Skype Multi-Point Video for Health Programs
Filed under: Skype, Technology, Videoconferencing | Tags: bandwidth requirement, video streams, yoga program
Leave a Comment After several weeks of using Skype Multi-Point Video connections for a three-location community-based Chair Tai Chi/Yoga program, we’ve come to some conclusions and “possible best” practices.
1. Skype multi-point video is available as part of the Skype business offering at $9.00 per month. Since multi-point connections are set up on via a single computer, that machine must be able to accommodate multiple video streams. The internet connection used for that machine must also accommodate multiple video streams. Skype has published minimum and recommended bandwidth requirements. So, for example, a 3-way video connection has a recommended bandwidth requirement of 2Mbps/512Kbps (upload/download) speed. This is usually within the nominal speed of a low-end cable connection, and most DSL connections.
2. In our case, we wanted to call the outlying machines, and have them auto-answer with video. The Skype settings for this, (version 5.x) are:
Under General Settings
Start Skype when I start Windows. check
Under Privacy
Allow my online status — to be shown on he web — uncheck
Accept Skype browser cookies — uncheck
Allow Skype to use non-personaly identifiable information about me when saving third party ads. uncheck
Other odd things that happened…
1. For some reason, we kept losing our sound. Since I hadn’t had this issue before, I attributed it to a faulty sound module on the DocBox motherboard. What I had forgotten was that we have a blue-tooth microphone that we’re using on the unit that the instructor uses. If the instructor simply removes the bluetooth dongle the DocBox doesn’t automatically reset to a default sound configuration, using the on-board sound card. Instead it simply shows that there is no sound hardware available. This is easily remedied by rebooting the DocBox.
2. Multi-point video performance with a wireless connection is anywhere from sub-par, to completely unworkable.
Texting While Driving… Now Health Monitoring in Cars?
In the “you’ve got to be kidding”… bin this morning, from Federal Telemedicine News:
Ford, Microsoft Corp, and Healthrageous announced at the Digital Health Summit, that they plan to work together to develop connected devices to help people monitor and maintain health and wellness while in their cars. Since trends show that people are spending more time in their cars, researchers will examine how to extend health management into the personal vehicle in a nonintrusive way while people are on the move.
“With the tremendous growth in mobile healthcare solutions, Ford is dedicated to understanding the value of connecting to health and wellness-related services while driving,” said Gary Strumolo, Manager of Infotainment, Interiors, Health and Wellness at Ford Research and Innovation.
As Strumolo explained “Our connectivity platform Ford SYNC provides easy voice-controlled access to mobile devices such as smartphones and tablets and it makes sense to research areas that are important to our customers. Customer research and societal trends suggest that there is a strong business case for Ford to explore opportunities in health and wellness technology.”
A prototype system being developed by BlueMetal Architects is leveraging Ford SYNC® technology, Microsoft HealthVault, Windows Azure, and the interactive services Healthrageous provides in conjunction with compatible biometric measurement devices.
The prototype system would capture biometric and vehicle data as the basis for real-time health and wellness advice and monitoring. The driver can provide voice inputs plus other details on their health routine such as the number of glasses of water consumed during the day or what pills they take.
The data would then be uploaded into the HealthVault cloud, at which point, the data would be transferred to Windows Azure. Then the information would be processed with other health data to create graphical reports that drivers can access after leaving the vehicle.
Since last year, medical and healthcare was the third-fastest growing category of smartphone apps, with more than 17,000 available for download. By 2015, this market is expected to reach $392 million according to a new Frost and Sullivan report and 500 million people are expected to use mobile healthcare apps. As Strumolo explained, “These trends point to a natural role for the automobile in the emerging digital health and wellness field.”
“Sorry officer, I was trying to make sure my blood-pressure cuff was on correctly, when I inadvertently made the wrong turn onto the exit ramp, and I was just telling my car how many glasses of water I had drunk, when I accidentally hit the other car head-on.”
I do love the name “Healthrageous” though.
I just wish Microsoft could fix Windows, and Ford build a decent car.
CMS: Independence at Home Demonstration
From Healthcare Payer News,
Up to 10,000 Medicare patients with chronic conditions will be able to get most of the care they need at home under a new demonstration project developed by the Centers for Medicare & Medicaid Services. The pilot is underpinned by the use of information technology.
