What phone system should a new practice get?

Key facts

Hosted VoIP or an on-site system?

Either can work, and the federal 911 rules apply to both. The FCC's rules cover multi-line telephone systems installed after February 16, 2020, and that includes the person who installs, manages or operates them (eCFR). What differs is where the brains live. Hosted VoIP puts call routing in the provider's cloud; an on-site PBX puts a server in your closet.

For a startup, I usually recommend hosted, because there's no phone server to back up, patch or replace. Either way, decide before the low-voltage contractor prices the job, because the cabling plan depends on it. When you compare providers, ask four questions: how they configure 911 notification, how they validate your suite address, who owns the admin portal, and what they charge to port numbers out if you leave.

What has to happen before drywall?

1. Count every phone location. Front desk positions, each operatory that needs a handset, doctor's office, sterilization, lab, break room.
2. Run a data drop to each one. Most VoIP desk phones get network and power from one cable. See network drops per operatory.
3. Budget PoE at the switch. Fluke lists 802.3af at 15.4 W per port (Type 1) and 802.3at at 30 W, 25.5 W at the device (Type 2) (Fluke Networks). Add up phones, access points and cameras against the switch's PoE budget.
4. Plan battery backup for the switch and firewall, so phones survive a short outage.
5. Locate overhead paging and door intercoms if you want them; they need their own runs.

Put each drop on the plan in Studio. The network & IT plan generator (free tool, coming soon) will list phone drops and PoE totals with the rest of the network.

What do the 911 rules require?

The FCC's MLTS rules, known as Kari's Law and RAY BAUM'S Act, require:

• Direct dialing. A user can call 911 from any station without dialing any extra digit, code, prefix or post-fix, such as the digit 9 (eCFR).
• Notification. Where the system can be configured to do so, it notifies a central location at the facility, or another person, when someone dials 911. The notice goes out at the same time as the call and doesn't delay it (eCFR).
• Dispatchable location. Fixed devices had to send an automated dispatchable location by January 6, 2021. Non-fixed and off-premises devices followed by January 6, 2022 (eCFR).

The FCC's MLTS page summarizes the obligations (FCC). For a dental office, dispatchable location means the validated street address plus suite number. Notification should usually go to the front desk. If the system doesn't comply, the manager of the system is presumed responsible (eCFR). Put both in the provider's scope of work in writing.

How much internet do phones need?

Not much per call. Meraki's design guide lists VoIP at 16–320 kbps per call (Cisco Meraki). Ten simultaneous calls at the high end come to about 3.2 Mbps. That's small next to cloud imaging and backups, but voice needs priority (QoS) on the firewall. See dental office internet speed.

Wireless handsets need roaming that doesn't drop calls. Meraki recommends bridge mode for VoIP clients and says NAT mode isn't recommended for voice (Cisco Meraki). See dental office Wi-Fi.

Who should own the phone numbers and account?

The practice, always. The FCC says you can keep your number when you switch providers in the same area. Once you request service from a new company, the old company can't refuse to port your number, even if you owe money (FCC). The new carrier still needs your account details to do it.

That's why the carrier account, the admin portal and the number inventory should be in the practice's name, with the doctor or office manager as the account owner. Your MSP or phone vendor should have its own login. The credential ownership checklist (free tool, coming soon) includes the phone carrier and VoIP portal. See who owns dental office passwords.

Security basics for VoIP

The phone system is on your network, so it falls under the same practices. HHS 405(d) recommends segmenting networks and disabling unused ports (HHS 405(d) HICP). Put phones on their own VLAN, keep admin portals behind MFA where offered, and include the phone system in the HIPAA IT checklist.

How FloorStack helps

The free Studio plan marks every phone, paging speaker and intercom drop on the floor plan before drywall. The network & IT plan generator (free tool, coming soon) will roll phones into the drop list and PoE budget. The credential ownership checklist (free tool, coming soon) will make sure the carrier account and numbers are in the practice's name. FloorStack is a vendor-neutral dental build-out platform. See the Dental Office IT Setup hub.

Free tools for this step

• Studio (live, free plan): mark phone and paging drops on the plan.
• Network & IT plan generator (free tool, coming soon): build the drop list and PoE budget.
• Credential ownership checklist (free tool, coming soon): keep the carrier account and numbers in your name.