Set up or obtain access to consultation space that:
- is quiet and fit for purpose
- has arrangements to protect the privacy and dignity of patients who may be required to remove clothing for a physical examination (eg a screen in the room or a separate private area where patients can remove clothing and be suitably covered with a gown or drape ahead of the video consultation)
- has plain decor that will not distract from visual images on the screen
- has good lighting, avoiding high-intensity light (eg a window) behind the patient who is being viewed
- has ready access to medical equipment that may be required during a video consultation
- has systems to prevent interruptions (eg a ‘do not disturb’ sign to indicate that a video consultation is in progress)
- has access to a phone as a back-up if the video call fails.
If you use equipment with a wireless connection to the practice router, you may experience a significant drop in video quality in rooms that are far from the router. This is a small but important consideration when selecting appropriate rooms for video consultations.
Hardware and software
You can hold telehealth video consultations using low-cost options such as a desktop computer and Skype or invest in specific video hardware and software systems. Practices that have a high volume of videoconferencing (not only for telehealth video consulting) may find it worthwhile to invest in more specific videoconferencing hardware and/or software. Practices who plan to offer more ad hoc video consultation might find that Skype is adequate. Box 3 has further information about Skype.
Up-to-date MBS guidance on technical specifications for equipment and software can be found on the Department of Health website.
Ensure the system you choose meets the requirements of the MBS item descriptor and applicable laws for security and privacy.
Box 3. Use of Skype and other free video software
Skype and other free video software (such as WhatsApp, Facebook Messenger and Tox) are convenient and widespread, and an easy way to conduct telehealth video consultations, especially on an ad hoc basis.
There is currently no evidence to suggest that Skype is unsuitable for clinical use. The RACGP supports its use in clinical settings by GPs and those providing clinical support on behalf of the GP. However, it is recommended that practices:
- register a Skype name that provides some anonymity
- always have a back-up mode of communication in instances where the connection cannot be established or drops out.
In undertaking your initial business/clinical use case assessment, consider Skype as a low-cost entry point to video consultations. Given there are no significant up-front costs and no up-front contracts, the business risk is small. Once you have a better idea of the demand for video consultation services in your practice, it may be worth considering professional software and hardware to ensure the sustainability and quality of your service.
At a minimum, consider buying:
- a high-quality webcam that can be zoomed in on the patient, and with a built-in high-quality microphone
- microphones that enable all participants in a video consultation to be clearly audible (eg remote ceiling microphones or cabled/wireless extension microphones)
- speakers and microphones with echo-cancelling properties, or an echo cancellation box.
To ensure they don’t get missed, include maintenance checks of videoconference equipment in the practice’s equipment maintenance schedule.
Connecting with the specialist
To ensure that your practice’s videoconference system connects with the equipment used by the specialist:
- test the interoperability of the two systems prior to holding the consultation
- keep a log of the equipment used by participating specialists and confirmation of advance interoperability testing
- inform participating specialists and re-test interoperability of the two systems if you update or change your systems.
To avoid lengthy disruptions to telehealth video consultations, you should:
- have ready access to technical support for videoconferencing equipment and connectivity
- develop and maintain documented contingency plans for managing technical problems during a video consultation (eg completing interrupted consultations by telephone)
- ensure all participants are aware of the contingency plan (eg who will call whom)
- keep troubleshooting guides with the teleconferencing equipment for common technical problems
- have a dedicated person in the practice who can provide technical support on the spot.
Offsite telehealth video consultations
When providing video consultations from external sites:
- ensure that the videoconferencing equipment and connectivity are capable of delivering sound and image quality suitable for clinical purposes
- ensure the equipment maintains the privacy and security of patient health information
- ascertain the availability of emergency resuscitation equipment in advance
- ensure GPs take a suitably equipped doctor’s bag to consultations at an offsite facility.
Poor sound and visuals during a video consultation can be irritating and distracting, and can affect the clinical usefulness of the consultation. Box 4 provides tips on maximising audio and visual quality.
Box 4. Technical tips
|Place the microphone on a firm, flat surface as close as possible to participants to enhance audio quality and minimise background noise
||Ensure good lighting in the room so that faces are clearly visible on the screen – avoid placing bright lights behind the people being viewed
|Ask participants to speak clearly, at their normal voice volume, and one person at a time
||Check the camera gaze angle in advance and adjust if necessary to allow eye contact between participants – this is important for effective communication between the patient and specialist
|Ask participants to switch mobile phones off or to silent mode before the consultation
||Ask participants prior to the consultation to avoid wearing brightly patterned or reflective clothing as this may affect the focus of the camera
|Minimise background noise (eg typing on a computer or background clinic noise) – it can be useful to use the microphone’s mute button when people at the other end of the video consultation are speaking
||Check the ability to move the camera to focus on certain items (such as skin lesions)
||Check the ability to share the screen to enable specialists to view results or images stored in the clinical information system
If you experience issues with the quality of a consultation, use a telephone speaker phone for the audio component of the consultation. If you have poor internet coverage, muting the audio could save some bandwidth and increase the picture quality.