We at TTAC recommend working with a professional videoconferencing specialist when deploying and supporting videoconferencing equipment. If the solution being implemented is hosted by a third party, it is likely that they will also offer installation and support personnel. 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.
The broad topic of videoconferencing contains a complex mix of systems and parts. This section of the toolkit will begin with a broad discussion of issues to think through when deploying any videoconferencing system. Subsequent sections look specifically at things to think through for videoconferencing endpoints. Additional information on deploying and supporting desktop videoconferencing software can be found here, and information on the deployment and support of videoconferencing bridges can be found here.
- Before You Begin – General Videoconferencing Issues
- Planning – Videoconferencing Endpoints
- Site Preparation – Videoconferencing Endpoints
- Deployment – Videoconferencing Endpoints
- Support – Videoconferencing Endpoints
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 – 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?
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
Deployment
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.
Support
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.