The Wyoming legislature appointed a consortium of health stakeholders and organizations= to create Telehealth Policy and Procedure for applications in Wyoming. Documents which should accompany this document include the Wyoming Telehealth Provider Guide, the End User Troubleshooting Guide, the Polycom Quick Guide, and more. Inform= ation can also be found on the Southeast Wyoming Telehealth Network website at www.sewtn.net

Room Considerations

Both the physician video conferencing room and the pat= ient video conferencing room should adhere to normal exam room requirements base= d on HIPAA requirements and policies for your clinic or hospital. Treat patient privacy to the same = level as if you were seeing the patient in person.

Recommended Room Color: Benjamin Moore paint numbers= 1627 or 829 This light blue-= grey contrasts well against skin tone.

Microphone placement should be close to the patient to receive appropriate patient intake in an Exam Room. Microphone placement should be cen= tral to all participants and the use of an omni-directional flat mic works well = in small to medium groups. Perma= nent fixtures such as ceiling mount microphones should be considered for auditorium-like applications or for very large conference rooms. Ceiling mount microphones should n= ot be mounted near in-ceiling speakers, PA announcement systems, HVAC vents, or ceiling mount fans; these items will create ambient noise which will be distracting for a video conference.

Lighting should be controlled room lighting and not na= tural lighting. Natural lighting fr= om windows will cast heavy shadows and other uncontrollable effects. Windows should be covered or blinds closed during a video conference. Video conferencing equipment should not be facing windows as this will cause attendees to look like ‘silhouettes’. If overhead lighting is not adequate, provide ambient can-lighting fixtures ne= ar a wall. These fixtures sit on t= he floor and point upwards to provide additional ambient lighting and are very inexpensive.

Lighting considerations are especially true when worki= ng in an Exam Room environment as patient examination is critical.

Please refer to the Telehealth Provider document for m= ore detailed information.

Video Conferencing Endpoints

System Requirements for H.323 Systems:
The ITU-= T H.323 protocol standards should be adopted for Wyoming= telehealth video conferencing as it is an industry standard. The following minimum requirements should be included for Room Based video conferencing u= nits as well as H.323 based Desktop video conferencing implementations.

H.323 Stack Minimum Requirements

IPv4/IPv6 S= upport

H.460.17-19 Firewall/NAT Traversal

UDP Signali= ng (Annex E)

HTTP-Based Service Control for H.323 Devices (Annex K)
Telephony Signaling Tunneling Through H.323 (Annex M)
DNS support (Annex O)

Remote Came= ra Control (Annex Q)

H.341 MIB Support

Q.931 Multiplexing

High Capaci= ty Registration (Additive Registration)

H.245v13 Ad= vanced Call Control

H.235v3 Security

Full H.450 Supplementary Services

H.245 GEF API

H.350 LDAP support

System Configurations for H.323 Room Based Sy= stems:

In addition to room considerations and network considerations:

· All telehealth video units should be registe= red to a public gatekeeper. This gatekeeper will provide a registered alias for direct dialing.

· The recommended alias configurations will en= sure future scalability and reduce the potential for alias conflicts. Aliases identified by location may= also assist with troubleshooting.

· Video conferencing equipment must be kept up= to date by using vendor supplied annual maintenance. Video conferencing equipment that = is two (2) revisions of software older or no longer supported by the industry (end= of life) will not be allowed for the use of telehealth.

· Video conferencing equipment will be given a static IP address, DHCP is not an option.

· Duplex and Link set to 100 Full

· SNMP community is set to: wythealth

· Qos is set for Diffserv: Audio: 46, Video: 34, Data and Signaling: 26

· Each video conferencing endpoint will be set with an administrator password and provided only to pertinent video conferencing IT administrators.

· Web Snapshots turned OFF for patient privacyEncryption On

Room based video units:

E164 Al= ias by Region:

City	Hospital	Alias
Cheyenne	Cheyenne Regional Medical Center=	1000-1999
Cheyenne	Wyoming Hospital Association	2000-2999
Cheyenne	UW Family Practice	3000-3999
Douglas	Memorial Hospital of Converse County	4000-4999
Laramie	Ivinson Memorial Hospital	5000-5999
Lusk	Niobrara Health & Life Center	6000-6999
Rawlins	Memorial Hospital of Carbon County	7000-7999
Torrington	Torrington Community Hospital	8000-8999
Wheatland	Platte County Memorial Hospital	9000-9999
Afton	Star Valley Medical Center=	10000-10999
Evanston	Wyoming State Hospital	11000-11999
Jackson	St. John’s Medical Center=	12000-12999
Kemmerer	South Lincoln Medical Center=	13000-13999
Rock Springs	Memorial Hospital of Sweetwater County=	14000-14999
Basin	South Big Horn County Hospital	15000-15999
Cody	West Park Hospital 16000-16999
Lovell	North Big Horn Hospital / Eastern= Montana Tele. Net.	17000-17999
Powell	Powell Valley 18000-18999
Riverton	Riverton Memorial Hospital= 19000-19999
Thermopolis	Hot Springs County<= /st1:PlaceType> Memorial Hospital 20000-20999
Worland	Washakie Medical Center 21000-21999
Buffalo Johnson County Healthcare= Center=	22000-22999
Casper Wyoming Medical Center	23000-23999
Casper Wyoming Behavioral Institute	24000-24999
Gillette	Campbell County Memorial Hospital	25000-25999
Newcastle Weston County Health Services	26000-26999
Sheridan Sheridan Memorial Hospital=	27000-27999
Sundance	Crook County Medical Services District	28000-28999

