Toolkits

Videoconferencing - Deployment and Support

The TTAC recommends working with a professional videoconferencing (VTC) specialist when deploying and supporting videoconferencing equipment.  Should an organization decide to implement and support their own videoconferencing equipment, having a trained person on staff to manage and support the system will be critical to the program's success.  If a third party will host the solution it is likely that they will also offer installation and support personnel that may supplement or replace some of the recommended on-site personnel.

The broad topic of videoconferencing comprises a complex mix of systems and parts.  Depending on the type of product to be deployed, very different issues may need to be considered.  The requirements for a purpose-built telepresence room will be quite different than the requirements for a consumer-oriented software system that reaches into a patient’s home.

Each product, organization, and intended user will bring their own needs and complexities to any deployment.  Acknowledging that, TTAC has compiled a lengthy, partial list of things to think through when deploying a videoconferencing system.

Before You Begin – General Videoconferencing Issues   

As the implementation of a videoconferencing system is generally a sizable investment, there will often be many stakeholders and key individuals who need to be included in the initial discussions about organizational needs and the goals of the videoconferencing system.  You will want to bring in staff from networking (local area and wide area), clinical users, program coordinators, audio/visual and VTC staff, administrators, other organizations that you will be connecting with, and perhaps vendors and internet service providers who may be able to address equipment and connectivity issues.

A common practice is to look at the needs and capacity of an organization when planning such a large project.  Consider performing a “SWOT” (Strength, Weakness, Opportunity, and Threat) assessment or some other standard assessment for determining exactly what is in place within the organization, what the goals and growth plans are, what will be needed to ensure project success, and why the project is being implemented.  Getting people to agree on this last point can be useful as you shape the initial project – it is important to know what the goals of the project are:

  • Are you trying to provide services for administrative functions and personnel?
  • Are you trying to either gain or provide access to specialists and clinicians?
  • Will you be partnering with other organizations, or is the goal to develop a communication tool for use primarily within your organization?
  • How will the organization pay for the network and system?  Is this a cost supported by administration, or does the program need to gather outside sources of revenue?
  • Do you qualify for federal, state, or local funding to assist with the costs of connectivity or equipment?

Make a plan for both the short term and long term.  It is important to have a direction for the videoconferencing system so that proper infrastructure and personnel can be brought in at the appropriate times.  An organization that is trying to implement a system to connect a handful of remote clinics with primary care doctors in a central hospital will have very different goals than an organization that wants to provide 24/7 emergency care services through videoconferencing to hospitals across the state while also supporting non-clinical department who want ad-hoc conferencing capacity for administrative personnel.  Think through what your program will look like in the future:

  • What needs to happen before you can begin putting videoconferencing equipment into the facilities?
  • What kind of growth and utilization would you like to see?  
  • How will you measure your successes and failures?  
  • How will you support users locally?  Remotely?
  • Do you intend to grow the network over time, connecting with other organizations?
  • Will you operate across state lines?

Thinking through the networking and organizational changes that need to happen before jumping into purchasing technology for videoconferencing is important, as insufficient resources or poor organizational support can hinder the implementation and use of a videoconferencing system.  Consider if your organization has adequate bandwidth, wireless infrastructure if using mobile platforms, and Quality of Service systems to ensure that videoconferencing does not negatively impact existing IT services within the organization.

When starting with videoconferencing, think big, but implement small initially. While many of the modern videoconferencing systems are designed to be mostly standards-compliant and easy to use, there are still many possible issues that can pop up when actually using the systems.  By starting small, it is possible to ensure that the system is configured correctly and that proper support systems are in place should there be issues with the conferencing capabilities. Videoconferencing can receive the wrong kind of attention if it experiences problems in the middle of a clinical encounter or executive-level administrative meeting.  As your organization gains competence in the area of videoconferencing, growth can happen at a more accelerated rate.

If your organization will be working with other facilities and organizations, consider discussing a dialing plan as you move into the planning phase.  This can be a complex and political topic; working things out earlier than later can help resolve potential problems down the road.

