IM NHSmail2 - North West SIS Conferencing... · Web viewIn a typical scenario a remote care...

North West Shared Infrastructure Service (NWSIS)

HEALTHCARE CONFERENCING STRATEGY

3rd December 2015 1 Version: 1.0 DRAFT

Index

1. FOREWORD...................................................................................................................................................3

2. THE REQUIREMENTS...............................................................................................................................4

3. CURRENT CAPABILITY............................................................................................................................5

3.1 Video as a Service for Health (VaaS)...................................................................................................................5

3.1.1 Terminology............................................................................................................................................................................. 6

3.1.2 Technology................................................................................................................................................................................7

3.2 Cisco Jabber................................................................................................................................................................. 7

3.3 Microsoft Lync (Skype for Business).................................................................................................................. 8

3.4 Unified Communications (UC).............................................................................................................................. 9

4. CONFERENCING STRATEGY...............................................................................................................10

4.1 Reasons to deploy conferencing services...................................................................................................... 10

4.2 The Start Point......................................................................................................................................................... 11

4.3 Interoperability and Collaboration.................................................................................................................. 11

5. CONCLUSIONS...........................................................................................................................................13

6. RECOMMENDATIONS............................................................................................................................14


1. FOREWORD

The NHS faces a demographic time bomb and the ever-increasing costs of newer tests and treatments. While better treatments and a population that is living longer are both good news, the forecast is that there will be a £30bn year-on-year funding gap between our taxes going in to pay for the service and the costs of running the NHS by the time we reach 2020.

The British population as a whole, therefore, faces a choice between paying more tax, cutting services, what is available on the NHS, or designing a health care service that runs more efficiently.

A significant part of the answer might be provided by a third great revolution that we are currently living through

‘The Information Revolution’

The Information Revolution has transformed many areas of society – banking, commerce, media and telecommunications. However, healthcare has largely been left behind. Greater use of innovation and technology has the potential, if used in the right way, to empower patients and health care professionals to produce better value healthcare for us all.

Information Revolution

The challenge of moving from traditional models of care delivery to new services and without leaving anyone behind ‘either patients or health care staff’ should not be underestimated, and the benefits of getting this right could put the NHS on a sustainable footing for many years to come.

Conferencing is the use of telecommunication and information technologies in order to provide and support clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities and directly into the patient’s home.


2. THE REQUIREMENTSConferencing requirements can be met by a wide range of technology and services, the most complex usually being in the home environment.

The dramatic increase in the capability and capacity of networks, the availability of the internet ‘broadband services’, technology, audio visual applications and services, and the plethora of devices available to end users is beginning to impact on how the health care can be provided in the future.

Smart Devices

In Lancashire we have a de-facto strategy for the use of Video Conferencing (VC) services that is network, service and device agnostic, it has proved to be a limited success but the services have not had the take-up that we had expected (see current capability at Section 3).

The key areas are to:

1. gain acceptance and management and financial support from Senior Management for a collaborative conferencing strategy for Health and Social Care in Lancashire

2. recognize that a range of technologies will be required for the foreseeable future, including traditional video conferencing

3. aim to provide an agnostic service that meets the end user requirements regardless of network, system, application, or device

4. recognize that many clinical uses will be trust and organizational centric but this should not prevent collaborative initiatives in order to leverage economies of scale

5. recognize that finance and tariff is key, and will to a large extent dictate what can practically be provided

6. implement policies and ‘software’ to manage the unplanned and ad-hoc growth of technologies in order to exploit the use of best-of-breed deployments and to guarantee the best services possible


3. CURRENT CAPABILITYThere is a range of Audio Visual (AV) conferencing systems and services that are currently providing a range of systems and services across Lancashire:

Video as a Service (VaaS)

Unified Communications (UC):

Cisco Jabber

Microsoft Lync (Skype for Business)

It is highly likely that there will be a mix of these technologies being used for the foreseeable future, the key is to ensure that end users are provided with the most appropriate system, and that those systems are interoperable with each other.

The underpinning technology that directly supports AV and innovation are:

the Lancashire Regional VMB ME WAN: this provides a 24/7 SPOC, and connectivity to anyone, anywhere, with any device, at any time, and supports the inherent security features for information and service assurance.

Microsoft Active Directory: directly supports VaaS, mail, UC and ISE in providing the capability to deliver seamless services across all stakeholders

Cisco ISE: the core engine that underpins the delivery of seamless WLAN services across Lancashire

3.1 Video as a Service for Health (VaaS)Video as a Service (VaaS) provides a fully managed and hosted video conferencing service specific to the NHS and is hosted on the Lancashire 10GB WAN that has access to: N3, Lancashire Trusts and boundary networks, Internet and mobile networks. The service is delivered using the VaaS model which means that Virgin Media Business (VMB) will provide (utilising Imerja) as the central video conferencing infrastructure as a fully hosted and managed service.

