Room set up for web-based telehealth

As with face-to-face consultation, healthcare professionals using telehealth need to ensure the environment is suitable for the purposes of a healthcare consultation, including ensuring privacy and confidentiality. Requirements for: Specific to Specific to  Clinician without patient (e.g. specialist end)  Clinician without patient (e.g.  Clinician with patient  Clinician with patient (e.g. supported patient at healthcare site) specialist end)  Patient with support  Patient with support at home Hardware MINIMUM: Note: web-based video does not currently work on ‘thin-client’  Web-based video consultation requires a computer or device (iPad, computers (ask your IT provider if you are not sure about your desktop iPhone, tablet, android) with a webcam, speakers and microphone. environment) Built in is often sufficient.  Most webcams and built-in cameras are designed for up to 2-3 people  Two monitors are highly recommended – one for video and the other at each end – the speaker may not pick up the sound from more people for viewing patient records etc. and more than 2-3 people may struggle to fit within the field of view of  Alternatively – consider a computer set-up as usual (including thin the camera. clients), and add a tablet just for video purposes. However, this EXTRAS: removes the option of screen (and content) sharing in the video call.  Plug-in (external) webcams can be very useful as they can be moved –  A USB extension cable enables greatest mobility for the webcam, in for example closer, further away or to see (a body part) in more detail. particular for meetings or in meeting rooms (e.g. non clinical) where They also include a microphone. the computer may not be close to the projector screen.  If there are often more than 2-3 people in a call, consider purchasing a plug-in conference camera.  Noise-cancelling speakers are not generally required these days – test before you buy.  Some webcams now come with a small tripod which improves the line of sight (eye contact) between participants when set up in front of the computer screen.

Software and  Many WebRTC-based programs do not need a software download (e.g. downloads Healthdirect’s Video Call, Zoom and others) but they do need Google Chrome. Some also work on Firefox. These browsers need to be kept up to date.  Many web-based video calls require a software download of some sort – e.g. a program app (GoToMeeting, Skopia etc.).

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Requirements for: Specific to Specific to  Clinician without patient (e.g. specialist end)  Clinician without patient (e.g.  Clinician with patient  Clinician with patient (e.g. supported patient at healthcare site) specialist end)  Patient with support  Patient with support at home Internet  A reasonable and stable internet connection is needed. Ideally, wired. connection  If using a wireless connection to a modem, check the device is always within the specified range of the modem. This is modem specific but often between 5-10 metres (check with your IT provider to confirm local capabilities).

Privacy  People often speak louder on a video call. Ensure that telehealth Arrange computer screen so it Arrange rooms as with any consultations will not be overheard by others. cannot be seen through a glass consultation to ensure patient  Minimise the risk of interruptions (e.g. ‘do not disturb - video window or by someone walking privacy. consultation in progress’ signs). past.

Layout,  Make sure everyone can be seen on camera. Sometimes this means Tidy your background beforehand –  The environment needs to be environment sitting what seems to be uncomfortably close to each other. other callers will see what is behind appropriate for patient access and safety  Make sure there is enough light. Avoid strong light (e.g. lamps, lights or you (e.g. personal belongings, – e.g. the drug room with easy sunlight through windows) behind anyone on video (they will look very whiteboards etc.) access to medications is not dark on screen). appropriate.  Pulling curtains or blinds across windows often improves the light in a  Usual consult chairs should be video call. Turn on overhead lights. used – for example a swivel  Position the camera to fill the screen as much as possible with people office chair may not be rather than with the table, chairs, walls or the floor. appropriate.  Ensure enough space for the patient, attending carers, clinicians and any support staff.  If required, ensure there is enough space for assessment (e.g. to assess range of movement, gait).  Ensure cabling does not cause a tripping hazard.

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Requirements for: Specific to Specific to  Clinician without patient (e.g. specialist end)  Clinician without patient (e.g.  Clinician with patient  Clinician with patient (e.g. supported patient at healthcare site) specialist end)  Patient with support  Patient with support at home Clinical Access to tools or resources that Ready access to medical support might be required – e.g. demo equipment that may be needed, packs of medications; script pads, including emergency equipment pathology ordering pads

Pre- Got all this set up? DO A TEST CALL consultation test call Check:  You are using the correct access point / instructions  Internet connection  Software  Video and audio  Camera layout o Your background on the call o Can or will everyone fit on camera?  Lighting  Privacy  Do you have all the appropriate equipment and resources?

Key Legislation, Acts & Standards  Australian Commission on Safety and Quality in Health Care (2012). National safety and quality health service standards. Retrieved December 16, 2013 from http://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/  Medical Board of Australia (2012). Technology-based patient consultations. Retrieved January 15, 2015 from http://www.medicalboard.gov.au/documents/default.aspx?record=WD12%2F7052&dbid=AP&chksum=BWu6uoWlwW2PcJUUZUwcRw%3D%3D  National Health Chief Information Officer Forum, Cross Jurisdictional Telehealth Reference Group (2011). Guidance on security, privacy and technical specifications for clinicians: Draft for consultation. Canberra: Department of Health and Ageing. Retrieved January 15, 2015 from http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/63CDBE743351A0CCCA257CD20004A3AC/$File/Telehealth%20Guidance%20on%20Tec hnical%20and%20Security.pdf  Standards Australia (2017) AS ISO 13131:2017 Health informatics – Telehealth services – Quality planning guidelines. Retrieved 18 December 2017 from https://infostore.saiglobal.com/en-au/Standards/AS-ISO-13131-2017-1942305/

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Resources  Healthdirect Video Call equipment guide: https://vcc.healthdirect.org.au/techguide/Content/D_Articles/Equipment%20Guide.htm  International Organization for Standardization (ISO) (2004). 6056-1:2004 Health informatics – interoperability of telehealth systems and networks – Part 1: Introduction and definitions. Retrieved January 15, 2015 from https://www.iso.org/obp/ui/#iso:std:iso:tr:16056:-1:ed-1:v1:en  APNA telehealth set-up checklist (available to members: https://www.apna.asn.au/secureassets/9ce186dd-f6aa-e611-80d2- 005056be66b1/TelehealthSetUpChecklist.pdf)  The RACGP (https://www.racgp.org.au/your-practice/ehealth/telehealth) and the RACP (https://www.racp.edu.au/docs/default-source/advocacy- library/telehealth-guidelines-and-practical-tips.pdf) both have guidelines for practices, and the RACGP have standards for VC

Useful links (examples only)  Tripod – one option, and cost effective - https://www.teds.com.au/gorillapod-original  Webcam – for example Logitech C920 (http://www.logitech.com/en-au/product/hd-pro-webcam-c920?crid=34) webcam (high definition, wide field of view), which comes with ~2m cable.  Logitech Conference camera (http://www.logitech.com/en-au/product/conferencecam-bcc950?crid=1667) for group consultations or training sessions.

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