Telemedicine

Telemedicine gives your organization secure video visits. Providers and patients meet in a web browser. Patients do not need an account or an app. Persons without video can join by phone.

How Telemedicine works 

A telemedicine meeting takes place in a conference room. Each room has a permanent room ID, a web link and a dial-in meeting ID.

A provider opens the room from the portal. The provider is signed in, thus we know the provider.
A patient opens a link in a web browser. The patient types a name and an email address.
If the room is locked, the patient waits in the waiting room. A provider admits or denies the patient.
A person without video dials an access number and types the meeting ID. The caller goes directly into the meeting. Until a host joins, the caller is muted.
All persons are in the same meeting. Phone callers hear the meeting. Web users see and hear the meeting.

Roles 

We give each person a role when the person joins. The person cannot change the role.

Host:: A signed-in user who is a moderator of the room. A host can control the room and the other participants.
Member:: A signed-in user of your organization who is not a moderator. A member can speak, show video, share a screen and chat.
Guest:: A person who joins from a link without a sign in. Usually this is a patient. A guest can speak, show video, share a screen and chat.

These users are moderators of a room:

The users in pbx_conference_moderators of the room.
The owner of a personal room or a one-time room.
All users of the account, if the room has no moderators and no owner.

Important

A room with no moderators and no owner makes every user in your organization a host. Add moderators to each shared room.

Room Types 

There are three types of room.

Shared room:: An administrator makes the room under Settings > Conferences. The room belongs to the account. pbx_conference_moderators controls who is a host.
Personal room:: A room that belongs to one user. The room does not have a start time. The owner is the only moderator.
One-time room:: A room that belongs to one user and has a start time (begins_at). We remove the room after the start time plus max_duration minutes.

Each room can start its meetings locked. The start_locked field controls this. For a personal room or a one-time room, the default is true. For a shared room, the default is false.

We set these values for a personal room or a one-time room:

The extension is the same as the room ID.
The moderator PIN is the same as the OnCall PIN of the owner.
The moderator list is empty. The owner is the moderator.
If you do not give a name, the name is “<user name>s personal room”.
The room records if the owner records calls and your account permits recording. You can change this.

Ways to Join 

Each room has these access methods. Click the access info link next to a room to see them.

Web link:: https://<meeting host>/joinme/<room ID>. Send this link to patients. A patient joins as a guest.
Moderator web link:: Use this link to join as a host. It opens the portal, thus you join as a signed-in user. Do not send it to patients.
Meeting ID:: The room ID in the format 123-456-789. Callers dial an access number and type this ID.
Phone:: The access phone numbers.
One tap mobile:: An access number with the meeting ID included. A mobile phone dials the meeting in one tap.
On network:: The extension and the short name. A user in your organization dials one of them from a desk phone or the mobile app.
Moderator PIN:: A caller who dials in types this PIN to join as a moderator.

Entry Rules 

We apply these rules when a person joins.

Public Access 

When enable_public_access is false, the room is for your organization only.

Signed-in users can join.
Users can dial the extension or the short name.
Guest links and guest invites do not operate.
Callers from access numbers cannot join.

When enable_public_access is true, guests and callers from access numbers can join.

Start Time 

A room with a begins_at time opens 15 minutes before that time. Before then, nobody can join. This rule also applies to hosts.

A person who is too early sees “This meeting hasn’t started yet” and the start time.

Lock 

A locked room has a waiting room for persons who join from a web browser.

Hosts go directly into the room.
Other web users wait until a host admits them.
Persons who join by phone do not go to the waiting room. They go directly into the room. Refer to Moderator Entry Gate.
A request to join stays in the waiting room for 60 minutes. After 60 minutes, the request stops. The person can ask again.
A request stays for 60 minutes also when no host is in the room. When a host comes in during this time, the host sees the request.

A host can lock and unlock the room during a meeting. When the meeting ends, the lock resets to the start_locked value of the room.

Moderator Entry Gate 

Until a host is in the room, we mute the microphone of each person who is not a host. When the first host comes in, we unmute all persons.

A web user can unmute. Web users can speak before a host comes in.
A phone caller cannot unmute. Phone callers wait in the room, muted, until a host comes in.

Patient Experience 

Use these steps to tell a patient how to join.

Open the link that the clinic sent.
On the “Welcome!” page, make sure that the Guest / Patient tab is selected.
Type your email address.
Type your name. The provider sees this name.
Accept the Terms of Service and the Privacy Statement.
Click Next.
On the “Video Preview” page, select your microphone and your camera.
Click Join to Meeting.
If the room is locked, wait. The message “Waiting for the host to admit you…” shows.