Using this model means no capital expenditure on video conferencing infrastructure and hosting which is required by the NHS.

The service is available to all trusts and organisations and would enable them to deliver to their own solution(s) on an annual per-user subscription basis.

The service will define a number of fixed subscription categories with a bundle of features appropriate to different user types.


Examples of VaaS customers are:

Cumbria and Lancashire including Ormskirk - Telestroke

Cumbria and Lancashire - Cancer MDT

Lancashire Teaching Hospital - Renal Home Dialysis

Blackpool Victoria Hospital - Speech and Language Therapy

Cumbria and Lancashire - General purpose systems

VaaS is provided as a codec based service and does not currently provide the Virtual Clinic as described within the Cisco service.

VAAS Topology

3.1.1 Terminology

VaaS: Subscription-based Video Conferencing Service (for a Closed User Group) providing gatekeeper, multi-conference, recording, Internet & N3 VC proxy services (Delivered in conjunction with Imerja)

VaaS Subscriber: Paid subscriber to the VMB VaaS

Internet Guest: Any public internet connected non-subscribing VC user who participates in a VC with Lancashire Care VaaS subscribers


N3 Guest: Any N3 connected non-subscribing VC user who participates in a VC with VaaS subscribers

On-net: Any endpoint connected to the COIN either directly or via IPVPN or private APN

Off-net: Any endpoint connected to the public internet, guest WiFi or public AP

3.1.2 Technology

Core infrastructure and Endpoints:

Gatekeeper; Multi-conference Bridge, N3 and public Internet Video Border Proxy services and SSL Authentication Service

Endpoints: Polycom CMA & 3rd party enterprise VC endpoints and VC software, Apple IOS and Android Apps

3.2 Cisco Jabber

Cisco conferencing has been implemented in Lancashire but in a limited way, the next stage is to further develop the service to provide a full range of services including ‘Virtual Clinic’.

Cisco addresses the Audio/Visual challenge in three different domains:

Patient/Citizen Centric Care: developing solutions in the home where technology isn’t seen as a barrier or threat. Familiar and simple to use solutions are paramount.

Carer Enablement: whether it’s a community midwife, social care worker or GP, they must be equipped such that they can access and update information at the point of need.

The Information Store: consolidating information from multiple sources for the maximum benefit to all.

In a typical scenario a remote care worker using a tablet device to securely access information whilst treating a patient in either their home, or other place of care. The device operates over a variety of networks and mobile technologies, and all data is secured in transit. The virtualised technology environment allows data to be viewed and input on the device, but for the data not to be resident on the device.

Video support allows remote expertise to be available on demand and collaboration tools allow the remote care worker to share information with others in real time.

Applications are consolidated either to the organisation or shared services Data Centre or indeed into the private cloud or approved, connected suppliers;

Voice and video services may be either locally provisioned or offered through the private cloud.


3.3 Microsoft Lync (Skype for Business)Lync was Microsoft's UC product that is now known as “Skype for Business” and the Lync server will become “Skype for Business Server”

This service offers voice, video, instant messaging and videoconferences delivered from a single client, integration with Microsoft Office means a click-to-talk operation.

A Lync client will get Skype's look and feel. None of Lync's features will go, but some of Skype's will appear including the individual clients Skype contacts being available to Lync.

Your communication and collaboration in one place with no need for multiple apps and solutions — one client, one set of sign-in credentials.

Deliver a familiar experience that invites people in, and provides:

Cross-platform support. Connect to your team anywhere, and to millions of people on Skype, using Skype for Business apps on Android, iOS, Mac and Windows, in browsers, and on compatible IP Phones.

Presence, location, contact card. Know who’s online, where they are, and how to reach them. Rich presence tells you who is available, and contact Cards appear throughout Office apps letting you communicate with anyone – from whatever you’re working on.

Communicate within Office apps. Collaborate right within your Office documents using IM, screen share, talk or video chat. Schedule meetings and see IM history in Outlook, and start meetings from apps like Word and PowerPoint to present whatever you’re working on.

Meeting room systems. Easily bring remote participants into meeting spaces of all sizes with Skype for Business Room Systems and Surface Hub.

Delivers meeting room solutions:

One solution for every kind of meeting. Audio, video and web conferencing are combined in one user experience and a unified platform, with the ability to schedule a meeting in Outlook or start one in real time.

Universal audio conferencing. Join over the Internet with smartphone, tablet, PC or browser, or join via telephone.

Multi-party HD video. Make video a more natural part of everyday business and collaboration, with 1080p resolution, conference sizes of up to 250 participants, and up to 6 people shown live simultaneously.

