National Video Conferencing Project Technology Pilot Review and Interim Report

Transcription

1 National Video Conferencing Project Technology Pilot Review and Interim Report Version 1.0 November 2011

2 1. Executive Summary A project to pilot improved video conferencing across the NoS NHS Boards was established in October The scope of the project was increased from 50 devices to cover all 400 video conferencing endpoints in the North, within the existing financial envelope. The technology pilot was completed successfully and is in full operational use. A standard for video conferencing has been developed and formally adopted by NHS Scotland. Collaboration with JANET (Joint Academic Network) and Scottish Government has already started. Further collaboration across the public sector is anticipated. The project was extended to cover staff access from home and allow participation by other NHS Boards. With additional funding from the SCTT / NHS 24 additional capacity and resilience was added to the core infrastructure. All NHS Boards in Scotland have agreed to migrate to core service. The rollout is well underway. 529 of the estimated 800 video conferencing systems in NHS Scotland are currently registered on the management platform. During November 2011, 8500 video calls totalling 6700 hours of video traffic were made by registered systems. A live, online directory of systems is now available and can found at directory.vc.scot.nhs.uk. (Available on N3 only.) The project has delivered a significant uplift in the quality and reliability of video conferencing across the participating sites. 2. Background In October 2009, the Regional Planning Chief Executives sub group tasked NSS with improving video conferencing. Working in conjunction with the Scottish Centre for Telehealth & Telecare (SCTT) and the North of Scotland Planning Group, the National Video Conferencing Project was established. Leading a consortium of the 6 North of Scotland NHS Boards the project aimed to pilot a pan-scotland approach to Video Conferencing Services running over the N3 network. Around the same time, terms for a Video Conferencing service under the N3 contract were agreed between BT and CfH in June 2009, however NHS Connecting for Health (CfH) sign off rules changed around this time and CfH were then required to get approval from Treasury for this service. On the 14 th October CfH informed NSS that the service would only go ahead if CfH secured local funding. Following discussion with e-health leads it was clear that NHS Boards that had already invested in video infrastructure had little appetite to embark on a pilot involving a rip and replace of existing infrastructure. It was therefore agreed that an organic development of existing infrastructure was the preferred route. This was perceived to provide the most cost effective and sustainable solution. 2

3 2.1. Project Objectives The original objectives of the project were to undertake a Technology Pilot, serving 50 video conferencing endpoints, across the 6 NoS NHS Boards and to develop and Outline Business Case (OBC) for full rollout. The Technology Pilot was to be trialled by the Northern Boards, the North of Scotland Planning group and key clinical users and would include: Standard Definition Video capabilities over N3, with appropriate firewall traversal; Devolved User Provisioning for booking video conferences; Remote management of video devices; Aggregated Directory of Video Devices; Visibility of MCU capability. Depending on the outcome of the pilot, an OBC would be developed for full implementation. 3. Technology Pilot During the early stages of engagement with local NHS board video conferencing and network leads it became apparent that attempting to run a pilot limited to 50 systems would cause severe operational difficulties as it would result in an incoherent numbering scheme, a multitude of management systems and a requirement to provide duplicate infrastructure for the two distinct video networks. Importantly, it was recognised that the level of service provided to video conferencing users would be unacceptable and undermine the project objectives.. Having completed the tendering process for the procurement and agreeing the basic technology design, discussion with the manufacturer indicated that they would be willing to transfer existing software licensed to the new setup. The participating NoS Boards and the Project Board agreed that the pilot should proceed on that basis, with a full rollout across the North, increasing the project scope from 50 to approximately 400 endpoints. Although this had a major impact on the project schedule, costs were not increased as additional work was undertaken by the participating boards in light of the perceived benefits. 4. Development of Standards When planning the initial technology rollout, it became clear that agreement between boards was required in a number of areas. These included: Naming conventions Dial plan Firewall traversal IP addressing Rather than limiting discussion with the NoS Boards, a wider consultation including key stakeholders and e-health infrastructure leads from across Scotland was undertaken. A standards based approach was agreed that allowed Boards to build on previous investment and these standards were formally adopted by NHS Scotland in September 2011 and have been published, as follows: 3

