Choosing a Service to Host your On-Line Consultations

COVID-19 has led to the healthcare world flock to video call systems which offer a means of delivering ‘Telehealth’. But how can you choose between them? In this post Simon, our CTO discusses some things to consider before choosing.

Simon Taylor

Rehab Guru Co-Founder

Yesterday I both read an article in the Financial Times (FT) about the security of Zoom and listened to Radio 2’s Jeremy Vine discuss the complexity of video conferencing technology. To say that video calls are flavour of the month is an understatement, this is obviously as most of us are on lockdown due to social distancing. Also, as Rehab Guru's sign-up rate and support ticket count continue to rise daily, hundreds of you are pivoting your face-to-face clinics and fitness business to embrace online consultations.  

Social media and governing body blog posts have been alive with advice and guidance on performing remote consultation, however there is a lot of confusion about data retention, encryption and security. This post is not going to tell you exactly what platform to use as you embark upon new ways of working, however it will highlight things you should consider when choosing. It will also discuss why we elected to use Open Source software for our Telehealth platform which offers transparency  and offers you everything you need to know to make an informed decision.

You may wonder why we would you let your source code be seen by the world?

Inside the Black Box

We make no secret of the fact that we use an Open Source product to run our telehealth platform. For the non-technical reader, “Open source software is software with source code that anyone can inspect, modify, and enhance”. You may wonder why you would you let your source code be seen by the world? It’s an approach taken by much of the software you use every day, such as Chromium (Chrome Browser), React (used in Netflix, Facebook, New York Times) and indeed Android, the platform you may well be reading this article on is also Open Source. Even the UK Government advocates for Open Source in public IT programmes.

The reasons we see some of the largest companies in the world use Open Source software are:

Preparatory systems such as Skype, Zoom, Facetime, WhatsApp, etc advertise security and hold certifications to demonstrate their compliance with regulations and are owned by some of the most well-resourced companies in the world, but does that necessarily make them more trustworthy?

Transparency

Open Source, much like this blog post offer complete transparency as to what software is used to offer a service. Preparatory systems such as Skype, Zoom, Facetime, WhatsApp, etc advertise security and hold certifications to demonstrate their compliance with regulations and are owned by some of the most well-resourced companies in the world, but does that necessarily make them more trustworthy? Maybe, however the truth is that no-one really knows, they are closed ‘intellectual property boxes’ that undoubtedly come under significant attack from malicious actors due to their size. Being as ubiquitous as they are without weekly data breach is probably good evidence of their security. However, we cannot be certain of how they handle user data when worrying headlines such as “Microsoft listened to Skype calls with 'no security' to protect recordings, report says”. Zoom, as used by Boris Johnson has been banned by the Ministry of Defence over security fears, yet the National Cyber Security Centre (NCSC) advise that there is no reason why zoom cannot be used for conversations below a certain classification.


Embedding the Telehealth software into Mobile Apps makes it much easier for patients to join the consultation and eases the amount of hand holding required.

“Onboarding” Patients

A topic on yesterday’s Radio 2 was the complexity of staying connected. The steps involved to connect with your family during COVID-19 social distancing measures are sometimes too difficult for non-technical users. This is a topic close to everyone in the Rehab Guru Team’s heart, we need to make patient connections simple. Finding and installing software, entering meeting codes and connection information can all be too much for some, and we agree. It's certainly worth deleting the apps on your shortlist from your devices and stepping through the process that your patients will have to go through to see how complex it is. As you're doing this you may as well write down the steps to begin the process of creating your documentation for sending to patients ahead of their first appointment.

Our approach has been to embed the Telehealth software into all our Mobile Apps across all App Stores to make things simple and consistent for patients (the same app for the consultation, exercise prescription, outcome measures and ongoing assessment). We have created a resources section on our help documentation and created several walk-through guides which can be included in your appointment emails. Our aim is to be more than just a Telehealth platform, but to offer the assistance and resources before and after the appointment.  

New procedures for pre-appointment administration, patient on-boarding and post appointment care are things you are unlikely to want changed very regularly, a change of platform could give you a real headache

New Ways of Working and Vendor Lock-in

Open Source allows Rehab Guru to offer videocall features without passing any additional costs onto our users. Unless our users demand more features, or the service offered by Open Source WebRTC does not provide the level of service required then we will move service, we are not locked into any underlying infrastructure. The beauty of this is that the workflow you’ve become reliant upon will not change. New procedures for pre-appointment administration, patient on-boarding and post appointment care are things you are unlikely to want changed very regularly, a change of platform could give you a real headache. This is certainly something to consider as you move towards increasing your on-line assessments. How easily could you transition to a new service and process? In the tech world we call this vendor lock-in and it’s something we try to avoid. Leaning on Open Source offers the ultimate flexibility for this. If Jitsi does not work out for Rehab Guru then we can move to Voxeet, Vontage or any of the others available to us while your service and usage and routine remains unchanged.  

 

Summary

I am aware as I write this post that as a director of a company that offers a Telehealth product it is likely to be biased. However, trying to persuade you to use Rehab Guru is not my aim. The aim of this post is to offer an insight into the software and architecture of our telehealth system and through this transparency allow you to make an educated decision on what system works best for your business.

If I was to be candid about where I think Rehab Guru beats the competition, I would provide the following 5 reasons:

  1. No additional costs regardless of usage
  1. Embedded, easy to use mobile apps for patients and clinicians offering two step call access
  1. Secure and encrypted peer to peer calls
  1. Transparent Open Source software is used
  1. Embedded connection details offer the opportunity to tighten the integration between Exercise Prescription software and video consultations. Features such as sending appointments and reminders are all coming to Rehab Guru over the coming months.  

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Simon Taylor

A former Exercise Rehabilitation Instructor (ERI) in the Royal Air Force (RAF). He went on to compete for Great Britain in Modern Pentathlon. He is now an RAF Training Officer. As the CTO he leads the engineering team at Rehab Guru.

Simon Taylor

Rehab Guru Co-Founder