We started using a fast DSL connection and Voip lines but rather quickly ran into a ceiling on how many concurrent connections our DSL line could handle. We ended up leasing space in a network operations center who gave us a 48 mega bit connection and now we have no problems accepting 13 simultaneous incoming calls. We have around 75 doctors and 9 transcribers using the system who love it.
Some doctors have complained that the system is too complicated but once they start using it they seem to get the hang of it. I still have a few who complain but not too many.
The biggest complaint I get is that the number 9 is used to start recording and also to hang up. It is too late for me as I do not want to re-train 75 doctors but I suggest using a different number then 9 to start recording. That way 9 will only be used to hang up. One function per button probably makes more sense.
4 of our transcribers moved over from a dictaphone system. They are a little older and there was definately a learning curve getting them trained on using ExpresScribe. Once they all got some sort of high-speed connection and we got past the training all has gone pretty well.