Appendix A: video conferencing

Video conferencing (VC) services provide the ability to conduct real time video meetings that can cover one to one or one to many site locations. VC technology has become more refined over the past decade, with the benefits of high definition (HD) quality images, clearer digital sound and interaction with other collaborative tools, such as WebEx services. There are different types of VC provisions tailored to suit local business requirements and budgets. Some of the key benefits of a video conferencing service are:

• saving time - reduces unproductive time spent for travelling to and from meetings 
• the ability to quickly organise real time face to face meetings for critical decision making
• saving money - reduction for travel and expenses costs
• environmental benefits -  a reduction of CO2 emissions

VC services are extensively used within the NHS, providing assistances for day to day collaboration, especially in the areas of health management and diagnosis by medical professionals and medical training. It is also a main technology tool to assist administrative and support functions and senior management teams within NHS organisations.

There are a number of common video conference end point deployment types as follows.

Mobile video

This solution is based on apps that enable users to participate in video conferences via smartphones and tablets, regardless of their location. This works via mobile networks (recommended 4G or above) or with Wi-Fi.

Desktop and computer software clients

This option provides both desk based users and mobile workers a VC service that is used via a desktop or laptop PC. There is a requirement for software to be installed on the PC that enables users to manage their local VC session. It is important that any PC based service has been thoroughly assessed to ensure that it meets the business requirements, such as usability, security and associated costs.

Room-based video - multipoint conferencing

This option offers a variety of configurations to support small, medium and large meeting rooms. Available features typically include support for multiple screens, the ability to project content from laptops or mobile devices and cameras that focus on active speakers around a room.

Hardware multipoint control units (MCUs)

Also referred to as a "bridge", this is the hardware that provides interconnectivity between organisation endpoints. MCUs provide the users to "bridge" / configure a VC session between sites via the appropriate VC meeting planning software, allowing them to set the locations, start/end time, date and session duration. 

Immersive telepresence

This provides a service via large screens mounted on a wall or above conference tables and shows people at life-size. Similar furniture, directional acoustics and cameras mounted at eye level give the appearance that participants are sitting at the same table and looking at one another. As this service requires more equipment and a more sophisticated configuration, immersive telepresence can be an expensive option, but has the quality benefits associated for a high end user experience.

Over the past decade, a common approach for buying services is to procure a video conferencing system and the associated infrastructure. This would include the hardware required to host an in-house multipoint conference and would probably be bought outright as a capital expenditure and supported internally by the local ICT staff. However, over recent years, the introduction of cloud based solutions and its associated benefits of deployment and running costs, has changed how organisations can approach the procurement of their video conferencing services.

Cloud based solutions provide various models to suit business requirements, and are charged as a fully supported service on an annual subscription. Cloud solutions are available to any size of organisation and can be used by any commonly used devices, such as smartphones, tablets and laptops, and can allow easier scalability as service demands grow.

Standard VC protocols

Please be aware that information presented in this section is subject to potential future change. Organisations should always carry out further research to ensure they are aware of the latest standards and protocols.

All key video conferencing protocol standards are developed and ratified by the Internet Engineering Task Force (IETF).

Video conferencing standard (Codex) involves several different protocols covering telephony and voice standards. At a minimum, video conferencing infrastructure should be capable of supporting H.320, H.323, H.264 and Session Initiation Protocol (SIP) calling. The associated voice codex standards for video conferencing infrastructure should support G.711, G722, G.723, G.728 and G.729.

H.320: This is the standard associate with ISDN video calls and is supported if an additional ISDN option has been purchased. It is accepted that the use of H320 - ISDN connection type services - are becoming obsolete. Note - support and guidance will be offered to customers who are using legacy VC services via their chosen CN-SP.

H.323: H.323 is a protocol standard for multimedia communications. H.323 was designed to support real-time transfer of audio and video data over packet networks like IP. 

SIP is an open signalling protocol for establishing any real-time communication session. The communication session can involve a combination of voice, video, and instant messaging and take place on any device that people use for communicating: laptop computer, Smartphone, mobile phone, Instant Messenger (IM) client, IP phone, for example.

H.264: With ubiquitous usage of mobile smartphones and tablets there is now a growing move towards the industry standard H.264 and Scalable Video Coding (SVC). This provides high-quality video at lower bandwidth over a wide range of networks and systems, which enables quality video conferencing on a wider range of mobile devices, compacting the use of bandwidth usage over 4G and Wi-Fi, while retaining image and sound quality.

