Skype was first released in 2003 and by September 2011 there were 663 million registered users, with approximately 5 000 000 conversations happening at any time in the day.
Currently 40% of Skype calls are video calls. The basic Skype program is free to download and easy to use – only a good quality webcam and an internet connection are required. It works on PCs and Macs, tablets, and smart phones. Many people use Skype to keep in touch with friends and family. Since the release of the Telehealth Medicare Item numbers in July 2011, there has been much publicity and conjecture over the use of Skype as a tool for clinical video consultations.
Is Skype safe for a clinical consultation?
The answer is yes, however there are some aspects GPs and other medical professionals need to be aware of before making the decision to use Skype.
There is no guarantee of the routing path digital data is sent through on internet networks. This means it is possible for data transfer to occur outside of Australia through countries without the same privacy laws as Australia.
A further complication of the transfer occurring off-shore is the possibility of content being delivered with a virus. For this reason, the RACGP advises medical content, such as still images or desktop screen shots are not exchanged during a video consultation using Skype.
Skype has an open access address book (directory), which means anyone, anywhere with an internet connection can search for anyone published in the Skype directory. The RACGP advises if Skype is used for video consultations, you consider creating a slightly encrypted user name (ie pseudonym) and avoid a username like Dr John Smith, Townsville. It is important to note configuration is required to ensure the default of retaining history files, which record all episodes of communication, are set correctly as these files can be accessed with spyware. Configuration is required to make Skype work in networks with firewall restrictions.
The Skype support page provides access to frequently asked questions, community discussions and online email support. There is no telephone support available. Anecdotally Skype is quite reliable, however the company publishes no statistics on call drop-out rates.
The Skype connection relies on the internet; the quality of the connection will be determined by the lowest bandwidth from either end – there can be fluctuations in the quality of image and audio due to local internet usage. The RACGP advises if Skype is used for video consultations you should have a back-up option in place, such as a telephone (not currently claimable under MBS Items) or another form of video conferencing software or hardware.
The use of Skype does not contravene the Privacy Act 1988. The relevant sections of the Act to video consultation (in general) pertain to the recording of a consultation and the subsequent use and storage of the recorded material. If a recording is made of a Skype telehealth video consultation, it must be conducted according to the Health Records and Information Privacy Act 2002. The RACGP recommends that general practices adopt a default position of not recording video consultation, and not authorising patients to make their own recordings of video consultations.
What the literature says
As at 28 May 2012 a search of PubMed with the word Skype resulted in finding and reviewing 25 articles – of these 10 were on the use of Skype for clinical consultations with a patient and a medical professional. The most recent publication was a literature review on the articles use of the seven publications that related to controlled trials of the use of Skype for clinical consultations. The authors found that while there were many case reports and small studies, no firm evidence either in favour of, or against, the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are unknown.
In summary, there is currently no clear evidence to suggest Skype is unsuitable for clinical use, therefore the RACGP recommends GPs and those providing clinical support on behalf of the GP, such as practice nurses or Aboriginal health workers:
- Register a Skype name which provides some pseudonymity
- Medical content, such as still images or desktop screen shots are not exchanged during a video consultation using Skype
- Always have a back-up mode of communication in case the connection drops out, or cannot be made
- Do not expect immediate access to technical support from Skype if the connection cannot be made.
In undertaking your initial business/clinical use case assessment, consider Skype as a low cost entry point to the world of telehealth. Given there are no significant up front costs and no upfront contracts, the business risk is small. Over time and once the ongoing demand and usage has been quantified, to ensure sustainability and quality of service, it may be worth considering moving to a professional software and hardware solution.