Videoconferencing can be accomplished with a fixed camera and video systems or mobile telehealth stations (such as a camera and laptop system that can be moved from room to room). Desktop video conferencing systems use software on a personal computer along with a webcam, microphone, speakers, or a headset. Mobile devices, such as tablet computers and mobile phones, are increasingly used for videoconferencing-based telehealth services.
General hardware requirements include a desktop computer, laptop or tablet, high definition video camera, and audio system. An existing laptop or desktop computer can serve as the foundation of a simple system suitable for most videoconferencing visits by adding a USB webcam and a USB microphone.
Regardless of the manufacturer, videoconferencing equipment should meet specified HIPAA requirements as well as patient privacy and data security requirements consistent with applicable local guidelines.
Mobile devices (i.e., smartphones and tablets) provide capabilities for both synchronous and asynchronous telehealth. A principal benefit of mobile technology is that it provides a cost-effective way to increase the potential sites of service for both the client/patient and healthcare service provider. Smartphone and tablet devices that have video camera capabilities may be used as mobile videoconferencing devices if electronic data security requirements are met. Some mobile devices can also be used to connect to external hardware devices such as biofeedback or health monitoring sensors.
The physical space that is used for telehealth services does not need to be specialized as long as basic requirements are met. When using videoconferencing equipment to provide services, the spaces at both the originating and distant sites should be adequately lit. The lighting may need to be adjusted to ensure that the client/patient’s face and that of the service provider is sufficiently illuminated. Keep in mind that how the camera picks up the image may be different (washed out, too much contrast, too dark, etc.) than how it appears when in-person. It is therefore important to test the image quality and to make sure that it is adequate at both ends of the connection.
The space should also provide adequate acoustic isolation to assure privacy and to limit distracting noise from the outside. Acoustic treatments (sound barriers/absorbers, etc.) may be helpful. A white noise sound generator placed on the outside of the room may also be helpful to mask voices inside of the space (for privacy). Discussion regarding how to schedule the space to reduce the risk for disruptions is also recommended. This may be especially a concern in home-based care services whereby family members, roommates, pets, or other disruptions may impact sessions.
The camera at both the distant and originating site should have sufficient resolution to capture detailed images. Microphones should be placed close enough to the person during the telehealth encounter. If there is too much noise, the provider can mute the microphone and call the patient. It is important to test the quality of the video and audio connections prior to starting the clinical session.
The health Insurance Portability and Accountability Act, or HIPAA protects individually identifiable health information and requires health organizations to follow National Security standards and report security breaches related to protected health information. COVID-19 has sped the delivery of telehealth services at home and prompts greater vigilance in recognizing ways to continue protecting health information.
When setting up a telehealth workstation health care providers should locate a private space, such as a room with a door. Next, ensure that the environment is free from distractions like loud noises and to limit access to only persons with a valid need to know such as other health care providers involved in the client's care, then provide adequate lighting in the workspace. Next, check that the laptop or computer has a working web camera, microphone and speakers. Finally ensure sufficient internet bandwidth with a stable and secure Wi-Fi connection.
Before a telehealth consultation test the equipment to ensure it is working correctly. After powering on the devices find the audio and video settings on your computer to test the web camera, microphone and speakers. Position the camera at eye level to facilitate eye contact during the visit then check that the computer connects to the internet. Finally, launch web conferencing and other relevant software like the electronic health record.
Similarly before the telehealth visit clients should locate a private space with plenty of light. If the environment is semiprivate suggest the client move to a reasonable distance from others, speak in lowered voices and use a headset instead of the speaker phone. Plug-in devices for power to avoid connection issues. Download any required apps and test the video and sound on their devices. Avoid connecting to public Wi-Fi networks. Lastly, prepare a list of questions or concerns and complete any paperwork before the visit.
Health care providers delivering telehealth services can protect clients health information by limiting access to protected health information to only persons with a valid need to know by logging out of computer sessions when stepping away from the workstation. Next, use acceptable tools that comply with HIPAA regulations such as using non-public facing videoconferencing applications like Cisco Webex Meetings, Skype for Business and Zoom for health care. Providers should avoid using public facing applications like Facebook Live, TikTok and Twitch.
Lastly configured devices to support encryption and minimize security risks by maintaining software, operating system and antivirus updates as well as regularly changing passwords to devices, using a firewall and connecting through a virtual private network, or VPN. To recap, health care providers should consider protecting clients health information in the setup and delivery of telehealth services.
Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM and Colleen Harris Marzilli, PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, NEA-BC, FNAP
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