Interworking solution should be established to ensure that any protocol translation between H.323 and SIP is transparent to the end user.

A gatekeeper is a management tool for H.323 multimedia networks. A single gatekeeper controls interactions for each zone, which comprises the terminals, multipoint control units (MCUs), and gateways within a particular domain. Although the gatekeeper is an optional component, when it is included, it becomes the central administrative entity.

Video conferencing systems using SIP should be compatible with open standards for video encapsulation.

Firewall traversal should be established to support both H323 and SIP video traffic.

There are a number of key areas that will need to be considered at the early planning stages for a video conferencing service deployment (in no specific order):

Locations

1. How many end locations of the business will be required to have a VC service installed?
2. Will the VC service span across the entire business locations or selected sites? 
3. If not rolled out across the entire business, is there scope to expand the roll out to other sites in the future?

How many will be using the video conferencing?

1. Concurrency of usage - how many users will be using the system at once?
2. Usage profile scenarios - with whom will users be having conferences?

Assessment of the current infrastructure to accommodate the VC service

1. Communications room space for central kit (if the service is to be locally managed)?
2. Hosted service (cloud) or on site locally managed bridge services?
3. Circuit connectivity - appropriate bandwidth for the VC service and associated costings? For example, monthly, annual costs.
4. Appropriate power provision?
5. Assess the rooms that will be used to house VC equipment - will they be fit for purpose?
6. If deploying mobile/ PC based video conferencing, are the current user devices fit for purpose? 
7. Costs for install and on-going maintenance?

Functional features

Network/technical configuration:

1. Consideration should be given to establishing a dedicated IP address subnet for video conferencing devices. 
2. Quality of Service (QoS) should be implemented either/both LAN and WAN links to support video conferencing. (See HSCN QoS Guidance)
3. SIP dialling should be via DNS / SRV record

Non-functional requirements

The following must be incorporated:

1. Local VC usage policy - ensure users of the service comply to basic "do's and don'ts" in using the VC, such as recording of sessions with confidential information.
2. User guidance and training:
   • Users understand the process for booking VC sessions
   • Ensuring that users have the necessary training and manuals to maximise their usage of the VC service.
   • Helpdesk assistance for end users
3. Robust change management processes

Security considerations

Given the open use of typical video conferencing facilities, it is vitally important that organisations adopt some basic security principles for the day to day use of the service. There are some key considerations that should be factored into the operational service to minimise any potential security breaches.

There are some basic operational considerations that should be reviewed when implementing video conferencing services.

1. Ensure VC systems can support encryption to support patient confidentiality.
2. Compliance to any applicable Information Governance and IT Security regulations and processes.
3. If VC systems are not configured to meet policy requirements, then they may not align with compliance and audit requirements and may expose the organisation to additional risks. Ensure that an appropriate risk assessment is carried out to mitigate any potential issues for service.
4. Similarly, a UC solution should be configured in such a way that it is compliant with your local information security controls and policies. This will require planning, risk assessment as well as auditing and continuous monitoring.
5. Do not leave videoconferencing equipment unattended or "in conference" in locations that are isolated. Only video conference with known and approved site(s) and with location's permission.
6. Ensure room and content security. For example, do not leave confidential information on whiteboards or documents which could be viewed. Clear room of any confidential information on completion of a VC session.
7. If VC sessions are recorded, ensure the process for storage of the recordings complies with standard local and national Information Governance policy, such as off-shoring information for any recorded VC call. Are they kept local to site, VC supplier Cloud solutions and are these kept in the UK?

There will be a requirement to ensure that specific service based SLA's are in place to guarantee that users and expect a certain level of service. Over time, users will become more familiarised with using VC services, this then places more reliance on the service being available and fit for use. To ensure a decent level of service, consideration should be given to establish some basic SLA components (based on ITIL industry standards) that cover:

Availability

1. Agreed service uptime - for example 99.99%  
2. Managing downtime or upgrades via Planned Engineering Work (PEW's) processes
3. Agreement of fix times if the services is unavailable

Performance

Maintains an agreed level of operational quality for the service. Ensuring that VC monitoring of key network measurements (jitter, latency and packet loss). 

Helpdesk operation

1. Will this be available during the Mon-Fri working week or 24/7?
2. Accessed via telephone and email

NHSmail - further reading about the core and additional services available on NHSmail

G-Cloud - video conferencing is available on G-Cloud. View the basic search results.