Content sharing. Focus on the things you're doing together, even when you’re far apart, with integrated real-time co-authoring, desktop sharing, application sharing, and PowerPoint presentations.

Expand your reach. Include anyone in a collaborative meeting, even if they are not a Skype for Business user, with anonymous access on a browser or smartphone, and reach thousands in webinar and cinema style meetings with Meeting Broadcast


3.4 Unified Communications (UC)In addition to standards based VC systems, UC is being increasingly deployed by a number of trusts and organizations Lancashire.

The two main UC platforms are:

Microsoft Lync (Skype for Business) Cisco Jabber

Individual trusts will decide on their preferred solution that meets their respective business requirements.

The important thing is that interoperability between all AV and UC platforms is in place to support the business requirements of those trusts and organisations and work is currently on-going to ensure that both systems are interoperable and seamless to the end user.

Note that NHSmail2 will be provided with Skype for Business, the details of how this service will interface with other systems are currently unknown.


4. CONFERENCING STRATEGY

To agree a strategy for providing conferencing technology is the key enabler for healthcare organizations that will drive the digital revolution, provide multiple services across a range of specialist areas, such as: Stroke, Renal, Neurology, Cardiology, Dermatology, Vascular, post-procedure follow-up, acute care, and to patients in the home.

The Digital Revolution

4.1 Reasons to deploy conferencing servicesThere are a number of reasons why trusts and organizations are looking to deploy conferencing systems, such as:

• reducing costs

• improving patient services

• avoiding hospital readmissions

• providing improved access to specialists

• providing education and training

• expanding the geographic footprint of the service, trust or organization


At any given time there are a few limited deployments of conferencing technology in a small handful of areas across trusts and organizations, but these often lack a unifying strategy and/or the ICT architecture to be able to accommodate deployment at scale.

Many system implementations are usually a result of direct purchases made by individual departments, and often the purchases were completely or partially funded by a grant. In these situations, it is often found that the systems lack technical and workflow interoperability with other video systems, are costly to expand, may not be fully funded, or do not have the flexibly to use multiple endpoints (network, system, device agnostic) to deliver audio visual sessions to the end user.

Unlike in Lancashire, very few trusts, organisations and areas have developed a scalable deployment ie one that is effectively deployed, marketed, has a high utilization rate, or could even resell its services to other local or regional organizations. This is where a conferencing strategy is critical, by helping them to establish a vision and architecture strategy for deploying a telehealth program at scale.

4.2 The Start PointThe start point is to:

• define the immediate needs of the trusts and organizations

• promote a unifying architecture approach

• ensure flexibility to handle the needs of tomorrow

• provide a service and help desk for the service

The core of this strategy is the existence of a conferencing architecture foundation where you can add on the individual endpoints and software necessary to fulfil a particular requirement, and do that cost effectively as well as have the security required for a healthcare architecture that is involved in transmitting Patient Identifiable Data (PID).

This type of unified approach also provides interoperability and helps to reduce the IT support and administrative overhead of managing multiple disparate systems.

Last but not least, the system is nothing if it does not deliver value to the business, and thus defining and measuring the value including Return On Investment (ROI) is paramount to a successful deployment.

4.3 Interoperability and CollaborationRegional video interoperability and collaboration will provide end users with high quality, secure, network (system, service and device agnostic), and scalable for all end users:

• Enable collaboration across healthcare teams

• Support better outcomes and more timely access to care


• Reduce unnecessary hospitalizations

• Education - patients and healthcare providers independent of location

• Enable faster implementation of new healthcare professionals

• Support better chronic disease management

• Support prevention and wellness programs

• Improve patient care by providing more convenient access to specialist expertis

• Provide better utilization of specialists

• Survey, test, and confirm success of disease management programs

• Providing service metrics for auditing and confirmation of success

• Exploit the internet, particularly for mobility and in the patients home


5. CONCLUSIONSThe current Audio Visual (AV), Conferencing, and UC services are providing a range of end user requirements across Lancashire, it is important that these services are co-ordinated to ensure inter-operability to meet the end user requirements.

To date, no one system and/or service can meet all the end user requirements, it is therefore operationally important that we continue to provide the current standards based core deployment (VaaS), exploit UC and the internet, whilst at the same exploring future technologies that may be provided as part of the new WAN procurement.

It is clear that we do need a much more collaborative and joined up approach to conferencing if we are to fully exploit the full potential of tele-health across Lancashire, and potentially wider


6. RECOMMENDATIONS

1. Regional support

2. Vaas

3. WAN, futures etc


IM NHSmail2 - North West SIS Conferencing... · Web viewIn a typical scenario a remote care...

Documents

Transcript of IM NHSmail2 - North West SIS Conferencing... · Web viewIn a typical scenario a remote care...