phone system. Analytics gave us the ability to use the phone system to inform staffing and organizational change. By utilizing a service provider, innovation happens at a faster pace and upgrading to new functionality is often included bring enterprise features to the mid-sized enterprise. Most importantly by treating the project as an opportunity to change business practice we standardized the workflow in all locations and provided a consistent experience for our customers. 

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