Prior to desktop and mobile video technology becoming commonplace, if a business wanted to use live interactive video over the Internet, the primary option was to invest in a dedicated video conferencing system, which housed the hardware onsite. This investment typically required an investment in IT services to support and maintain the equipment. As these were rather expensive endeavors, usage was typically limited to conference rooms and boardrooms of large companies. This greatly influenced the design of this technology and attention was given to the infrastructure needs of those clients. At the time, and with few other options available in the market, the decision to use this type of equipment and set up was rather straightforward when looking for an option for use in patient care.
A growing number of cloud based video services offering healthcare compliant solutions have significantly reduced the obstacles to incorporating online video communications for a business. With the availability of mobile devices that can support live video, the typical office desktop system is now powerful enough to run live video software, and cloud based “Video communication as a service”. Companies are now offering near commodity level pricing, which allows for entry into the telehealth space an attractive option for smaller clinical , as well as less burdensome for large systems. Organizations that have invested in dedicated equipment in the past have reasons to continue to leverage onsite hardware technology, while new smaller practices have the option of avoiding dedicated or onsite installations all together. There is no “one-size-fits-all” video solution for healthcare. This toolkit will aim to describe the primary options with information to help each provider or organization begin their path towards a well-informed decision that meets their individualized needs.
Because video is being used across many aspects of operations, any organization looking at an initial or additional investment in video technology should first identify planned uses for video technology beyond direct patient care. If the only use case for video is for direct patient care isolated from other workflows, then almost any option will suffice with the understanding that decisions around features or planned use of peripheral equipment make some options more attractive than others. However, if the intent is to incorporate video technology within the communication infrastructure – integrating it into the office and patient care workflow – then the additional requirements of the overall system will dictate which technology investments are made.
How the company culture thinks about video can also impact the approach to an investment. If the culture is to think of a video system primarily as a tool for the physician to communicate with a patient, then the justification for that investment will be viewed strictly around the financials of that activity. However, if video is considered as just another means of communication for the entire office or system, then the financial return on investment can be spread across a wider set of activities and customer service interactions.
General categories of Internet video equipment
With transitions in any market, the consumer will find vendors dedicated to a specific video choice, while other vendors will work to integrate various video options. For someone new to this space, the terminology (and choices) can be overwhelming. This portion of toolkit provides a brief overview of the major choices an organization has when deciding on the video platform for their individualized purposes.
Dedicated video conferencing systems – Legacy hardware
Many healthcare systems in the US, who were early adopters of Telehealth, use a dedicated video conferencing system. Generally, the hardware is on the premises of the healthcare system and maintained by their IT department. Some States have invested in a Statewide Telehealth Network which includes investment in a video network infrastructure. as well as local control around issues of access and impact on the corporate or State health network. These investments are likely used not only for patient care, but also for administrative purposes, online education, repository for storage of corporate video, and many other functions.
From a technology standpoint, dedicated systems adhere to the standard known as H.323, which is a mixed bag of standards that cover how the audio, video, initiation, and other parameters are constructed. However, despite the standards, there is enough room for customization of the technology such that one company’s H.323 system doesn’t automatically connect to another company’s H.323 system and keep all the features offered by the video platform. While these interconnectivity issues can be addressed, sometimes they require additional purchases or customizations, so it is a good idea to ask experienced users if you intend on connecting a new system to older equipment.
Dedicated systems run independent of any other computer support. They run their own operating systems and software and manage their own user interfaces. In short, it is a computer, monitor, camera, and microphone system that is dedicated to doing one thing – video conferencing. The benefits are that the hardware doesn’t have to balance running other programs or applications and the risk of . Additionally risk of security compromise is significantly different than with solutions designed to work on consumer available computer devices. Of course, the benefit is also the primary drawback, as computer equipment that is commonly found in clinical and back office settings cannot be used.
With the rise of mobile devices and consumer interest in accessing video services from their own devices, historically dedicated and isolated systems have been modified to connect with personal computers through browsers and various applications.
The interface navigation was initially designed to use a TV remote, which left a lot to be desired as far as user experience. To make dedicated equipment useful in multiple rooms, equipment was placed on carts and moved from room to room. This increased the complexity of use as, with every move, the system would have to be set up again and connectivity re-established. Despite all these obstacles, in the late 1990’s and early years of 2000, this was really the only practical option. More modern systems have significantly improved the user interface with touch screens and use of contact lists to make connecting .
Desktop video (and related solutions)
While software based video chat has been available to consumers since the mid 1990’s, the launch of Skype in 2003 helped frame expectations and awareness that consumer computing devices were getting powerful enough to handle the complex encoding calculations required for real-time video communications. Since then, the envelop has been expanded to include HD video and even multiple HD video streams to reliably be passed between two computers on the Internet in a peer-to-peer configuration. Today, with the introduction and adoption of WebRTC (Web Real-Time Communication) protocols and application programming interfaces, video communication solutions that leverage the common internet browser are relatively easy and inexpensive to build for peer-to-peer .
While many of the pure software video solutions provide excellent quality for a 1:1 call, and multiparty calls with a few participants, these offerings were historically geared toward the consumer and for non-business critical communications. Personal and mobile devices have achieved a level of functionality and onboard features such as camera, microphone, and speakers and provided a rather standard foundation to support significant growth in the online communication market. Today there are numerous web based video communication solutions in the market, which are specifically tailored for healthcare services in design, security, and implementation. The first direct-to-consumer services used these types solutions initially for their web based video solutions and remain in use today. Depending on your clinical and operational needs, web-based software platforms can be a very cost-effective way to provide services to your patient(s) and customer(s).
Hybrid solutions (hosted integrations)
As businesses and healthcare systems purchased various video systems, and as the industry changed and new, easier systems came on the market, it quickly became clear that there was an interest in having different systems connect to each other. One challenge with on-premises solutions was that each client had their own version of customization, depending on how their network and security solutions were implemented around their video infrastructure. More recently, video vendors have been taking on the task of managing the video servers themselves, offering video as a hosted service either completely or in tandem with on-premises hardware.
For many businesses and healthcare systems, this approach offers a cost-effective way to incorporate video into operations without having to assume the task of hiring IT staff that are trained to manage the complexities of video hardware. For vendors, this approach allows them to maintain the servers in scaled and redundant environments, while monitoring the quality of their services as well as ensuring that updates are quickly and appropriately implemented. Administrators find this option attractive as the companies offering these services are typically large and well financed since their services are offered across multiple .
For larger systems or for systems that produce or frequently access corporate video streams, on-premises storage or on-premises media servers can be a reason to invest in tools and servers to support management of proprietary content.