CMS defines the home practice as one that “uses electronic health information systems, remote monitoring, and mobile diagnostic technology.”
“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner.
Created by the Affordable Care Act, the new Independence at Home Demonstration greatly expands the scope of in-home services Medicare beneficiaries can receive. The Independence at Home Demonstration will provide chronically ill patients with a complete range of primary care services.
The CMS overview here here, as a PDF file.
Skype Group Video used for Senior Exercise Program
It is early days, however, Central Vermont Community Land Trust, has put together a chair Tai Chi/ Yoga program which they are delivering via Skype multipoint video. They held their first three-way video program with six participants at one senior housing site, seven at another site, and one at a third site with the promise of a couple more participants at the latter site next week.
They are using three of our DocBox units, configured with Skype for Business, connected to TVs. The class is hosted on a laptop computer Skype for Business, and a subscription for the Skype Group Conferencing service, at U.S. $9.00 per month. (That’s only nine dollars!)
The instructor, located at the originating site uses a bluetooth headset microphone. This isolates the site acoustically from the other two sites.
Home Medical Teleconferencing: Conversation with a Sceptic
We had a candid conversation with an IT person who supports telemedicine applications at a major research university. I thought it might be useful to post a de-identified version of the discussion, as it brought out a number of points, both positive and negative about our DocBox units that we developed and deployed to deliver a 12 week 3x per week Tai Chi session for elders who had fallen or had a fear of falling. The conversation addresses several questions regarding installation, support, and the differences between the DocBox vs. Tandberg and Polycom gear. I’ve changed my interlocutor’s name to “Tom”. His questions and responses were copied to clinical staff at the university, when the staff asked about the feasibility of using the DocBox, and about videoconferencing in general.
LK: Tom, I’ve left a phone message if you want to chat…. feel free to call or eMail at any point. Here are some answers questions you have raised. I’ve have your questions enclosed in chevrons, and my comments below.
>>>>>>>>>
Q. Videoconferencing has come a long way in recent years and the video quality is impressive provided all the network issues can be resolved. In recent months, I have worked with pediatrics and family medicine on installing videoconferencing equipment at several off-site locations and in some cases it has taken months to get some of the network firewall issues resolved at these locations.
>>>>>>>>>
LK: No miracles here. With all of our DocBox home installations, we’re either dealing with
a.) a direct connection to a cable modem or DSL modem, or
b.) connecting to a home (Linksys, Netgear, etc.) type router.
In the first instance, a.) we attach a laptop to the cable or dsl modem to assure it is functioning as expected, figure out what the IP address is from DHCP, and/or whether we can or should assign a fixed IP address to the DocBox. Then we attach the DocBox. We’ll use the firewall on the DocBox for fire walling.
In the second instance, a home router, then we have to accommodate a possible firewall…. Usually we’ve installed the unit in the router’s DMZ, and then activated the Windows firewall on the DocBox for firewall protection. (If there is a firewall on the DSL or cable modem, then that has to be dealt with as well.)
You can also go the port-forwarding route, but that tends to be less reliable on consumer-grade routers, and the DMZ method is set up quickly.
We prefer to have our “own” internet connection, just so we don’t end up fiddling with a patient’s existing connection if they have one. In one or two instances we’ve installed a second cable modem, or even a whole second internet connection within a home to accommodate the DocBox.
>>>>>
Q. In recent months, I have worked with pediatrics and family medicine on installing videoconferencing equipment at several off-site locations and in some cases it has taken months to get some of the network firewall issues resolved at these locations. While videoconferencing technology has many benefits, it is not simple to deploy at clinics or at a private residence. There are many technical issues that often prevent videoconferencing from working correctly including: the lack of bandwidth, unreliable network connections, network firewall at residence, and no service level agreement with the Internet service provider.
>>>>>
LK:This is more likely to be problematic where you are dealing with physicians practices a opposed to home consumer-grade internet connections. In our own work with physician practices, we do indeed have to deal with their IT service providers who manage the firewall for the practice. We’ve found it essential to establish a good working relationships. In a couple instances (hospitals), we have installed our own cable modem connection to the hospital, and the internal hospital cabling folks ran a Cat 5 pair from the modem site in the wiring closet or basement, to the site where we installed our unit.