If the provider denies the request, the patient sees “The moderator has not admitted you to this meeting”.

Note

The browser asks for permission to use the camera and the microphone. The patient must permit this, or other persons cannot see or hear the patient.

Provider Experience 

Join a Meeting 

Sign in to the portal.
Open the room from the access info, or open the moderator web link.
If the “Welcome!” page shows, click Host / Provider and sign in.
On the “Video Preview” page, select your microphone and your camera.
Click Join to Meeting.

Important

Join a meeting from one device at a time. If you join from a second device with the same account, we disconnect the first device.

Participant Controls 

All persons have these controls in the meeting toolbar.

Microphone:: Mute or unmute your microphone. Select a different microphone.
Camera:: Turn your camera on or off. Select a different camera.
Share screen:: Show your screen to all persons. Click again to stop.
Participants:: Show the list of persons in the meeting.
Chat:: Send a text message to all persons in the meeting.
Transcript:: Show the captions as a list, with the time and the speaker.
CC:: Show or hide the captions on your screen.
Caption settings:: Change how captions look on your screen.
Connection settings:: Change the video codec. Force a relay connection. Reconnect.
Connection quality:: Show the diagnostics for your connection.
Leave Meeting:: Leave the meeting.

Note

We do not keep chat messages. When you leave the meeting, the chat history is gone. Do not use chat for information that you must keep.

Host Controls 

A host has these controls in addition to the participant controls.

Lock:: Lock or unlock the room. While the room is locked, other web users wait in the waiting room. The lock does not stop phone callers.
CC (Captions):: Start or stop live captions for all persons.
Record:: Start or stop the recording. A red REC indicator shows to all persons while the meeting records.
Invite guest:: Make a guest invite link. Click Copy link to copy it.
Waiting room:: In the Participants panel, click Admit or Deny for each person. Click the admit all control to admit all persons.
Member menu:: In the Participants panel, use the menu for one person. You can mute or unmute the microphone, stop or start the video, or remove the person.
Mute all:: Mute all persons.
Copy invite:: Copy the invite link from the Participants panel.
End meeting:: Click Leave Meeting. Then select to leave, or to end the meeting for all persons.

When a host removes a guest:

We lock the room.
The guest cannot come back for 4 hours with the same connection.
If the guest tries again, the guest goes to the waiting room.

To let a removed guest come back, click Unban next to the name.

Note

A host can mute other persons at all times. Unmute of other persons does not always operate. If unmute does nothing, ask the person to unmute.

Invite Links 

A guest invite link lets a guest join the room.

An invite link is valid for 24 hours.
Many guests can use the same invite link.
While an invite link is valid, Invite guest gives the same link again.
Anyone with the link can ask to join. Send it only to the persons that you invite.

The room web link (/joinme/<room ID>) is also a permanent guest link for a room with enable_public_access set to true. Use the invite link when you want a link that expires.

Captions 

Live captions help persons who are deaf or hard of hearing. Captions are off when a meeting starts.

A host clicks CC in the host controls to start captions for the meeting.
We show each caption with the name of the speaker.
We also make captions for phone callers.
The captions come from a transcription service that has a Business Associate Agreement (BAA) with us.

Each person can change how captions look. This does not need a host. The settings stay in that browser.

Size:: S, M, L or XL
Font:: sans, serif or mono
Position:: Top or Bottom
Color:: white, yellow, cyan or green
Background opacity:: 0 to 100 percent

Click Reset to use the default settings again.

Recording 

You can record the audio of each participant in a meeting.

The record_conference field of the room sets the start value for each meeting.
A host can start and stop the recording during the meeting.
All persons see the REC indicator while the meeting records.
We attach the recording to the call record of the meeting.
Your account must have recording enabled.

Important

We do not play a recording announcement in a meeting. Tell all persons that you record the meeting before you start the recording. Consult local laws about call recording.

Notifications 

We tell moderators when a person joins and no moderator is in the room.

The owner of a personal room or a one-time room gets an email.
If email_mod_on_participant is true, all moderators get an email.
If message_mod_on_participant is true, all moderators get a text message.
We send one notification each time the room has no moderator. More persons who join do not cause more notifications.
If a moderator is in the room, we do not send email or text messages. The moderator sees the person in the meeting.

Call Records 

Each meeting makes call records in your call history.

One record for the room. This record has the duration of the meeting and the recording.
One record for each participant connection. If a person reconnects, we make a new record for the new connection.

The records have the tag conference, and the tags of the room.

