GP TELEHEALTH VIDEOCONFERENCING

Transcription

1 Title of Project GP TELEHEALTH VIDEOCONFERENCING Frequently Asked Questions

2 GP Telehealth Videoconferencing Table of Contents What is VC-ready?... 2 What s the quality like?... 2 What s the difference between a Telehealth Video Consult and a Video Conference?... 2 How do I get started?... 2 How do I choose the right things?... 3 What do I need to do a VC?... 3 How much does it cost?... 3 How do I do a VC?... 4 Are VCs secure?... 4 What is Standard Definition vs High definition, and which one do I need?... 4 Do I need a separate computer?... 5 What type of internet connection do I need?... 5 Do I need a separate internet connection for VCs?... 5 How much data does a VC use?... 6 Gold Coast Medicare Local would like to acknowledge the Townsville-Mackay Medicare Local TeleHealth team for allowing the use of this document. 1

3 What is VC-ready? Title of Project The term VC-ready is used to describe the holistic status of the hardware and software of a practice in terms of its ability to support Video Consults. The components of this (in order of importance) are an internet connection, computer hardware and computer software, and they do not occur in isolation: that is, all three must be VC-ready for the practice to be considered VC-ready. What is the quality like? If you have made a video call using Skype or your mobile phone, you may well have an idea what the quality is like. To give you an idea, all you need to do is watch a video of an up-close interview with someone on your computer. This will mimic how a person would appear and sound through your computer during a video conference. Don t confuse quality with the experience. Technically, the quality is a scientific constant and a tangible, controllable parameter that can be set and which typically will not change once set. The experience amounts to the sum of all of these parameters audio quality and volume, video quality, the amount of delay, ample lighting, reliable connection with minimal interruptions etc etc. Ultimately, your experience may vary, even from VC to VC, as any one of these parameters changes. Programs like Skype are designed to scale the quality to improve the experience ; in essence, they adjust to suit your set-up. What is the difference between a Telehealth Video Consult and a Video Conference? For the purposes of the Telehealth Support Program, a Video Consult is a scenario involving live two-way audio/visual communication between two end- points, where the GP is at one physical location at one end, and the patient is at a different location at the other. This scenario involving two locations only is called point-to-point. A Video Conference is a video Call that can involve two or more end-points, i.e. can be point-to-point or multipoint. Typically, many software programs allow you to make point-to-point video calls for free, but will charge for the ability to hold multipoint video conferences. How do I get started? 1. Subscribe to a suitable internet plan 2. Determine how you will use the system, and where it will be used in the practice 3. Determine who you will be conducting VCs with and what software they use 4. Purchase the required hardware to the minimum requirements of the software you want to use and the quality of the VCs you want to make 5. Install the VC software on your VC computer(s) a. Note: ensure you become familiar with the features of your software and hardware. Most software and hardware provide options for adjusting settings which will enable you to enhance your experience even over a less-than desirable connection. 6. Test the system by conducting a test VC between two computers: a. Identify a willing party; b. Obtain their end-point identity (e.g. joebloggs@jabber.com or their Skype name); c. Arrange a suitable time d. Attempt to establish the VC call e. Monitor the quality of audio and video over time say, a standard 15 minute consult and make adjustments to lighting / quality settings etc as appropriate to achieve the desired effect. 2

4 How do I choose the right things? Title of Project There is no golden solution for a fixed price, and the end result can often be as individual as the GP or practice which it served. DoH, ACRRM and RACGP all provide ample guidelines for choosing a solution, but the underpinning principle is universal: be comfortable with what you choose. Being comfortable is as easy as learning a little bit about the technology: knowledge dispels fear. As with any new purchase, a small amount of research is involved in order to ensure you are getting what is right for you. Don t be strongarmed into choosing a particular brand, component or plan if you are not 100% confident you know why you are purchasing it. Peers and colleagues can offer some useful advice, as well as using literature availablefrom the RACGP and ACRRM websites. You may also choose to speak to your IT professional (if you have one). Things to Consider: 1. Standards-based technology. For software, if you see things like H.323, H.264, G.711, SIP and AES, these are all good things, as software which use thesestandards are interoperable with anything that also uses the same standards. 2. Hardware encoding. Any external device which does the encoding/decoding of audio/video on the actual device itself, rather than on your computer, will ultimately place less stress on your computer, and serve to improve your experience. If you are looking at conducting VCs from your existing computer, this becomes more important. What do I need to do a VC? A computer, camera, microphone, speakers and VC software. Now days, all these devices can be combined in one package a laptop, for example but can be purchased separately. Things to consider: 1. A dedicated computer for VCs is best, although adding the required equipment to your current computer can still work. 2. A mobile computer (laptop or tablet) for VCs is very handy: it can be moved around the practice and connect wirelessly to your network. 3. External cameras that can be moved around to show wounds etc are particularly handy compared to those that are built in to a computer. How much does it cost? Costs vary greatly with the choice of brand, provider and capability. Typically, to become VC-ready, you can expect an initial cost of around $1500, with an ongoing cost for an internet connection of around $80pm. This is based on the purchase of a dedicated VC computer if you plan to run VCs from your current desktop computer, the cost would be considerably less. A ball-park breakdown of the general costs are as follows: COMPONENT BUDGET HIGH-QUALITY VC capable PC or laptop $1000 $2000 External USB camera $50 $150 External speakerphone $100 $300 Internet $50-$100pm + setup costs $100-$200pm + setup costs Making a VC call No charge unless you exceed your data use No charge unless you exceed your data use