With home systems, we have them set up the day we bring the equipment; it hasn’t been a big problem as long as the internet connection is active. You have to bring a laptop on the installation to figure out what is happening, and to access the management screens of their modem and/or router.
>>>>>>>>>
Q. There are many technical issues that often prevent videoconferencing from working correctly including: the lack of bandwidth, unreliable network connections, network firewall at residence, and no service level agreement with the Internet service provider.
>>>>>>>>>
LK: Regarding bandwidth…. we need 384Kb in each direction for a solid connection. We’ve managed with 256Kb. We have had issues when the IP provider is DSL “at the end of the line”, for example, when line quality was not what it should be. We are working in rural Vermont, and a solid home internet connection is not a given, and many places have none whatsoever, (or cell phone service for that matter..) Some DSL connections at the end of the line have been problematic. Cable is most reliable (or fiber, of course, if you can get it.) Haven’t tried 3G. 4G is a pipe dream up here.
That said, the quality is not designed to be identical to commercial -grade Tandberg/Polycom business systems using HD. In all cases we’re attaching to the person’s TV set, and in many cases people still have their older sets.
Wireless service (via satellite) does not work. Internal wireless within a person’s home can be unreliable, and finicky to set up. We preferred a wired connection if at all possible, although we have successfully used Wireless G in a couple homes.
>>>>>>>>>>>
Q. Skype often does better at videoconferencing from a residence simply because it was designed for low-quality, low bandwidth environments such as home use.
>>>>>>>>>>>
LK: We have a version of our unit that uses Skype. It is not H.323 compatible, so for our telemedicine application wasn’t going to work. We’ve never used it in a production situation, but it looks promising, and the cost of our unit can be considerably lower, if Skype is an option. Skype will also now do at least 4 connection multipoint. Skype looks really interesting for point-to-point connections, but it does require you to go through the Skype servers to make the connections. There has been a lot of discussion in the literature of using Skype for psychiatric counseling, and the security implications of using Skype to set up the conferences. (jury is still out.)
>>>>>>>>>>>>>>>>
Q. I have asked our Cisco product team to put together some other videoconferencing options that could work in this application.
>>>>>>>>>>>>>>>>
We use a Tandberg/Codian (now Cisco) MCU 4205 for our multi-point connections. We would love to be able to afford some of their clients units, but developed our unit to serve as both a lower-cost alternative, and to allow for “no interface”….i.e. the patient just needs to turn it on and tune it to their TV.. everything else happens on the back end. Their Umi product is interesting, and we have a long history with it, including beta testing a couple earlier versions but we never got it to work for us. The main issue for us was that we needed to be able to control the interface. We couldn’t present the patient with a multi-windowed interface that had directories, and buttons, etc. (Not least because they had no way to manipulate the interface…no mouse or keyboard).
>>>>>>>>>>>>>>
Q. There are two main “protocols/technologies” to hold video conferences online. First would be with something like Skype with a low cost camera and a computer and high speed Internet access. The pros are it is cheap and fairly easy and straight forward. The cons are you can only do one on one, but there might be other software out there which would possibly allow up to 3-4 connections at the same time. This might cause some performance issues, it would just have to be tested.
>>>>>>>>>
LK: See above. Our point-to-point tests for Skype were favorable. Multipoint with four connections were also good (by our standards, anyway….again it isn’t as “perfect” as standard H.323). Our unit does use a PTZ web-cam and is based on a mini-ITX form-factor PC running Windows Embedded.
>>>>>>>>>>>>>>
Q. The next technology is the H.323 video teleconferencing. This is the protocol Polycom uses, and it also works over existing high speed lines. It is just dedicated to be a video teleconference system, and needs to be setup at each location. The nice thing about this system, is as long as you have the equipment, you can include multiple parties on a video call. You don’t want to do too many, or it will look like a Brady bunch theme. You might choose to see yourself on the screen and a few people, but many people can see you IF they have the equipment.