Planning – Hardware-Based Videoconferencing Endpoints

When an organization is ready to being implementing a videoconferencing system, they will need to make a detailed plan for configuring, deploying, and supporting the equipment.  The locations, installation types, room configurations, and infrastructure changes will all need to be well documented prior to putting in equipment.

Locations

  • In how many different environments will the equipment be installed?
    • Outpatient clinics
    • Inpatient clinics
    • Intensive / emergency care facilities
    • Administrative / conference rooms
    • Doctor's offices
    • Non-clinical offices
  • Do the rooms have adequate lighting and provide a professional appearance?

Networking

  • How will the endpoints connect to the network?
    • Wired / Cat 5 cable
    • Wireless
    • Dedicated or shared network
  • Is the wireless network capable of supporting the equipment, if connected?
  • Are there dead spots in wireless coverage?
  • Are there weak signals or overly-congested access points?
  • Do the wireless networks support other mission-critical applications that may slow down if shared with videoconferencing systems?

Installation Types

  • What types of endpoints will be installed?
    • Wall-mounted, stationary system
    • Hand-moved cart
    • Robotic cart
    • Desktop, all-in-one unit
    • Videophone
    • Mobile, hand-held unit

Infrastructure Requirements

  • Are there sufficient network resources within the hospital to support multiple simultaneous videoconferences?
  • Do you need to provide additional functionality on your network to support videoconferencing, such as Quality of Service?
  • Will you be providing access to your videoconferencing to people outside of your network?
  • Will you allow people inside your network to call out to other systems or organizations?
  • Are there existing resources or videoconferencing capabilities within the organization that need to be connected to the new equipment?

Planning  - Software-Based Videoconferencing Endpoints

Assuming that your organization has taken steps to choose the appropriate product(s) that meet your needs, the next step is to look into planning how you will move forward with implementing your selection.  You will need to think through how many users will be accessing the system, where they will be accessing the system from, and how you will work with any external partners or patients that will be using your implemented system.

User Population

  • How many will users need to install the software?
  • Your organization may decide to allow only select departments to access this software, or may choose to open it up to any interested participants.
  • This will impact how many licenses are required for your organization.

On-Campus

  • Will you begin with a limited number of select departments?
    • Staging the deployment with smaller groups can help work out any problems before impacting a broader user base.
  • Are there champions willing to beta test?
    • Dedicated groups that understand the nature or a test deployment can help provide feedback about the experience.
    • Champions can encourage the use of the software within their department.
  • Will you start with intra-campus use only?
    • Limiting access to the software to your network may reduce some of the cost and complexity.
    • Users may eventually request access to the software from home or remote offices.

From Satellite Office

  • Will they have direct access to your network?
    • Standards-based systems may require you to plan for supporting either a Virtual Private Network (VPN) or a proxy device to allow for external users to access resources that are internal to your network.

From Home

  • Are there justifications for telecommuting?  Is this fulfilling a need?
  • Standards-based systems will require you to plan for implementing either a VPN or proxy device.
  • You will need to decide if you will be providing hardware for them to use, or if they will be using personal computing and video equipment.  This applies to employees as well as patients.
  • Minimum bandwidth and computer requirements will need to be met to ensure sufficient quality in videoconferencing sessions.
  • You will need to establish how support will be provided to users outside of your network.

Usage Requirements

  • How many users will be engaged in simultaneous, separate videoconferences?
    • Simultaneous videoconferences will require additional bandwidth.
    • Some applications have licensing limits for the number of simultaneous connections with your users.
    • This will impact the infrastructure and licensing needs of your organization.
  • How many simultaneous users do you have that will need to participate in the same conference?
    • Multicast videoconferences may require additional planning and configuration of virtual conference rooms.
    • This may require the purchase of additional bridging devices.
    • This may impact the infrastructure and licensing needs of your organization.

Connections

  • Will users be using desktop videoconferencing to communicate with other organizations?
    • Your organization will need to ensure sufficient bandwidth and connectivity to the other organizations.
    • Gateway devices may be needed to manage interoperability between different standards-based applications.
  • Will your organization be using desktop videoconferencing to communicate with existing hardware-based VTC systems?
    • Gateway devices may be needed to manage interoperability with hardware systems.
  • Will your organization be communicating with patients through this system?
    • Standards-based systems may require additional licenses for each patient using the system.
    • Consumer-grade systems will require users to install, configure, and manage the selected software clients.
    • Sufficient bandwidth will be required to the patients’ homes to ensure sufficient connectivity and video quality.
    • Your organization will need to assess and mitigate any risks associated with using these products, and may want to prepare educational content for your patients and providers regarding these plans.