5 How do I do a VC? 1. Determine what the other party uses (if anything) to conduct VCs, and negotiate a middle-ground which you are both comfortable using. 2. Exchange end-point or user IDs with each other (e.g. Skype name, or joebloggs@jabber.com etc) and schedule a time for the VC. a. Note: It is recommended to schedule a time before the actual consult when you can test the connection. 3. Follow the steps to establishing a Video Call outlined by the software you are using. 4. Follow the business processes required to claim with GCML for the VC. Are VCs secure? For the purposes of conducting a clinical consultation, yes. VC traffic is almost always encrypted, even when using Skype; however, there is no guarantee of the routing path of VC data sent through internet networks. This means that it is possible for data transfer to occur outside of Australia through countries that may not have the same privacy laws as Australia. By comparison, telephone calls are completely insecure: what type of information do you discuss over the phone? As a rule, the decision to use or not use a particular mode of communications becomes a risk management / risk acceptance activity, based on the sensitivity of the information. This can sometimes be an entirely subjective exercise. The computer security implications are wide and varied, and if you have concerns please speak to your practice IT professional. What is Standard Definition vs High definition, and which one do I need? Both terms refer to the level of detail in the image which directly affects the perceived quality. High Definition is technically better than Standard Definition, but the differences may be difficult to notice in many applications, for a variety of reasons. Whilst not all the different quality formats are available for every video, you will generally be able to select at least one SD format (generally 360p and below) and at least one HD format (720p and above). To help you understand the difference between the two, consider that the current free-to air ABC HD channel is broadcast in 720p. Channels 7, 9 and 10 HD are broadcast in 1080i. Can you spot the difference? Is your experience drastically altered between the two formats? By comparison, Blue-Ray movies are 1080p. Most HD Web streams are 720p, and for the purposes of this document, the term HD refers to a 720p format (and its inherent internet connection requirements). Some HD cameras are capable of encoding 1080p but beware: this places additional burden on your internet connection. In any case, becoming familiar with your camera and software features will enable you to select which format you want to use to avoid this unnecessary wastage. Things to consider: According to the National Health Chief Information Officer Forum (NHCIOF) Draft for Consultation: Guidance on Security, Privacy and Technical Specifications for Clinicians, 31 August 2011, standard definition is more than suitable for clinical diagnoses. Your own experience may vary depending on a multitude of reasons including anything from lighting, to angle of viewing, to eyesight, to display size etc. As a guide, visualise and compare your other viewing experiences and determine what you are comfortable with. 4

6 Do I need a separate computer? Title of Project No, although a separate computer particularly a laptop would be highly advantageous. What type of internet connection do I need? It all comes down to speed!you should aim for an internet connection that will support the industry standard for Web-based HD video traffic of 720p. This will enable you to have room to grow if you choose to start off using SD and later choose to improve your experience by using HD. Quality For a shared connection (downstream/ upstream) For a dedicated connection (downstream/ upstream) Minimum type of service SD 2mbps / 1mbps 900kbps / 900kbps ADSL2 or ADSL2+ HD (720p) 4mbps / 2mbps 1.7mbps / 1.7mbps ADSL2+ with Annex M HD (1080p) 20mbps / 10mbps >=10mbps / >=10mbps ADSL2+ with Annex M and DSL bonding One additional factor to consider is the amount of data to include in your plan. A recommended starting point is 50 GB per month for shared connections. A few new terms: 1. ADSL is limited to how far away from the local exchange your premises is. The general rule is that although, for example, ADSL2+ promises speeds of up to 24mbps downstream and 1mbps upstream, the further from the exchange you are the slower your speeds, and this maximum would only be achievable if your premises was right next door to the exchange. 2. Annex M and DSL Bonding refer to methods that a service provider can use to increase the speed of ADSL technology beyond the standard theoretical limits. Annex M is, for example, provided free of charge for business customers by iinet, and is simple a feature that they switch on at your request. DSL Bonding is where the service provider basically binds two lines together for you, effectively doubling your speeds. Unfortunately, this generally attracts a proportionate price tag, and not all providers supply this. When evaluating ADSL plans, look at business packages (the above two additions are available under the business internet solutions part of the iinet website), and mention these methods to your sales representative. Do I need a separate internet connection for VCs? No. Things to Consider: 1. Your current connection may need to be upgraded. 2. Your current connection carries more than just VC data, and the amount of bandwidth available exclusively for VC data cannot be guaranteed; therefore, the quality and reliability of the VC cannot be guaranteed. 5

7 How much data does a VC use? Roughly 500mb per 15 minute consult for High Definition, and approximately half that for Standard Definition. This is an extremely generous estimate. Questions? Contact the Gold Coast Medicare Local Better Health Care Connections Aged Care Team Ph: bhcc@gcml.com.au 6