NextGen Virtual Visits™ Troubleshooting Guide NOTICE: This document contains information that is confidential and proprietary to NextGen Healthcare, Inc. and its subsidiaries and affiliates ("Company") and is intended for use solely by Company's authorized clients. This document may not be copied, reproduced, published, displayed, otherwise used, transmitted, or distributed in any form by any means as a whole or in any part, nor may any of the information it contains be used or stored in any information retrieval system or media, translated into another language, or otherwise made available or used by anyone other than the authorized client to whom this document was originally delivered without the prior, written consent of Company. By retaining or using this document, you represent that you are a client or an authorized representative of a client of Company who is authorized to use this document under one or more agreements between you and Company now in force, and that you will use this document and the information it contains solely as and to the extent those agreements permit. Any other use or distribution of the contents of this document, as a whole or in any part, is prohibited. Although we exercised great care in creating this publication, Company assumes no responsibility for errors or omissions that may appear in this publication and reserves the right to change this publication at any time without notice. © 2020 NXGN Management, LLC. All Rights Reserved.

NextGen is a registered trademark of NXGN Management, LLC. Mozilla and Firefox are trademarks of the Mozilla Foundation in the U.S. and other countries. Safari is a registered trademark of Apple Inc. All other names and marks are the property of their respective owners. NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Contents

Best Practices for Optimum Service 4

Test Internet Download and Upload Speed 5

Firewall Configurations for Preventing Video Blocking 6 Network Readiness...... 6 Proxies and Firewalls...... 7

E-mail and Spam Filtering Adjustments for Preventing E-mail Blocking 8

Bandwidth Requirements 9

04/29/2020 Page 3 of 10 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Best Practices for Optimum Service

Category Best Practices

General • Use a wired/Local Area Network (LAN) connection where possible instead of a wireless network. • Use a wireless network over phone carrier signal. • The quality of the device (computer, phone, or camera) impact stability. • Newer devices have more compute capability. • High-resolution webcams traditionally have more tuning options and enhanced performance. • Ensure you have adequate lighting in the room. Low lighting impacts quality of picture and performance. • Disable low light compensation (Auto Backlight Compensation). • Check your firewall configuration. For more information, see Firewall Configurations for Preventing Video Blocking (on page 6). • For local network or router configuration, set Quality of Service (QoS) priority high for Telehealth sites to assure video streaming is optimized. • Do not walk and talk between access points (if wireless or mobile). It causes disconnects and latency.

Laptop • See the General category in this table. • Reduce the computer's graphics hardware acceleration. • Different laptop manufacturers offer various tips for improving video quality and reducing lag. Check your webcam's user manual for tips specific to your model. If you do not have the manual, you can usually download it from the manufacturer's website. • Update firmware and software to latest versions for your integrated camera.

Universal Serial Bus (USB) • See the General category in this table. webcam • Ensure that your webcam is connected to a high speed USB 2.0 port. • Different webcam manufacturers offer various tips for improving video quality and reducing lag. Check your webcam's user manual for tips specific to your model. If you don't have the manual, you can usually download it from the manufacturer's website. • Update firmware and software to latest versions for your USB camera.

™ Google Android OS • See the General category in this table. (phone or tablet) • Ensure that your device is on the latest supporting operating system.

® Apple iOS (phone or • See the General category in this table. tablet) • Ensure that your device is on the latest supporting operating system.

Page 4 of 10 Confidential - Proprietary Information - For Use By Authorized Company Clients Only. Do Not Distribute. 04/29/2020 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Test Internet Download and Upload Speed

You can perform a server smokeping (network latency test over Wide Area Network (WAN)), which can provide you insight on the global network latency. 1. To test your device and browser compatibility, go to the following website: https://connect.ottohealth.com/video/test 2. To test your internet download and upload speed, do the following: a. Go to www.google.com. b. Search for internet speed test. c. Select RUN SPEED TEST. Note: Google™ collaborates with Measurement Lab (M-Lab) to run the internet speed test. The speed test displays internet download and upload speed results. For example,

3. Calculate your total network capacity need for download and upload. Note: For more information, see Bandwidth Requirements (on page 9) and Network Readiness (on page 6). For example, • 10 users @ 350 kbps = 3500 kbps (3.5 mbps) concurrent upload speed needed at minimum within a shared network. • 3500 kbps + other upload capacity needs = total upload capacity requirements.