Considerations for a Standards-Based Software Product

  • Will your organization be hosting the core infrastructure, or will your organization use a service provider?
    • Hosting the core infrastructure will require additional work to ensure that it is properly configured for your organization.
    • Using a service provider may reduce how much immediate control your organization has over the equipment in the case of a technical problem.
  • Will your organization be purchasing or leasing the devices from a vendor?
    • Video equipment changes rapidly; purchasing equipment may mean that you are supporting legacy equipment until your organization can afford another large capital expense.
    • Additional funds may need to be set aside for software upgrades and extended warranties to adequately maintain this equipment.
    • Leasing equipment may include fees for upgrading to new equipment before the lease has ended, or may require a time- and resource-intensive upgrade of equipment for your organization.
  • Will your organization need additional hardware infrastructure to meet all of their needs (bridges, gateways, proxy servers, etc.)?
    • The need to support multicast conferences, connect to existing devices or outside organizations, and home-based users may all require additional devices.

Considerations for a Consumer-Grade Software Product

  • Does your organization currently block any of the ports or IP addresses required to communicate with the manufacturer’s system?
    • Manufacturers may utilize a different IP addresses or communication protocols for logging in, videoconferencing, and sending files.
  • Will your organization provide physical media for users to install the software, or will it direct users to a download location?
    • Users may select the wrong version of an application if using the internet to find the correct software.
    • Malicious websites may provide downloads of viruses posing as popular software.
  • Will your organization be providing a “Business” or “Professional” edition of the software to your users, as opposed to the free version?
    • Free versions might not have options to be controlled by available administrative interfaces.
    • Business editions will require an additional cost for each person to use the software.

Network Requirements

  • Does your organization have sufficient bandwidth to support the demands of videoconferencing?
    • Videoconferencing can require immense amounts of bandwidth, especially with multiple simultaneous calls.  Bandwidth requirements vary by manufacturer, video resolution sent and received, and other factors.  Look at the manufacturer recommendations to decide if you need additional bandwidth in your organization.
    • Quality of Service tools may help control traffic, but will add more costs to implementing a VTC program.  QoS can be useful, as it can prioritize delivery of certain content, meaning that video content may be sent in real-time, while email and asynchronous communication may be sent as bandwidth is available.

Hardware Requirements

  • Do your users have sufficient computing power to run the desktop videoconferencing software?
    • Achieving some of the high-resolution capabilities of these applications requires more modern computers than some organizations may have for all of their users.
    • People accessing the software from home computers may not have the budget to purchase a computer that can handle the demands of videoconferencing.
  • Do your users need USB webcams?
    • Built-in webcams may be sufficient, but often have lower resolution, cheaper optics, and microphones that are close to both the speakers (causing feedback) and the spinning parts of a computer (hard drives and fans cause background noise). 
  • Do you users need USB headphones with microphones?These are an additional cost, but depending on location that conference are taking place, can provide additional privacy and reduce background noise in open office environments.
  • There may be support issues related to any additional equipment that is used in conjunction with desktop videoconferencing

Site Preparation – Videoconferencing Endpoints

Room Setup

Much work and time is dedicated to the selection of videoconferencing endpoints, but one of the key issues to a successful videoconferencing experience is often ignored – room configurations for the equipment.  When a room is not properly set up for videoconferencing, even the nicest equipment can provide unsatisfactory results.  It is possible to improve audio and image quality as well as the patient and provider experience by doing a few things to set up the room.

Lighting

Appropriate placement of lights, as well as avoiding strong back lighting, can make for a clearer, more visible subject.  Lights that are closer to the plane of the subject's face can reduce excessive shadows; harsh overhead lights can cause some details in the eyes and mouth to be lost depending on the subject's positioning.  