4 In developing the standards, it was accepted that there was a need for local flexibility of infrastructure. This standards based approach has allowed boards to implement the standards on existing infrastructure hence maintaining existing service provision and keeping costs low. This fits with e-health policy of growing services organically and with the recommendation from McClelland 1 to first re-use, then buy and build only as a last resort Collaboration with JANET (Joint Academic Network) JANET provides video conferencing services to higher and further education, research bodies and schools. As part of the wider global video network, JANET links to the Global Dialling Scheme (GDS). Rather than develop a dial plan restricted to NHS Scotland, it was agreed that the scheme developed should link with JANET and the global network beyond. This provides each video endpoint registered within NHS Scotland a unique numerical ID. Security and policy decisions permitting, this can provide the basis for developing video conferencing links across the public sector in Scotland as well and providing onward links across the world Collaboration Across the Public Sector Having developed a standards based approach using an internationally recognised dialling scheme, the setup provided a good platform for developing video conferencing across a shared public sector network. Discussions have already taken place with Scottish Government and plans developed to link the video network. It is anticipated that further work will be undertaken with partners across the public sector. 5. The Initial Rollout The initial rollout was made up of a number of tasks: Firewall and local network configuration to support the IP addressing scheme; Renumbering of video conferencing endpoints to comply with the agreed dial plan; Reconfiguration of endpoints to comply with the naming convention; Reconfiguration of video conferencing gatekeepers to establish the hierarchical network; Migration of existing management systems to the central platform. While much of this work proceeded as planned, there was a delay in the rollout out of the management system, possibly due to corruption in the underlying database imported. As a result, the management system was re-installed in June Since this time the database has been performing well and system migration in the north has been completed. 6. Increase of Scope Following agreement form the Regional Planning Chief Executives Group, it was agreed that the scope of the project should be expanded to include a pilot of staff video links from home and that other NHS boards should be allowed to access the service. 1 Report by John McClelland C.B.E. on his Review of ICT Infrastructure in the Public Sector in Scotland 4

5 As a result, further funded of 15k was obtained from Scottish Government to provide the necessary hardware. This was procured and installed in early With the increasing utilisation of the central service, the project board agreed that additional funding of 72k should be sought to provide additional capacity and fault tolerance for the central gatekeeper. This was provided by NHS 24, through the Scottish Centre for Telehealth and Telecare. A fault tolerant cluster, spread over the Atos and ScoLocate date centres has since been installed. 7. Engagement with other NHS Boards Throughout the project, great weight has been place on ensuring that health boards outwith the pilot area were fully engaged in the process and were able to comment and influence the standards developed. This was achieved through regular updates and consultation with both the e-health leads and e-health infrastructure leads groups. In January 2011, a stakeholder event was organised to both discuss and review the proposals for the video service. This event was well attended by representative from almost all NHS boards throughout Scotland and there was unanimous agreement on the proposed development of the service. 8. Summary of Achievements All 6 NoS NHS Boards are capable of using N3 as a communications network for video conferencing. All systems in Grampian, Highland and Tayside that are currently connected via IP communications have been reconfigured and registered on the new service. Following the installation of N3 to Orkney, systems on the core Orkney sites have been migrated. Following the installation of N3 to Shetland, a number of systems on the main site have been migrated. Further work is ongoing to improve the local area network structure to support a full migration. Test systems have been established in the Western Isles. Further configuration work is awaiting input from the local e-health team. A centralised management server is operational. This provides a conference management tool, booking system, directory services and helps with problem resolution. Of the estimated 440 systems in the North of Scotland, 85% (374) are currently registered with the centralised management system. By utilising secure firewall traversal technologies, SIP based PC video clients are capable of accessing the core video conferencing service. Using the Cisco Movi application, a centralised licensing service has been established. This provides the core Movi service as well as linking to those NHS boards who have invested in their own infrastructure (Grampian, NES and Health Scotland). In conjunction with NSS, an internet connection to the core video conferencing service has been established. Using the same technology that support N3 based PC clients, secure firewall traversal has been enabled to support home workers connecting to the video network. It is anticipated that this will prove particularly useful for those providing clinical on-call services from home. 5