04/29/2020 Confidential - Proprietary Information - For Use By Authorized Company Clients Only. Do Not Distribute. Page 5 of 10 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Firewall Configurations for Preventing Video Blocking

NextGen Virtual Visits™ practices may need to change firewall settings to enable video visits. You may need to adjust the settings on both the network and GPO/computer levels. Within the web access protection settings (the name of this setting may vary by product), you must set the following addresses as allowed: • https://connect-stage.ottohealth.com • https://connect.ottohealth.com Additionally, NextGen Virtual Visits uses Tokbox, which is a video platform service facilitating the video and audio connection. You must set the following domains as allowed: • https://*.tokbox.com* • https://*.tokbox.com* Note: For more information on restricted network guidelines for Tokbox, go to https:// tokbox.com/developer/guides/restricted-networks/.

Network Readiness Tokbox services require access to specific User Datagram Protocol (UDP) ports. As a minimum requirement, you must open the Transmission Control Protocol (TCP) port 443 and change firewall settings (on page 6). Port Description UDP ports 1025 to 65535 Whitelisting this range of ports give users the best experience. NextGen Healthcare recommends UDP over TCP for better quality of audio and video. In this case, clients make a direct connection to the other client (or Mantis) and send media data over UDP. The signaling and messaging data still flows over TCP port 443.

UDP port 3478 If UDP port 3478 is open, the media data can flow through Traversal Using Relays around NAT (TURN) UDP. This is a step above TCP, however there is still a TURN server relaying packets. Adding a server in the middle can introduce latency and/or connectivity issues. The signaling and messaging data still flows over TCP port 443.

TCP port 443 At minimum, if you open TCP port 443, the client can have access to TURN TCP and TURN Transport Layer Security (TLS) candidates. As the media data is transferred through TCP, the experience may be less than optimal. If wildcards are allowed in the network rules, *.tokbox and *.opentok can be used for whitelisting. If not, the TokBox OpenTok IP whitelist feature can be used.

Page 6 of 10 Confidential - Proprietary Information - For Use By Authorized Company Clients Only. Do Not Distribute. 04/29/2020 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Proxies and Firewalls As a general rule, using the latest versions of TokBox and browsers produce the best results. If the only way to access the Internet from your network is through a proxy, it must be a transparent proxy, or it must be configured in the browser for Hypertext Transfer Protocol Secure (HTTPS) connections. Web Real-Time Communication (WebRTC) does not work with proxies requiring authentication. Along with these requirements, clients may have the following rules: Browser Support information Google Chrome™ Latest versions have full support for authentication.

Mozilla Firefox® Firefox® does not support Traversal Using Relays around NAT (TURN) over Transport Layer Security (TLS) or proxies that inspect packets to validate that connections are real TLS.

Apple Safari® Apple® added support for WebRTC in Safari® 11 for macOS® and Safari® on iOS® 11. You can now use OpenTok.js apps on Safari®. Safari® 12.1 also supports the VP8 video codec, in addition to H.264. Safari® versions earlier than 12.1 use the H.264 video codec exclusively and therefore, do not support the VP8 video codec.

04/29/2020 Confidential - Proprietary Information - For Use By Authorized Company Clients Only. Do Not Distribute. Page 7 of 10 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. E-mail and Spam Filtering Adjustments for Preventing E-mail Blocking

NextGen Virtual Visits uses the following static Internet Protocol (IP) address to send communications from the application, such as appointment confirmation and reminders containing the video link. Within your practice e-mail configurations, you must allow e-mails from the following IP address to be sent to your practice recipients: 168.245.111.197 [email protected]

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Video quality dynamically adjusts based on the strength of a user's network connectivity. The faster and more stable a subscriber's broadband connection is, the better the video quality it requests. This mechanism works well until a certain point. If a subscriber's bandwidth drops below a certain threshold, or if a publisher has very little bandwidth to upload video, behavior can be unpredictable. Video may be choppy, audio may have artifacts, and the connection can drop. NextGen Healthcare recommends a minimum dedicated 350kb/s down per downloaded stream, and 350kb/s up per uploaded stream to maintain a stable video connection. For various resolutions and quality combinations, the following bandwidth requirements must be met: Quality Video Resolution @ Video kb/s Packet Loss % 30 FPS Excellent 1280 x 720 > 1000 < 0.5

Excellent 640 x 480 > 600 < 0.5

Excellent 352 x 288 > 300 < 0.5

Excellent 320 x 240 > 300 < 0.5

Acceptable 1280 x 720 > 350 < 3

Acceptable 640 x 480 > 250 < 3

Acceptable 352 x 288 > 150 < 3

Acceptable 320 x 240 > 150 < 3

04/29/2020 Confidential - Proprietary Information - For Use By Authorized Company Clients Only. Do Not Distribute. Page 9 of 10 NextGen Virtual Visits™ Troubleshooting Guide Your feedback is important. Document Revision History

Date Document Version Summary of Changes 04/29/2020 1.0 Initial release

Please take a few minutes to provide your feedback on the experience you have had and your preferences on where our user assistance can move in the future to serve your needs better. Thank you in advance for your valuable time. We appreciate all that you do!

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