Back lighting, either from a window or other strong light in view of the camera and behind the subject, can cause a camera to automatically adjust the exposure levels to match the bright light.  This results in a very dark foreground and subject.  If it is impossible to orient the camera in such a way that the light is not behind the subject, consider using blinds to mitigate this problem and / or turn off the lights that are causing issues with the camera.

The color of the light, or color temperature, can also play an important role in affecting the overall appearance of a videoconferencing session.  The human eye is very good at adapting to different lighting environments, compensating for various hues of light to interpret surroundings as mostly-white light.  Imaging sensors are not as good at this, and light sources can cause color casting of the subject.  If possible, install neutral or white fluorescent bulbs in overhead fixtures.  Normal fluorescent bulbs tend to have a green or slightly “off” coloring, while incandescent lights tend to be “warmer” and slightly yellow or orange.

Microphone Placement

Depending on the unit being deployed, there may not be much that can be done to change the placement of the microphone.  If, however, there is an external or moveable microphone, consider where it will be placed in the room and whether or not the users of the system may move it.  Can the microphone be placed near the patient's or provider's position?  Will users be able to easily access the mute function of the microphone, or will they have to use a remote control?  

Be aware of other environmental noise sources that may be especially distracting to the users of the videoconferencing system.  PC fans can sound incredibly loud if a microphone is placed near the vent on a computer, and typing can become rather distracting if the microphone is placed too near the keyboard.  Other issues are more an issue of user education on reducing noise – tapping on a table top with a pen or tapping a foot against a table leg can result in distracting noises on the receiving end of the call.

Appearance

Videoconferencing equipment can quickly become a mess of wires and cables if poorly managed, which can result in a both unprofessional-looking environments and potential support issues should a cable accidentally become unplugged.  Also, consider the view that the remote end will have of an endpoint's surroundings.

There are many systems out there that provide an enclosure, mounting surface, or cable management solution.  Cables that should not be accessed by users need to be made inaccessible; simply expecting providers, administrators, and non-clinicians to not unplug a cable may result in unexpected support issues.  If there is support for sharing content from a computer, make the cable clearly identifiable and accessible.  If external video devices will be supported, make the necessary connections available.  You may also want to consider providing a breakout box with external switching between video sources if multiple devices are to be connected.

The appearance of the physical surroundings of a videoconferencing location also plays an important role in providing a positive videoconferencing experience.  Basic issues, such as clutter and haphazard placement of equipment, can result in a less than professional appearance.  Other issues also come up fairly regularly, and should be avoided and mitigated where possible.

  • Does the room provide privacy and is it free from interruptions?
    • People walking in and out of the image in the background can be distracting, though may be necessary in some clinical environments
    • A patient should not have someone who is not supposed to be a part of the conference walk into either their room or into the consulting physician's room
    • Consider having a sign available that can be used to indicate a conference is in session
  • Are there loud activities happening in the rooms and hallways surrounding the videoconferencing area?
    • Mechanical and vocal noises can be distracting in a videoconferencing session, and may result in a reduction of feelings of privacy and connectedness
    • Sound can carry very well in some settings – beware of sounds from private conversations making it into a video session or from the session being audible to surrounding areas
  • Is the room kept clean and professional?
    • Make sure that people are aware of how to use the system, and how the room should be arranged when they are done with their videoconference
    • Consider having a person whose responsibility it is to keep the room tidy – a short pass through the room each day can make sure that it is up to organizational standards
    • Ensure that users of the systems have training on how to present themselves when in a videoconferencing session – users should give their full attention to the conference, without eating lunch, focusing on non-relevant computer systems, or having side conversations

Purchasing

Hardware

Buying videoconferencing hardware is generally a more straight-forward process for hardware-based systems as there are more clearly-defined supply chains and regional vendors than might be found with software systems.  Additionally, in comparison with software systems, hardware products do not often raise the same issues regarding user licensing and account management.  It is recommended that you work with your regional representative for hardware-based purchases.

Software

The exact purchasing process will depend largely upon which class of product your organization purchases (standards-based, consumer-grade, or both), and which particular product within that class is selected.  Prices can range from free for consumer-grade applications with no support, up through tens of thousands of dollars for standards-based systems.  Based upon the decisions made in the planning process, various purchases will need to be made, quite possibly from different vendors.