6 Links to the JANET video conferencing network have been established and tested. Outwith the North, a number of NHS boards have already migrated or are in the process of migrating to the core communication service (devices reconfigured to be capable of connecting over N3 with the appropriate numbering scheme and firewall setup in place). These include: o NHS Lothian all systems linked to core service; o National Services Scotland all systems linked to core service; o NHS GGC 50% of systems linked to the core service, plans being developed to complete migration of remaining systems; o NHS Forth Valley system in Larbert linked to the core service; o NHS Fife systems in Victoria and Queen Margaret linked to core service via Lothian; o NHS 24 new equipment linked to the core service, plans being developed to migrate existing systems; o State Hospital, Golden Jubilee - test links established; o NES, Health Scotland, NHS Ayrshire and Arran installation in progress using additional equipment purchased; o SAS, NHS Lanarkshire, Quality Improvement Scotland implementation in progress; o NHS Dumfries and Galloway, NHS Borders links to the core service established via NHS Lothian. Rollout in progress; A total of 529 (of the estimated 800) systems in NHS Scotland are registered on the central management platform. Of these, approximately 150 are outwith the North. Since the management database was reinstalled in June 2011 a total of 36,000 calls have been made by systems registered (up to November 30 th ). This equates to 25,000 hours of video traffic. During November 2011: o A total of 8500 video calls were made by registered systems. o Video traffic totalled 6700 hours. o There were 340 booked multi-site conferences on TMS managed MCUs. On average 7.2 sites were dialled for each conference. 9. Benefits Realised Due to an increase in bandwidth over traditional ISDN links the audio and video quality of conferences has been improved. A consolidation of ISDN lines and associated equipment has been undertaken in NHS Highland. Agreement has been reached between NHS Orkney and NHS Highland to provide ISDN services. This will allow a consolidation between the two boards, reducing the need for dedicated lines in Orkney. Visibility of video conferencing end points on the management system has enabled support staff to easily reconfigure systems in line with the national standards. Up to date directories are available to all endpoints registered on the management system. 6

7 A web based video conferencing directory had been set up and is accessible from N3. This can be found at IP only equipment had been deployed in some areas, reducing the need for additional spend on ISDN lines. There is perceived to be a significant improvement in the overall quality of video conferencing meetings by service users. This is backed up by recent survey findings. A desktop video conferencing service had been established using Movi. This is being used by Grampian, NES, NHS 24 and Health Scotland. Trials are also underway or planned in Highland, QIS, Orkney, Shetland, Fife, Tayside, Lanarkshire, NSS and Forth Valley. 10. Analysis of User Survey Between February and October 2011, an on-line survey invitation was distributed to those booking meetings on either the Highland or Grampian MCUs. While this does not capture information on point to point calls, it provides a good indication of overall performance. It should be noted that most clinical interactions involving patients are likely to be point to point calls, not involving an MCU and further work will be required to ensure performance monitoring of such interactions. These results are therefore biased towards larger meetings such as case conferences, multidisciplinary team meetings, education and management. Of the 110 survey results collected, 20% were from NHS Highland and 15% from NHS Grampian. Given that the survey was distributed to users of the Highland and Grampian bridges, this highlights the cross boundary nature of multi-site conferencing services. Of those that responded, 55% described themselves and working in an administrative role, with 17% managers, 16% clinicians, 7% technical staff and 3% AHPs. The high percentage of administrative users is likely to be biased by the mechanism of distributing the survey to those booking the conference, who are more likely, particularly in relation to senior manager meetings to be in an administrative role. Of the types of meeting recorded, only 5% were described as clinical consultations. Again, this low number is likely to be biased by the survey being distributed to those booking multi site meetings, as patient consultations tend to involve point to point calls that do not require a bridge. The remainder of meeting types represented were for a mixed range of purposes, including administration 11%, senior management 27%, education and training 30%, case conferences 1%, clinical networks 14% and MDT meetings 10%. The average size of the meeting was 4.2 sites, however of these on average 2.8 sites were outwith the local NHS board area. Again, this demonstrates that the Grampian and Highland bridges are largely supporting cross boundary meetings and often pan-scotland videoconferences. When rating the quality of the video conference service: 92% rated the ability to connect to all sites as either good or very good (4% neither, 4% bad); 84% rated the image quality during the meeting as either good or very good (8% neither, 8% bad) 80% rated the sound quality during the meeting as either good or very good (12% neither, 8% bad). 7

