Using Videoconferencing in Parent-Infant Teams
26 March 2020
In the current climate, video conferencing offers a helpful way to maintain face-to-face contact with patients and colleagues. However, there are a multitude of platforms to chose between, and issues to consider such as affordability, ease of use, reliability, privacy, confidentiality and informed consent. In this document we have tried to pull together some useful information and advice. We are not experts however, and this is a guide only.
The document provides governance guidance from both NHSX and the Royal College of Psychiatrists. This is then followed by a table of the platforms we have been made aware of in our research.
- Information governance – advice from NHSX
NHSX Information governance advice in the light of Covid-19 states that
“The health and social care system is going to face significant pressures due to the Covid-19 outbreak. In the current circumstances, it could be more harmful not to share health and care information than to share it. The Information Commissioner has assured NHSX that she cannot envisage a situation where she would take action against a health and care professional clearly trying to deliver care. This advice is endorsed by the Information Commissioner’s Office, the National Data Guardian and NHS Digital.
We encourage the use of videoconferencing to carry out consultations with patients and service users. This could help to reduce the spread of Covid-19. It is fine to use video conferencing tools such as Skype, WhatsApp, Facetime as well as commercial products designed specifically for this purpose.
The consent of the patient or service user is implied by them accepting the invite and entering the consultation. But you should safeguard personal/confidential patient information in the same way you would with any other consultation.
You may well need to work from home – for example, when self-isolating without symptoms. If you are working from home and using your own equipment you should check that your internet access is secure (e.g. use a Virtual Private Network and/or if possible avoid public wi-fi) and that any security features are in use. If you are taking any physical documents home with you that contain personal/confidential patient information, you should also ensure the security of these documents at your home and when travelling.
Using Your Own Device
You can use your own devices to support video conferencing for consultations, mobile messaging and home working where there is no practical alternative.
Reasonable steps to ensure this is safe include: setting a strong password; using secure channels to communicate e.g. tools/apps that use encryption; and not storing personal/confidential patient information on the device unless absolutely necessary and appropriate security is in place.”
- Clinical Advice – Advice from RCPysch
The Royal College of Psychiatrists has produced useful advice for clinicians about the use of remote consultation. They state that
“During the COVID-19 pandemic, remote consultations should be encouraged where safe and appropriate to avoid unnecessary travel and face-to-face contact. Though ideally remote consultation should be an adjunct to, rather than substitute for, face-to-face consultation, this may not be possible in the current climate.
For initial consultations (where the patient and clinician are unknown to each other), remote consultations may be even more challenging. Despite this, the alternative of no consultation at all is not preferable and we recommend that initial remote consultations go ahead where possible.
However, the clinicians and professionals initiating the consultation will be expected to show sensitivity to patient’s comfort level with technology and determine early in the consultation what objectives of an initial assessment or screening can be achieved reliably.
It remains the case that these consultations are limited and those with lack of digital literacy or no access to digital platforms must not be disadvantaged, nor should those who are unconfident about using the technology. Use of telephone consultations, rather than more complex video platforms may be sufficient for lower risk conversations or to ensure engagement with those who lack digital technology or skills. ”
The college provide the following useful operational advice for undertaking video consultations, including consideration of accessibility, competence, confidentiality, consent, confidence, contingencies and communication . This can be found on their website at https://www.rcpsych.ac.uk/about-us/responding-to-covid-19/responding-to-covid-19-guidance-for-clinicians/digital-covid-19-guidance-for-clinicians
- Choosing which platform to use
There are tens, if not hundreds, of platforms available for video conferencing. The functionality and price of these platforms vary hugely and it is very difficult to find accurate information that brings all of this together in one place – particularly as many providers are changing their offers in response to COVID-19. There are blogs that describe many of the platforms, such as this one: https://www.uctoday.com/collaboration/video-conferencing/covid-19-ultimate-guide-to-free-video-conferencing-collaboration/
You and your service users may be more familiar with some platforms than others, and choosing a commonly used platform can be advantageous because it means people are more likely to have the required app and to be familiar with its use.
Some platforms work well for 1:1 calls (like consultations), but don’t provide the functionality required for group work or team meetings. If you want to use video conferencing for delivering groups or team meetings, then you need to chose a platform that enables multiple users to join a meeting. This may require paying for an upgraded offer. Some platforms offer the option of recording the session which may be useful for some situations.
Most platforms are encrypted to at least the industry standard of 128-bit AES, some go up to 256-bit AES. Some require you to share your contact details with other users, whereas others can be accessed by sending round a link, which may be preferable in situations where you don’t want to share contact information (for example, if using a personal device or organising a group with a number of service users).
If organising group calls, it can be preferable to have password protection or permissions so that you can limit who can join a meeting.
Some platforms can only be used on particular operating systems, for example:
- Facetime requires an apple device (iphone, ipad, Mac computer),
- Google hangout requires hosts to have google accounts (although they can then ask others to join)
As outlined above, NHSX advice states that it is fine to use any videoconferencing tools in the current situation. However, it is still preferable to use those with greater safeguarding measures in place. The US Department for Health has standards that video communication products must meet in order to be used for telehealth. Microsoft Teams, Zoom for healthcare, Google Hangouts and Webex all meet these standards, as do Amazon Chime and GoToMeeting.Video calling platform options
This table provides a range of options. It is not definitive. It collates information we have been able to easily locate and is accurate at the time of writing (26/03/2020). We are not experts and suggest you use this as a starting point for information on which to build.