>>>>>>>>>>>>>>>
LK: This describes our unit. We use the Polycom PVX client software which is H.323 compatible, allows AES encryption, and integrates with whatever H.323 infrastructure may already be in place, such as MCUs and session border controllers for firewall traversal. We aggregated up to 12 people for our classes, so the comment about the Brady Bunch, really depends on the application. We found that our instructor was able to observe and supervise about 10-12 class participants. Indeed, one of the advantages of such supervision is the ability to react if anything untoward happens, for example, if a participant falls. As a point of safety and manageability 12 was about the maximum that the instructor could handle, (displayed on a large (64?) plasma monitor and still give individual attention to each person.
In our case the Codian 4305 MCU which we used to aggregate our calls, was limited to 12 connections. We had a session manager actively viewing the MCU who would turn microphones on and off, change the view to whom was speaking, and allow occasional views of all the participants.
>>>>>>>>>>>>>>>
Q. Each patient would have to have high speed Internet, a router such as a Linksys, D-Link, Net gear, etc. which would have to be properly configured. They would have to purchase a webcam such as a Logitech 9000 Pro, and have a computer/laptop. On the computer, they would have to have the Polycom license and software setup to answer or call us.
>>>>>>>>>>>>>>>>
LK: We use Logitec Orbit web cams attached to a mini-ITX form-factor PC running the Windows Embedded OS. We don’t use laptops as in our applications, we want to make things as transparent as possible for the patient, so there is no keyboard or mouse provided. (We worked through other iterations of remote hand-held controls, etc, and found those presented problems for the patients).
Patients do not require a router, if they have no other computers in their home. In such cases we would connect the DocBox directly to the cable modem or DSL modem.
>>>>>>>>>>>>>>
Q. The challenge would be setting up the patients. IE: who would install/configure/pay for their Internet access etc. Perhaps we would need to contract someone?
>>>>>>>>>>>>>>
LK: A few comments above about the patient’s internet connection. We provide detailed installation instructions. We found that a successful approach is to have an IT-capable person, who knows about dealing with routers and firewalls do the installation. We’re happy to provide telephone help during the installation and make test calls to the unit once it is installed. Both we, and you (or either combination), can do remote access into the unit to help configure. In once case, when a patient moved 400 miles away, we had the Geek Squad from Best Buy set up her unit in her new home.
On the other hand, the DocBox has been successfully installed by a range of “lay” persons, usually family members, from a ten-year-old to persons with a PhD. degree.
>>>>>>>>>>>>>>>
Q. As far as outputting to a television set, they will need to have a TV that is capable of accepting the video input from a PC, such as a LCD or plasma high definition TV.
>>>>>>>>>>>>>>>
LK: We can actually work with pretty much anything, and one attraction from the patient’s perspective is we work with their existing TV, so there aren’t a lot of extra (new) electronics around. Our unit has a S-Video output and DVI . In most cases we convert the S-Video to a standard TV input. If they had a fancy plasma TV with S-Video input, we could go direct. New versions have HDI outputs, suitable for newer televisions. In several cases on really older TVs we used a scan converter to provide a coax connection(!) which sounds horrible, but actually worked fine. In one case we loaned them a flat computer screen, and mini-speakers.
>>>>>>>>>>>>>>>>
Q. The MXDesign website does not provide much information either. http://www.mxdesign.net/mxdesign/Telemedicine%20Summary%20with%20FAQ.PDF Why is there no technical information on their website? I don’t think this is an oversight. I’m not interested in marketing and sales information. I’m interested in seeing a real spec sheet on the how the unit is built, its capabilities, dimensions, weight, etc.
>>>>>>>>>>>>>>>>>>>>>>
LK. Tom, I hope you’ll forgive the lack of a “real” spec sheet; as I think most of the relevant technical specs are included in our narrative, and pictures, but let me summarize:
Video Client = Polycom PVX v. 8.04
AES Encryption
H.323 compatible
SIP compatible
Mini-ITX form factor.
Weight: I estimate it is about 1.5 pounds. (never weighed the unit..)