Your organization’s selection of a vendor will be very important when purchasing a standards-based desktop videoconferencing application.  Some vendors can provide a full range of services, including hosting, hardware, installation, support, and upgrades; while others may focus on only one particular aspect. 

When purchasing the core infrastructure, it is often necessary to plan for an annual service charge of 20% of the cost of the devices.  You should clarify with your vendor what level of service is included with these charges, how equipment failure will be handled, and what options exist for upgrading hardware and firmware in the future.

Consumer-grade systems can typically be purchased directly from the manufacturer.  In cases where the “Business” or “Professional” version of the software will be used, your organization will need to purchase licenses for your users.  If the free edition will be utilized your organization will not need to buy the software, though you may need to consider purchasing media to store and install the approved versions of the software.

Additional funding may be needed for increased network capacity, Quality of Service mechanisms, and personnel to operate the videoconferencing system.  Also, consider the hardware needs of the individual users; while desktop VTC is largely a software-based solution, it still requires a couple of devices for each user.  USB webcams are recommended even for many of the laptops with built-in cameras, as they often have inferior optics and microphones.  Headphones may be needed for some environments to reduce the disruption of videoconferences in an office environment or to counteract problems with audio feedback. 

Be sure to consider additional staffing costs when establishing these systems, such as networking personnel, Telehealth coordinators or scheduling staff, support services before, during, and after videoconferences, and other IT staff that may be needed to setup or troubleshoot the deployment and use of desktop videoconferencing applications.

Deploying Hardware-Based Endpoints

Running a deployment of videoconferencing equipment can quickly become a challenging process as the size and scope of the project increases.  Having a clear plan for ordering, receiving, configuring, building, and deploying systems will make things much smoother.

When ordering equipment, think beyond the basic elements that will be needed, such as the screens, CODECs, and cameras.  Will you be ordering carts or wall-mount systems?  If so, do they need to be ordered and built before the videoconferencing equipment arrives?  Are there additional cable-management pieces that are needed, such spiral wrap, cable ties, split loom, Velcro, or clamps?  What additional cables or connectors will be needed to integrate external inputs, such as S-Video, DVI, HDMI, Serial, Cat 5, power extensions, or surge protectors?

All of the equipment that is ordered will have to be stored somewhere as it is built and configured.  Depending on the types of videoconferencing endpoints to be received, this may require a sizable amount of floor and storage space. Five large monitors, CODECs, cameras, and supporting equipment can quickly fill a room.  Have a plan in place to ensure that the equipment is tracked, stored, and accessible as needed.

There are a couple of different methods for configuring the equipment prior to deploying it.  The availability of space plays a large role in determining which option can be pursued.  The first option is to build all of the equipment from start-to-finish on a one-by-one basis, with each CODEC configured and installed at a time.  This method may be the best option for those performing a gradual roll-out of equipment or with a limited amount of space.  Another option is to build everything assembly line style, with each CODEC configured together, each mounting system built, and everything pulled together at the same time.  This may require significantly more space.

The deployment schedule should be understood by all parties receiving the equipment so they can be prepared for a possible disruption to their work space if the installation happens during normal working hours, or if there is a sudden appearance of new equipment should the installation happen after-hours.  The equipment, after being physically installed, should be connected to other videoconferencing infrastructure and then go through some basic tests to ensure that everything is working properly.  Any peripheral devices or inputs should also be tested, and presets for camera positions should be programmed if desired.  It may also be useful to include basic instructions regarding how to use the equipment, as well as to give contact information if assistance and support is needed.

Deploying Software-Based Endpoints

While each manufacturer has a slightly different process for deploying a desktop videoconferencing solution throughout your organization, there are some steps that are generally required in the entire process.  At a high level, these include installing hardware components, configuring the devices for your network, and installing client software.  In order to have a successful deployment, your department needs to plan on how to deploy the necessary network infrastructure and configure the network design.  Then there needs to be a strategy set in-place for deploying equipment, software and training to the end users.

