Introduction: Healthcare organizations used off-the-shelf video conferencing platforms to provide telehealth services during the SARS-CoV-2 pandemic. However, the reliability and resiliency of these platforms for all-hazards disaster response when the telecommunication infrastructure may be damaged or overwhelmed is unknown. Further, industry standards to guide technology and system development for disaster response are lacking. This study characterized the impact of degraded networks on the ability to maintain adequate audio and video quality to support clinical telehealth encounters in simulated austere network conditions. Methods: Network manipulation testing was performed in a cyber-sandbox for HIT on off-the-shelf video-conferencing platforms (Zoom, Microsoft Teams, Webex, Skype, and Google Meet) and two commercial telehealth platforms in development for regional disaster response in the United States. A high-precision network emulator was used to perform controlled network degradation, including network bandwidth, network delay, packet loss, and packet corruption. Delays in establishing synchronous video calls, video resolution, missing video frames, video freezes, delayed video, audio quality, delayed audio, and audio intelligibility were examined, as these issues can compromise the quality of the telehealth encounter. Results: Decreasing the network quality of service decreased audio and video quality. With all platforms tested, when network bandwidth was 5 seconds, packet loss exceeded 15%, or packet corruption exceeded 20%, communication via audio and video conference failed. Conclusion: This study identified minimum network performance thresholds required to use video conferencing and telehealth platforms to deliver disaster telehealth services in simulated settings. These results inform system users and technology developers of methods, metrics, and expected performance to prepare for real-world performance degradation expected in disasters. Future studies should examine real-world network performance in a variety of disaster conditions.
Boyle et al. (Sun,) studied this question.