Note

A participant named RingRx_agent is in each meeting. This is our meeting assistant, not a person. It answers phone callers when the room is empty. It also makes the captions and the recording. It is not in the call records.

Configuration 

Do these steps to set up telemedicine.

Enable the Account 

Your account needs these settings. Contact our support team to change them.

Conferencing is enabled (basic or advanced).
Telemedicine is enabled.
Recording is enabled, if you want to record meetings.

Enable Users 

A user must have enable_telemedicine set to true to own a personal room or a one-time room.

A user does not need enable_telemedicine to be a moderator of a shared room.

Configure a Shared Room 

Go to Settings > Conferences.
Make a new room, or edit a room.
Set the name.
Add the providers to pbx_conference_moderators.
Set enable_public_access to true if patients will join.
Set the conference_mode and the limits.
Save the room.

All room settings are described in Conferences.

Room Limits 

Basic:: Up to 5 participants. Up to 120 minutes.
Advanced:: Up to 25 participants.

A meeting stops after 5 hours, for all modes.

Manage Personal Rooms 

A telemedicine user manages personal and one-time rooms from My Phone. The owner can change these settings:

The owner can also:

Recreate:: Make a new room with the same settings. The room gets a new room ID and a new extension. The old web link, the old meeting ID and all old invite links stop.
Delete:: Remove the room.

Important

You cannot recreate or delete a room while a meeting is in progress. End the meeting first.

Patterns 

Use these patterns as a start point.

Provider Personal Room 

Each provider has one permanent room for ad-hoc meetings or recurring use.

Set enable_telemedicine to true for the provider.
The provider makes a personal room.
Keep start_locked true. The provider admits one patient at a time.
Send the room web link to patients in appointment reminders. Refer to Outreach.

This pattern is easy for patients. The link does not change.

Scheduled Visit 

Use a one-time room for one appointment.

The provider makes a room with begins_at set to the appointment time.
Set max_duration to the length of the visit plus a margin.
Send the web link to the patient.

The patient can join 15 minutes before the appointment. We remove the room after the visit.

Group Session 

Use this pattern for group therapy or classes.

Use advanced mode for more than 5 participants.
Add all facilitators to pbx_conference_moderators.
Set start_locked to true. Participants cannot join until a facilitator admits them.
Admit the participants when the session starts.
Turn on captions at the start of the session.

Participants who dial in go directly into the room. They are muted until a facilitator joins.

Staff Meeting 

Use this pattern for meetings inside your organization only.

Set enable_public_access to false.
Staff join from the portal or dial the extension.

Best Practices 

Privacy 

Always add moderators to shared rooms. A room without moderators makes all users hosts.
Do not use one room for many unrelated patients at the same time. A patient in the room can see and hear the next patient. Use a personal room with start_locked true, or a one-time room for each visit.
Keep start_locked true for patient rooms. Admit one patient at a time.
Look at the name of each person before you click Admit.
Do not send the moderator web link or the moderator PIN to patients.
Use Recreate if a room link goes to the wrong person. This stops the old link.
Lock the room when all expected persons are in the meeting.
The lock does not stop phone callers. To stop phone callers from outside your organization, set enable_public_access to false.

Recording and Captions 

Tell all persons before you start the recording.
Offer captions at the start of each visit.
Do not use the chat for clinical notes. We do not keep chat messages.

Patient Readiness 

Tell patients to use a current version of Chrome, Edge, Safari or Firefox.
Tell patients to permit the camera and the microphone in the browser.
Give patients the access number and the meeting ID as a backup.
Tell patients to join 5 minutes early.

Connection Quality 

Use a wired network or a strong Wi-Fi signal.
If video stops or is slow, open Connection settings and click Reconnect.
If you are on a restricted network, turn on the relay option in Connection settings. Then reconnect.
Open the connection quality indicator to see the diagnostics. Send them to our support team if the problem continues.

Troubleshooting 

“This meeting hasn’t started yet”:: The room has a start time. Join 15 minutes or less before the start time.
“This meeting is open to signed-in members only”:: enable_public_access is false. Sign in, or ask an administrator to set it to true.
The patient waits and no host sees the request:: No host is in the room, or the request expired after 60 minutes. Join the room as a host. Ask the patient to click Next again.
A phone caller cannot speak:: No host is in the room. The caller is muted until a host comes in.
A signed-in user disconnects when another device joins:: The user joined from two devices. Use one device.
Unmute of a participant does nothing:: Ask the person to unmute.
No video from a participant:: The browser does not have camera permission, or the camera is off. Ask the person to check the browser permissions.