8 It is surprising that given the high levels of satisfaction, 23% of survey participants reported that they had a technical problem during their meeting. The key issues highlighted were connection problems, sound problems and video problems. An analysis of the free text problem descriptions indicated that the most common issue was a problem at the remote site, 46% and it is encouraging to note that in 85% of cases the problem was resolved by either telephone or local support. Of the 28 meetings disrupted, data on the outcome was available from 27. Of these, 18 proceeded with only minor disruption, 8 with major disruption and 1 meeting was abandoned. All meeting that reported problems occurred during normal office hours (Monday Friday, 8am 6pm). A full breakdown of the survey results can be found in appendix Financial Information Project costs in 000 are as follows: Original SG funding 80 Staff access 15 Fault tolerant cluster 72 System maintenance 24 Total 191k All costs are ex VAT 8

9 12. Appendix 1 Analysis of Survey Results NHS Board N=110 % Grampian Greater Glasgow and Clyde 5 5 Highland Western Isles National Services 6 5 National Education for Scotland Other Health Boards (less that 5% each) Other (Local Authority, University etc) 4 4 Role within the NHS N=108 % Clinician AHP 3 3 IT / e-heath 8 7 Administration Management Senior Management 7 6 Other 2 2 Type of Meetings N=70 % Admin 8 11 Senior Management Education / Training Case Conference 1 1 Clinical Networks MDT 7 10 Clinical Consultation involving patient / carer 1 1 Clinical Consultation using video to undertake 3 4 diagnostics Other 8 11 Number of Sites Average No. How many sites, including your own, took part in the meeting? 4.2 How many of the sites were outwith your own NHS board area? 2.8 Please rate the following aspects of your use of video conferencing Very Good Good Neither Good nor Bad Ability to connect to all sites Image quality during meetings Sound quality during meetings Bad Very Bad 9

