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Hosted PBX puts nurses on call

A medical answering service turns to a hosted PBX provider to facilitate growth.

When the owners of Exclusively RNs LLC first launched their company about four years ago, the after-hours answering service for physicians relied on a simple paging system to receive and return calls from patients.

I can't stress enough how difficult it is to manage a distributed network and make it behave properly.
Lisa Pierce
analystForrester Research Inc.
"When a patient called, they would leave a message in a voicemail," said Laura Hagler, co-owner for the Colorado Springs, Colo., company. "That would alert a pager we carried. We'd call the system, get the patient's information, and we would return the call."

As the small company began to grow, Hagler and her fellow co-owner, Anne Afshari, director of practice relations and clinical services, knew they needed a more sophisticated way of handling calls. But an on-premise private branch exchange (PBX) would require a serious investment in infrastructure.

Exclusively RNs' infrastructure made finding the right phone system a challenge. The company takes after-hours calls made to the offices of obstetric and gynecological physicians across the country. A network of registered nurses take these calls remotely, usually from homes, and offer advice to patients when the doctors are unavailable. As the company hired more nurses and contracted with more doctors' offices, the old paging system couldn't support the business. There were too many calls coming in and too many nurses to take the calls.

"We needed to be able to answer calls in real time," Hagler said. "We were looking for a real seamless call system, so the patients would perceive that the calls were coming into our system."

Hagler and Afshari elected to go with a hosted PBX vendor that could route calls and faxes to whatever phones they designated -- office lines, home phones, mobile phones, IP phones. But there were some bumps along the way.

A hosted PBX is similar to the traditional PBXs found on-premise at larger companies. However, since the equipment is shared over many users, the hosted system offers more affordable service to smaller companies. Incoming business calls are answered on the service providers' PBX and routed to employees over the public telephone system.

Lisa Pierce, a vice president at Cambridge, Mass.-based Forrester Research Inc., said hosted PBX technology is a good approach for small companies with multiple locations because it avoids big capital outlays.

"It also gives them access to technology that much larger companies can have," Pierce said. "I can't stress enough how difficult it is to manage a distributed network and make it behave properly."

Jonathan B. Spira, chief analyst at collaboration research firm Basex Inc. in New York, said hosted PBX can be a tremendous help for small and medium-sized businesses with limited resources and a high number of remote workers.

"From our research, 40% of knowledge workers work in nontraditional environments [outside the corporate office] between one and five days a week," Spira said. His firm surveyed 20 companies to determine that percentage.

"This means that companies have to support workers where they are," Spira said. "This could be a hotel, an airport lounge, a customer site. So the tools such as Virtual PBX offers can be critical to this if you have a workforce that is working widely from home."

Unfortunately, Exclusively RNs' first PBX deployment turned out to be problematic. It didn't have 24-hour tech support, and the tech support line was linked into the virtual phone system. If the whole system went down, there would be no way of reaching the company to have it troubleshoot and fix the problem.

"We provide direct patient care," Hagler said. "It's imperative that we had a system we could count on, and if any issues came up, that we could reach the vendor 24/7."

Exclusively RNs left that first provider and went with Virtual Inc., a San Jose, Calif.-based provider of virtual switching services. Afshari said the vendor had the technical support and reliability she was seeking.

Afshari said her customers want their patients to have a seamless experience. They don't want their patients to perceive that they're calling into a virtual system. Instead, they want their patients to believe that they're reaching a nurse waiting in the doctor's offices. By having an affordable but intelligent hosted PBX system that can route calls to nurses quickly, that illusion is created for patients.

Exclusively RNs has about 35 employees today. Afshari doesn't anticipate any scalability problems as her business continues to grow.

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"The technology that Virtual PBX offers is pretty much endless," she said. "We can add extensions. We can program multiple nurses onto a call. We can add different toll-free numbers into our system. We've grown 100% year-on-year, and Virtual PBX has never had a problem handling our calls."

Hagler and Afshari said it was important to create the perception of a larger company with the robust features of Virtual PBX so doctors would be confident in the service and patients would have a consistent, uninterrupted experience dealing with their nurses.

"I don't think it's a question of putting on a face [of a larger company]," Spira said. "Rather it's doing what the business needs. In other words, a lot of people are concerned with making a company look like a real business. But if you have 40 people, you are a real business. You don't need to fake it."

Let us know what you think about the story; email: Shamus McGillicuddy, News Writer

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