WebRTC to enable telehealth through your browser
This article first appeared in the August 2013 edition of Pulse+IT Magazine.
The developers of proprietary methods for enabling real time communications may not be too worried yet about the threat many think WebRTC poses, but there are a lot of people eagerly anticipating the formal ratification of an agreed standard for WebRTC, the browser-based platform for real time communications (RTC).
RTC is certainly nothing new, and video conferencing technology companies along with free services like Skype, FaceTime and Google Talk have all developed large markets. However, most of these applications require software to be downloaded and installed and are not designed to interoperate with rival solutions. What WebRTC promises to do is begin to move the world into browser-based real time communications.
WebRTC is referred to as a transport layer technology and is designed to be a native function of the browser. As Chris Ryan, managing director of telehealth consulting service Attend Anywhere describes it, WebRTC is an open source framework that works in a similar fashion to the framework that allows sharing of photos or videos in the browser today.
As the developers of the standard put it, historically RTC has been corporate and complex, requiring expensive audio and video technologies to be licensed or developed. That all changed when Skype was developed in the early 2000s as a free, peer-to-peer VoIP service that reflected the philosophy of its developers. Skype has obviously since taken off and is now almost ubiquitous, with close to a billion users, a net worth of around $2.5 billion when Microsoft bought it in 2011, and approximately 35 per cent share of the international call market.
If Skype revolutionised RTC last decade, WebRTC promises do so in this. What has many people excited about WebRTC is not just its promised ease of use, but its potential. WebRTC's network, audio and video components can be easily accessed by developers to implement their own RTC web apps.
The API standard is soon to be ratified by the World Wide Web Consortium (W3C), the main international standards organisation for the web, and a protocol is being ratified by the Internet Engineering Task Force (IETF).
The IETF met again last month to discuss WebRTC. It is understood that they discussed some of the enhanced security aspects and have agreed to work as quickly as they can to get a ratified version 1.0 of the standard out sooner rather than later, even if this means reducing the scope a bit.
Giving it even more weight is its enthusiastic backing by Google, which bought the rights to many of the components used in RTC in 2011 and made them open source. In November 2012, Google launched WebRTC on its Chrome browser and it has since been implemented in Firefox and Opera, and with a very streamlined plug-in for Internet Explorer. In February this year, Google and Mozilla announced that they had achieved interoperability between Chrome and Firefox.
WebRTC for consumers
What this all means for telehealth and telemedicine is not yet clear, but many in the industry believe it will enable more people to be able to access telehealth, but also to enable telehealth to be done better.
One of the new capabilities that will be enabled by WebRTC is a secure data connection between the browsers that will give users the ability to drag and drop images or files into the browser of the person you are talking to during a video call.
In a clinical consultation, for instance, a doctor could securely deliver an ePrescription to a patient at the other end in real time, or one doctor can drag and drop an x-ray or report, allowing another doctor to receive the file securely and immediately.
Mr Ryan is helping some of his clients to use WebRTC, including The Alfred Hospital as part of its Regional Cystic Fibrosis e-Health & Telemonitoring Program. This project, being led by the head of the Cystic Fibrosis Service at Alfred Health, Professor John Wilson, is being funded by the Victorian government's Broadband Enabled Innovation Program and the Victorian Department of Health.
WebRTC will allow specialists at The Alfred to conduct traditional one-on-one consults with patients but also facilitate the multidisciplinary consultations required for the ongoing management of chronic illnesses.
Attend Anywhere is also helping with plans to use WebRTC for video calls to Healthdirect Australia's health advice line, after-hours GP helpline (AGPH) and Pregnancy, Birth and Baby counselling service.
Mr Ryan is a keen advocate for WebRTC as an attractive option in many clinical scenarios, particularly its benefits in needing no video software or plug-ins like Flash. “This is a draft web standard for incredible quality, secure video conferencing that is highly scalable, resilient and interoperable between device,” he says.
“The technology works peer to peer between browsers so the only cost for the majority of calls is the user’s internet. Central costs are tiny, even to support massive concurrent volume.
“With no software downloads, the user experience is incredibly streamlined and there's no echo, even using standard computer speakers. It's safe to say we are pretty excited by it. You will also be able to make or accept calls through WebRTC to traditional SIP-based video and telephony systems, which is another part of the puzzle.”
Mr Ryan says WebRTC will increasingly be adopted by consumers using everyday applications and they will want to use it to access healthcare.
“One reason WebRTC will be so powerful for telehealth is that healthcare is consumer-driven,” he says. “In the physical world it is consumers who initiate the care – they choose when to go to a GP or a hospital and they choose the transport method to get there or to use the phone. They will want to do that with telehealth as well. The point is that consumers take responsibility for when and how they ‘arrive’, not the health system.”
WebRTC for providers
For healthcare organisations offering telehealth services, Mr Ryan says it will allow them to do things faster, cheaper and better. “From a provider perspective, enabling secure video consulting access to their service via their web site will be as easy as embedding a YouTube video.”
WebRTC will also be able to be used in conjunction with the existing telecommunications-based systems used by many health services, including the Cisco-owned Tandberg, Vidyo , Lifesize, and Polycom systems most commonly used in hospitals.
Mr Ryan goes to great lengths to point out that, as with physical transport, there are different video technologies suited to different circumstances.
“WebRTC is just one option that is particularly well suited to the consumer space and health professionals in their own practices or homes.”
Most hospital to hospital video communications use telecommunications standards based video conferencing equipment and that works very well within managed networks. Unified communications technologies such as Microsoft Lync are also an important part of the jigsaw.
Mr Ryan is helping Healthdirect Australia to set up a video consulting capability that works in the same way as a consumer physically arriving at a medical centre reception. The consumer either has an appointment or they take a number and wait for the next available clinician in the waiting room.
In the Healthdirect video setting, the consumers enter via a secure portal on a website and are given their own personal, virtual waiting room.
“It’s the same as sitting in the practice waiting room, just without seeing the person next to you,” Mr Ryan says. “The portal can also be used to schedule appointments, create case conferencing video rooms, manage the queues and transfer people between services.
“The aim of the capability is to accept multiple planned or unplanned video calls at once, and direct people to the right health practitioners without too much waiting and with the security, privacy, quality, and good records management that everyone expects for a health service.”
While Mr Ryan is a keen advocate of WebRTC, he is also up front about its limitations, such asWebRTC being in its early stages with some important parts of the picture still missing. “Although mainstream support in all browsers, support for mobiles and a more complete set of capabilities is expected to arrive in the next 12 months, we are not expecting this to be all smooth sailing until the standards and their implementations have stabilised.
“And while WebRTC promises to solve a range of issues relating to interoperability, access, peer to peer secure data transfer etc.it in no way solves the domain issues in health of how consumers initiate planned or unplanned healthcare encounters, how they access services, how multiple health care providers are incorporated into the care and how people are moved through the system as they are today, except using video instead of physical transport.
“WebRTC is going to make the ‘transport’ layer much easier but that’s only ever been 20 per cent of the exam. With the technology issues evaporating, people can now focus on what’s really important, which are all the service and service integration components.”
Posted in Australian eHealth