10 Did you have any technical problems during your meeting? Yes 25 No 48 Did not respond 37 Free text description of problems Local issue surrounding receiving sound from Edinburgh site Edinburgh Royal Infirmat Boardroom 1 could hear the other 3 sites but could not see them. If we do experience problems the bridge are excellent at solving the problems One of the sites dropped during the meeting. Had to contact the bridge to get it reconnected. sometimes, always fixed. Sometimes difficulties with connection. May be due to staff being unfamiliar with equipment at the other end. Probable with 1 site (Great Ormond Street) connecting to the bridge - problem at their end. Initialy one site did not connect. Problems with sound, including echoing problems. Setup of equipment in MidLothian Hospital. Resolved by calling helpdesk who supported colleague there to sort. The equipment in the meeting room was not set up correctly. When we plugged it in and switched on there was no connection. Technical support was not available and eventually a member of it staff solved the problem. This wasted 50 mins of a 2 hour meeting Only once because there wasn't anyone available who was familiar with the teleconferencing facilities at the site we were having our meeting at. Sometimes the other sites would dissapear off the screen and we could only see ourselves... other times we could see just one of the sites! There were very few occasions that both sites were visable on the screen at the same time. One of the sites (Western Isles) were cut off 5 minutes into the meeting and couldn't get re-connected. In the end they pulled out of the meeting due to this technical problem. The general diagnostic was that there was a fault with the equipment on the Western Isles end. Problems with connection At different points in the meeting, there was picture but no sound and sound but no picture. Also a lot of feedback noise Connection errors due to staff not being on site at the designated times. Technical difficulties are usually due to equipment problems at the other sites or lack of familiarity with using the equipment on their part Issues with remote sites VC kit. Both had audio problems and one also had problems with their video feed, resulting in a black and white image instead of colour. end time of conference was set incorrectly by the bridging team We had to call the provider to get better quality as when dialled from outside(provider) the quality wasn't great. unable to load powerpoint presentation Sound quality was appalling - with variable volume and intensity. Sound distortion++++ Made it impossible to follow any conversations Could not see the other sites at the beginning One site could not see us but they could hear us. Think it might have been a problem with their facilities but not sure Couldn't connect to my VC- although probably a fault at my end. Sound wasn't regulated but only a minor thing. kept losing contact with other boards. then audio failed There is a lack of knowledge in regard to meeting chairpersons on how to conduct meetings with VC or conference call participants, ensuring they are included and that the meeting is conducted so that external delegates can hear everyone speaking round the table. Inadequate provision of microphones is another technical problem. 10

11 occasionally linking with other sites took some time How would you categorise your problem N=28 (respondents were allowed to select multiple answers) Difficulty in starting the equipment 4 Problems connecting to the remote site 13 Unknown dial in details 1 Missing participants 4 Sound problems 12 Video quality problems 10 User error 2 Other 3 Did you receive technical support to solve your problem Yes by phone 13 Yes from on-site support staff 9 No fixed it without support 1 No unable to fix problem 3 How disruptive was your problem? Meeting was abandoned 1 Meeting was significantly disrupted 8 Meeting proceeded with minor disruption 18 Did your meeting take place during normal office hours? Yes 28 No 0 Other Comments The service provided by the VC Team is excellent and when problems arise the helpdesk staff are always friendly and very helpful, thank you for this service! 2 video conferences now with Edinburgh Royal Infirmary experiencing problems. The previous conference was in Boardroom 2 and was eventaully resolved by Support Staff. I understand NHS Lothian have upgraded their video conferencing so please check the Bridging Services (we used Grampian both times) are aligned with NHS Lothian upgrade. Administration time to arrange V/C could be slicker. Difiiculty when meetings are arranged/venue changed at short notice The Video conference enabled my manager to authorise the time off. If I had to take time off work to travel to Golspie or Inverness it would have entailed an extra member of staff to cover my shift. Session worked extremely well, with screen freeze only happening once for a very short period. Thank you for all your help. Only that the NGS Grampian bridge folk are extrememly helpful and approachable. Never made to feel a Ludite when asking silly questions. The Aberdeen Videoconferencing service are always very helpful and on hand to sort out connection issues. The main problems we face are the other sites not able to get to their equipment on time for start of meetings sometimes this is due to the fact that there is a growing demand for equipment. The most reliable VC attendees are the sites which have desktop cameras in their offices. I thought the sound and quality was fine. Other participants were not so favourable in their comments. Excellent service, and much appreciated The value of the availability and efficiency of dedicated Video Conferencing Advisers on site at Raigmore 11