Size: 8″ x 8″
Camera: Logitech Orbit PTZ with built-in microphone and echo cancellation
Outputs: DVI, S-Video, RCA audio
Inputs: USB 4
OS = Windows XP Embedded
>>>>>>>>>>>>>>>>>>>>>>
Q. have many, many concerns about this product and would not recommend it for any telemedicine project. There is a Telemedicine advisory board that reviews telemedicine technology for its validity, methodology, reliability, etc and I think those folks need to be involved with this project.
>>>>>>>>>>>>>>>>>>>>>>
LK: I hope the above comments address some of these concerns. I’d like to respond to each of them that were not addressed. I would be more than happy to:
1. Discuss these on the phone or via video (see for yourself what the connections look like…)
2. Send you a unit to try; (but it sounds like you need some additional reassurances before that would be helpful. )
3. Address your Telemedicine advisory board in any fashion convenient.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Q. The videoconference market is dominated by two very large international companies. These two companies are Polycom and Tandberg. Tandberg was acquired two years ago by Cisco. These two companies both provide very high quality videoconference systems designed for telemedicine applications such as this one. Both Polycom and Tandberg also provide videoconferencing technology to the United States government (DOE, DOD, NIH, CDC, etc.), universities, colleges, banks, corporations, and many other organizations. Polycom and Tandberg are the industry leaders in videoconferencing technologies. Most of the 17 University of (an eastern state in the U.S.) campuses use Polycom products. The Veterans’ Administration, including all VA hospitals in (an east coast-state) use Tandberg products. In our Telemedicine program here, we have used both Tandberg and Polycom products over the years to provide psychiatry and pediatric services to patients. Smaller companies like Vtel have not survived in this market. Cisco could not compete so they bought Tandberg just to get market share. The MXDesign website mentions the Polycom PVX, VSX-7000, and the Tandberg/Codian 4500 MCU in the sales brochure but provides few specifics.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
LK: For the record we LOVE our Cisco and Tandberg and Polycom products and the enhancements they provide
We use the VSX 7000 to originate our classes to the DocBoxes installed in the patient homes. I’d be happy to discuss that set-up at some point. (the VSX7000 itself can host up to four connections, which might prove to be useful for small multi-point sessions).
We manage the 12 connection multi-point using a Codian 4203 MCU. Codian was acquired by Tandberg which was acquired by Cisco.
One of our strengths is that the DocBox is not a “closed” system (like Skype, or many other cloud-based video systems) which rely on a third-party relationship, ongoing monthly fees, and the necessity of going to the hosts’ directory to make connections and establish end-points. We *want* to be able to interface with the standard systems used at all sites you describe. What we found was that the standard offerings from Polycom and Cisco did *not* address needs for patients in homes. We have no illusions about “competing” with Cisco and Tandberg but we did find that we add significant value for particular purposes.
Hope this helps!
— Larry
Lawrence Keyes
Microdesign Consulting Inc.
www.mxdesign.net
www.techforhomehealthcare.com
The Maine Approach – Virtual Assisted Living
I found a terrific book Alone and Invisible No More by Allan Teer, M.D. about what he calls the Maine Approach. He has developed a methodology for support for aging at home that works several steps removed from a medical model; using peer relationships, some technology for monitoring and maintaining contacts, and a fair amount of volunteer labor. It is both a lot of common sense, and quite innovative. He has a lot of problems with dealing with state entities (in this case Maine). Lots of anecdotes and personal stories make for very lively reading. Here’s a link to the book at Chelsea Green publishers… where I had gone to actually get a different book entirely.
http://www.chelseagreen.com/bookstore/item/alone_and_invisible_no_more
And his web site is:
http://www.FullCircleAmerica.com/
Their technology supports are interesting, and include:
1. Skype-like single and multipoint videoconferencing
2. Proximity and motion sensors
3. Limited surveillance cameras, especially for seniors living alone in isolated locations.
Electronic Health Record – Another view
From the Disease Management Care Blog…
Which reminds the DMCB of a parallel borg called the electronic health record (EHR). A eerily similar bipartisan government-industry ideology has somehow decreed that EHRs will increase clinical quality, enhance efficiency, promote safety and reduce costs. While the downsides of a miscalculation don’t come close the magnitude of a ”Too Big To Fail” disaster, that doesn’t mean we won’t be left with a lot of ill-suited and expensive legacy information technology systems that do little to make medical care any better than it already is.