Servers and Other Hardware

Standards-Based systems require the installation of additional hardware components, such as  their own server for managing the clients.  The servers need to integrate in some way to existing VTC infrastructure (such as videoconferencing bridges) or to other optional elements (such as proxy routers for handling firewall and NAT traversal).  Installing these in accordance with the recommendations of the manufacturer is critical.

The videoconferencing server and other components will require additional configuration steps to connect them to other network infrastructure, such as Active Directory servers that contain user authentication and contact information.  Firewalls may need to have additional ports opened to videoconferencing traffic, and settings may need to be configured to guarantee Quality of Service for video applications.

Webcams and Audio Devices

Webcams and any headsets should also be provided to users as a part of the deployment.  You may need to ensure that the drivers are properly installed, and that the devices are correctly working with your users’ systems.

Software

Client installation also varies by manufacturer.  Some manufacturers provide a way to download the clients from the desktop videoconferencing server, while others require your organization to use existing application deployment policies and tools to be used.  Whether this involves walking computer-to-computer with a CD or using a network-based installation tool is dependent upon your organization.  Your installation process will require administrative rights to the users’ PCs.

Your organization will also need to make a decision as to how the client application will be deployed to non-network computers and users, such as those located in home offices or patient homes.  A download link or physical media may be the most appropriate option for your organization.  Applications installed beyond your network may also need to include a guide for how to configure the software to communicate with your system.

Once the system has been deployed, testing of the software is critical.  There is no worse time to find out that there is an error in a configuration file than when trying to perform a conference with a patient or for a critical meeting.

Supporting Hardware-Based Endpoints

The support requirements for a videoconferencing installation will vary depending on the intended use of the systems and the needs of the organization.  Smaller installations may be able manage their videoconferencing network with existing networking staff or Health Information Technology staff. We recommend hiring a full-time videoconferencing specialist who can manage the system, provide assistance in system operations, growth, call scheduling and management, and troubleshooting.  Additionally, if a videoconferencing system is being used for 24/7 emergency services, an organization may want to consider implementing an on-call policy for their videoconferencing and/or networking staff.

Some organizations may not feel that it is necessary to hire a dedicated employee to support their videoconferencing system.  There are definitely some situations that may allow for using existing staff.  However, it is important to think through how the system will grow.  A dedicated employee can help to expand services, focus on fostering connections with other organizations, and provide timely responses to system failures and emergencies.

Supporting Software-Based Endpoints

Users will often look to your IT department for Tier 1 support unless otherwise informed.  This means that both local and remote users will first think of your organization when attempting to troubleshoot connectivity issues, software problems, and general computer problems.  If you are establishing an enterprise-wide solution, whether Standards-Based or Consumer-Grade, you need to be prepared for Tier 1 support for your users. 

A troubleshooting guide should be created and provided to your external users that walks through the most basic of network and computer problems, addressing topics such as how to restart a wireless router, install a USB webcam, reset their password, and place a call.  If your organization has the personnel available, providing phone support may be necessary when working with your patient population.

Many organizations will also be called on to provide more advanced levels of support, often referred to as Tier 2 support.  The support provided to your organization will vary greatly depending on the service level agreement made with the vendor in the case of standards-based systems, and by the software version used in consumer-grade applications.  Typically, if using a free version of a consumer-grade system, expect all support issues to be handled via community forum or email.

The issue of support grows more challenging when adding external users into your user base.  As you will not often have control over their network configuration and quality of their computer and internet service, problems that they experience will directly impact you without necessarily providing an easy resolution.

As your user base increases, your organization may need to plan for handling scheduling conflicts, either through the creation of dedicated physical and virtual meeting rooms or through the use of a formal scheduling application.

A backup procedure should be put in place if the desktop videoconferencing system is to be used to deliver patient care.  As network or computer issues may render a videoconference useless, have a plan to connect with the patient via the phone to either attempt to resolve the problem or propose a follow-up plan.

Upgrading the software and hardware will eventually become a necessity.  While you will often be able to configure the applications to perform automatic updates, you may occasionally need to install a new version.  In those instances, use a method similar to your initial deployment strategy to get the software out to your users.