12 Hospital, Inverness, cannot be over estimated. Their role in setting up the video conference and providing support, if required, is of great benefit to the organisation and to admin collagues arranging such links. It must continue. Start to dial out 10 minutes ahead of the meeting, not 5 as currently. Notification that conference is due to end in x minutes and again if has been extended. Not being aware of the time means that sometmes it comes as a surprise when the call is ended and the conversation is not finished. Electronic booking system would be much easier. I would like to add that there is a very good support team available that are great when you experience any problems The service received is nothing short of first class and everyone is willing to give that little bit extra and help out. Thanks again for your expertise and support We are impressed with the prompt response to our booking requests and also with your willingness to assist us even at short notice. I would just like to say that as I have now used the v/c seceral times via NHS Grampian, that I am delighted with the service and even although I have had a couple of hic-coughs they have been dealt with swiftly and successfully. I really hope that this service continues to be at our disposal and I would acvtively encourage others to use it to as I am sure it must be saving revenue as far as travelling expenses are concerned and time saved by employees. Many thanks to NHS Grampian. Support staff very helpful and supportive, however I often experience significant technical problems. Staff within our organisation have limited experience in using video conferencing facilities. The staff based within the Grampian video conferencing team have been an invaluable support to us and have provided advice on many occasions when using the VC facility. To date, there has been no occasion where they have been unable to help us with any queries and they have provided a superb service. Vcing facilities normally work well and are very much appreciated. Our problem was not user error as we followed the clear instructions on the information sheet available. The equipment had not been left in the correct manner by previous user. I/We are very satisfied and find Bridge staff helpful at all times - I would like to say thankyou for making, what could be quite stressful operations/situations, run extremely smoothly. I think that teleconferencing is the way forward and saves a lot of time travelling from place to place for meetings etc, the only problem is when using equipment at another hospital etc and there is nobody who can help to get the equipment up and running there are always difficulties using other sites equipment/facilities. Since this VC training in Thistle House we have done another training session which included VC in Assynt House in Inverness and their set up and equipment was outstanding and top notch... it would be useful if all the VC venues were fitted with the same or similar equipment as that in Inverness. Ran like clockwork, very impressed. There was a late addition to the meeting that was included without mishap, so pleased with smooth connection. Nothing to do witht he bridge service itself, but it would be good to suggest or better yet, implement a strategy / practice for VC equipments at NHS Board levels to be regularly maintained / updated etc to avoid future problems for everyone concerned. Still very impressed by system. Allows Lead Clinician to do more work due to less travel. Service always very helpful and do everything possible to resolve problems. Problems were outwith the control of NHS Grampian Videoconferencing and were with the VC kit used by the remote sites. The Technician at Grampian was very helpful and accommodating with our issues, doing his best to solve them. Generally we receive an extremely high standard of service from NHS Grampian VC which we are very happy with. No, service worked well. The Grampian V/C team are excellent - always helpful and supportive and have the ability to troubleshoot effortlessly (it's probably not easy but the impression given to the user is that it's not a problem!) Its a great service for the paediatric gastroenterology society and we would grately appreciate if this sort of teaching is continued and expanded. it may be useful to do a copy of VC for dummies for use during the sessions to fix minor problems and keep a copy with each VC Thank you for your prompt and efficient service. 12

13 Fantastic technical support - thank you. It would be ideal to be able to let sites that are IP based only to paticipate in my VC based educational events and not just ISDN connected venues. Ta Davie Blackie Found staff very helpful when organising the meeting and they answered all my questions. Will use this service again as they made everything much easier to organise. Sound and vision from the site I was at was perfect and I had no complaints, but following our last videoconferenced meeting the Elgin team requested that we return to face to face meetings and they found the vision and sound was not good at their end. This could have been due to the equipment used but we had no such issues in Aberdeen or Fraserburgh. Makes a difference being able to join in meetings etc without having to travel Training and familiarising of meeting conduct for chairpersons and participants of VC meetings would be desirable. G:\NOSPG\Dundee\e-Health\National\National VC Pilot\Project Board\ \Outcome\end report v01.doc 13