Case in point is this recent publication appearing in JAMIA. While the DMCB awaits a reprint request so it can dive into the details, the methodology seems simple enough: a “clinician panel” looked at the appropriateness of 3850 consecutive electronic prescriptions forwarded to a large pharmacy chain. They found at least one error in a whopping 11.7%. While omitted information was the most common mistake, a potential “adverse drug event” accounted for a third of the mistakes. The authors point out the interesting statistic that an approximate 12% error rate is about the same that’s been reported for hand-written prescriptions.
And this is what we’re spending our national treasure on? Egads.
While Americans bemoan partisan gridlock, an allegedly rudderless Presidency, complex regulations and uncooperative private industry, the DMCB is learning to fear its opposite: a confidently wrong Chief Executive backed by an enthusiastic and misinformed Congress that bulldozes its way through economic sectors like the healthcare industry.
Google Health bites dust.
According to an article in the New York Times, Google will discontinue Google Health, the personal health record portal that they began in 2008. Quoting from the blog post …
Now, with a few years of experience, we’ve observed that Google Health is not having the broad impact that we hoped it would. There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. That’s why we’ve made the difficult decision to discontinue the Google Health service. We’ll continue to operate the Google Health site as usual through January 1, 2012, and we’ll provide an ongoing way for people to download their health data for an additional year beyond that, through January 1, 2013. Any data that remains in Google Health after that point will be permanently deleted.
Ok, so maybe this shouldn’t be a great surprise. Google is one of many other sites which allow people to manually record their data on web form. Compared to the other behemoth, Microsoft HealthVault, the interface is pretty slick.
Google Health, Summary Screen
Economics of Medicare vs. Private Insurance
Paul Krugman’s column in the New York Times this morning argues that having more people enrolled in Medicare will save money. And that, horrors, all the ideas being floated to “save Medicare”, are misplaced, indeed the ideas should be to “save health-care for Americans”.
The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
Skype, Security and HIPAA
I had a discussion recently with a state IT administrator who scoffed at using Skype video for telemedicine connections because it was “insecure”. Since we’re doing exactly that for family connections and proposing it for (at least), connections for health-care interventions other than direct physician-to-patient conversations, I thought it would be helpful to do some more research; I found an interesting 3 part thread about using Skype, particularly for psychiatric consultations.
Skype hasn’t made all the details of its security system known, but it does have a lot of information online, and, assuming that they are telling the truth, it sounds like Skype is at least a secure as a cellphone conversation, and, as far as I know, every psychiatrist I know talks to people on cell phones without worrying that much about HIPAA violations.
Skype and modern cellphones use the same basic protocol to communicate (packet switching), but basically what happens is that when you make a call, Skype or your cellphone operator sets up a connection between you and the person you are calling and then steps out of the way, leaving you and that person to talk as if you had your own circuit. Both Skype and cellphones encrypt the data they send. If anything, the AES encryption method used by Skype is probably more secure than the 30-year old A5/1 encryption method used in most cellphones. AES is approved by the government for top secret information while A5/1 has already been partially broken.
I think that the real security issues with Skype (or with cellphones) are probably more with things like whether the government can compel Skype or your cellphone operator to tap into your conversations than with details of encryption or firewalls.
Until then, I think that doctors should give up talking to patients on cellphones before they get worried about whether Skype is secure.
Give up talking on cellphones?
The Telehealth.net discussion cited above is a little more nuanced…
On one end of the spectrum are professionals, both licensed and unlicensed who claim that HIPAA is not relevant to telecommunication video interactions with clients or patients. Some of these people state that even if HIPAA compliance is an issue, public VoIP platforms already have met HIPAA compliance requirements by being more than 128-bit encrypted. They consider themselves safe or safe enough, and many of them are already practicing on the open, public Internet, using systems such as Oovoo, Google Talk, Skype or any of a number of other VoIP video platforms.
At the other end of the spectrum are professionals who are more conservative. They seem to be choosing to either wait for more secure systems to be developed, or work in institutional settings where using equipment with stated HIPAA complaint technologies.
So … “It depends”. My guess is my IT manager friend is of the more conservative persuasion and that we would need to come up with some kind “compliance certification” to satisfy him.
