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For compliance purposes ( mainly HIPAA) I would stick with commercial off the shelf gear as its security has been proven. If the gear isnt certified, its alot harder to merely verify the...

I would use something like a Cisco ISR router at the main location to terminate the T1. I would then use something like a Cisco ASA 5505 at each location to create a VPN tunnel back to the ISR...

You mention patient data so obviously you have to be HIPAA complaint. Thus the data would need to be encrypted end to end. Althougth I have yet to see an exact encryption mandate, I would have to say...