The Covid-19 pandemic has brought about the greatest dislocation to Australian society since World War 2. Changes to work and life are affecting all members of the community and have required wholesale changes to the way we do things. 

Restricting virus transition has been the key to Australia’s success flattening the curve. Unfortunately the required isolation has left many Australians out of work and some industries have been shut down completely. Nevertheless, many aspects of society have had to keep functioning. 

In the last 3 months this shift to online services have created major changes in education, retail, hospitality and the law. Government services have managed to improve their online presence and even the Federal cabinet has seen value in online meetings replacing the twice yearly COAG meetings with the State premiers for a monthly video call hook up. 

The church has also adapted. The Easter mass at the Vatican was live-streamed and in the Northern Rivers you can attend mass online where you will find attendances booming. 

Perhaps the most telling sign of the times can be found in the May In Touch newsletter of the Queensland Government’s, Prostitution Licensing Authority, where readers are reminded that close personal contact is prohibited but “sole operator sex workers may continue to provide online or phone services, such as video streaming or phone chat.”

Even in the technical backwater of medicine, where the fax machine still rules supreme, there has been a shift to facilitating online services. While long term reforms to the Medicare system have been in the Health Department’s pipeline for years, the changes to day-to-day practice had been lamentably slow. Then suddenly with the advent of the Covid-19 shutdown changes happened almost overnight. Health minister, Greg Hunt, said that there has been “a decade's worth of work in a matter of days”.

Medicare’s rulings and payments for telehealth consultations were revised several times in the first few weeks of the pandemic. It had the feel of regulation on the run and it was. However, in recognition of the need to keep both patients and general practices going, the system became progressively more generous as the days went by. 

While physical examination is an essential element in clinical diagnosis and treatment for many conditions, much of our routine care can be accomplished without it. The loss has affected some disciplines more than others. Surgical work was curtailed but psychiatrists largely carried on with few restrictions. 

Many patients preferred the new system. Video consultations presented a technical challenge for many older patients but the convenience and efficiency of online consultations is prefered by many. In particular, telehealth has been promoted widely for the management of youth mental health issues where access to face to face consultations and cost can be prohibitive.

Studies have shown that having a properly functioning combined video connection with the patient is superior to audio alone and video consultations are also the government’s preference for telehealth. Changes in facial expressions provide information that cannot be gleaned by voice alone. At this stage, however, there is no difference in the rebate offered by the MBS between video and telephone consultations. Nevertheless, once the covid-19 pandemic passes, practices may find themselves incentivised to prefer video over telephone for their remote consultations. 

The key elements of videoconferencing are the input and output of sound and video, speed and something to bring it all together. Microphones and speakers, webcams and monitors can range in price and quality but cheap consumer grade hardware is adequate for most purposes. The increasing availability of the National Broadband Network has made videoconferencing a more reliable platform in Australia in recent years and the codecs that compress and decompress (co-decs) the data streams have become increasingly sophisticated over time. 

The first video chat clients date back to the mid nineties when CuSeeMe was first released by developers from Cornell University in America. Commercial clients followed 10 years later such as Webex from Cisco and SmartCloud Meetings from IBM. In Australia GoToMeeting from Citrix was widely used in the early noughties but is less popular in recent years. 

There are now literally hundreds of video chat clients that have been adapted for specific industries and uses. Some are platform restricted like Apple’s Facetime. Others like Skype started on Windows but despite being acquired by Microsoft in 2011 are now cross platform. Still others are extensions to existing social media platforms like Facebook's Messenger and Google’s Hangouts.

Most tech conglomerates have remote collaboration tools. In 2012 the Australian software juggernaut, Atlassian, promoted HipChat for its customers but has since sold off its IP to business software rival Slack and it has open sourced its video conferencing client, JItsi. Both of these products have carved out a place in today’s business environment. 

The big players Google and Microsoft have capitalised on their end user products and upscaled them for business. Microsoft is heavily promoting its Teams collaboration software and Google is once again trying to jump start itself into the business market with Google Meet

However, the killer app in recent years has been Zoom. It owes its success to being easy to use, cross platform and free for sessions lasting up to 40 minutes. Recent security problems have created a new term, zoom bombing, where unwanted participants can crash a meeting, but the company has responded swiftly to address the problem. Best of all “zoom” is a great name. Like google and skype before it, zoom is a verb with a new meaning.

Zoom uses a dedicated client for participants but some programs leverage the power of modern browsers to run the video chat sessions directly. WebRTC is available in Chrome and Firefox obviating the need for installing new software which can be a problem for less sophisticated users. This technology is also used by some Australian medical video chat clients like Coviu and the government supported Healthdirect. These programs are designed specifically for GP / patient consultations and the  latter is free for Australian GPs under COVID-19 funding until 30 September 2020. On the North Coast it is available through the NCPHN.

Most video chat applications allow users to share windows from their desktop and have a sidebar chat facility which is also useful for exchanging links and other simple pieces of information. Many allow the sessions to be recorded. Some applications are focussed on security or meeting government laws such as Australia’s privacy acts and America’s health information, HIPPA regulations.

During covid-19 most users have connected from home. It is therefore worth thinking about where to set up your laptop or ipad for these online sessions. There is often a lot of background noise so finding a quiet spot is the aim. It is also worth investing in a good quality headset or earbuds to reduce any echo that other participants will find annoying. 

A home office if available is the best solution where one can insure privacy and minimise extraneous factors. If your office is messy you can try using a fake backdrop that is generated by the computer software. This can work well in an appropriate room but if not parts of your body may disappear from the screen at times. 

Many will have to make do with a spare bedroom but one with a lock on it is best. Professor Robert Kelly’s 2017 BBC interview highlights the importance of having a dedicated secure space for work-related videoconferencing. 

People vary in their enthusiasm for making themselves and their background look good on camera but while one cannot be prepared for all eventualities, it is essential to always wear pants. 

Professor Robert Kelly’s 2017 BBC interview