System Configuration for H.323 Desktop Video Conferencing

Desktop video sessions use the CMA Desktop application= or Polycom PVX application. Thes= e applications allow for H.323 video conferences to occur using a web cam, instead of a ro= om based application. This appli= cation is only available for video conferencing at hospitals or clinics. Desktop Video Conferencing is not allowed from any other location at this time for telehealth use. To date, SIP based video conferenc= ing is not supported.

POLICY:

The CMA Desktop contains 300 licenses. In order for outside entities to use a CMA Desktop license, the CRMC video network administrator will need to know the name, address, phone, and email of the individual who would like to use it. The video network administrator wi= ll create a username and password for the individual. This will be documented and purged = on an annual basis each June. This information is used to create an Annex O registration in the CMA.

PROCEDURE:

- = The following is the configuration for a CMA Desktop installation:

<= span style=3D'mso-list:Ignore'>o&nb= sp; Registration to: CRMC’s external Video Border= Proxy STCRMC External Border Proxy: 65.121.101.124

<= span style=3D'mso-list:Ignore'>o&nb= sp; The same firewall ports will be necessary for desktop video conferencing as room based video conferencing systems. Please refer to Appendix A for an overview of common video conferencing ports used.

<= span style=3D'mso-list:Ignore'>o&nb= sp; Duplex and Link set to 100 Full

<= span style=3D'mso-list:Ignore'>o&nb= sp; SNMP community is set to: wythealth

<= span style=3D'mso-list:Ignore'>o&nb= sp; Qos is set for Diffserv: Audio: 46, Video: 34, Data and Signaling: 26

<= span style=3D'mso-list:Ignore'>o&nb= sp; Username and Password is created by the video conferencing administer on the CMA 4000 Server and will be provided to the = end user.

- = Annex O Naming Scheme:

<= span style=3D'mso-list:Ignore'>o&nb= sp; CMA Desktop Installation: the phone extension of the user

<= span style=3D'mso-list:Ignore'>o&nb= sp; In the event of a duplication, add a 1 or successive number to the end of the extension

Video Network

Video Network Consideration

The minimum network requirements for video conferencin= g at each hospital or clinic:

· Minimum bandwidth dedicated to basic video conferencing: 384k

· This number is the minimum, per video conferencing unit, that should be implemented for basic video conferencing which is defined as “people talking with possible H.239 graphics sharing”.

· Minimum bandwidth dedicated to advanced video conferencing: at or above 2 Mbps

· This number is the minimum, per video conferencing unit, that should be implemented for advanced video conferenci= ng which is defined as “high definition video of people talking with possible H.239 graphics sharing and advanced peripherals needed for special= ty practice”.

· Managed Switch at the video conferencing segments – Layer 3 aware

· Duplex and Link set to 100 Full

· SNMP community is set to: wythealth

· Qos is set for Diffserv: Audio: 46, Video: 34, Data and Signaling: 26

Gatekeeper Functionality

For gatekeeper the ITU-T H.460.17, H.460.18, and H.46= 0.19 protocol standards should be adopted for telehealth video conferencing in Wyoming.

H.225 for RAS and Registration
Q.931 for setup and connection
H.245 for negotiated media channe= l
H.323 Firewall / NAT Traversal
H.323 / ALG aware Firewall

Video Conference Calling

POLICY:

- &nb= sp; Point to po= int calls are accepted and encouraged. Point to point calls can be made within the network or with outside entities. Point to point calls within the network may be made by Annex O dialing by using the alias, or ma= y be made with the IP address. Video units which contain a Multi-Point feature m= ay place point to point calls with up to 4 entities at one time (license permitting on that specific video unit).&n= bsp; However, in most cases if more than 2 video units would like to be i= nvolved in a video call the bridge will need to be scheduled to launch the call to = all participants.

- &nb= sp; Bridging ca= lls are accepted and encouraged. Bridging is ideal when more than 2 participants would like to be involved in a video call.

- &nb= sp; =

- &nb= sp; The bridge = is a Polycom MGC-50:

§ Standard Video:

· = 96 ports fo= r 128k and 256k

· = 48 ports fo= r 384k and 512k

· = 24 ports fo= r 768k and 1152k

· = 12 ports fo= r T1

§ Standard Video with Continuous Presence:

· = 96 ports fo= r 128k and 256k

· = 48 ports fo= r 384k and 512k

· = 24 ports fo= r 768k and 1152k

· = 12 ports fo= r T1

§ Standard Video with Encryption:

· = 48 ports fo= r 128k

· = 36 ports fo= r 256k

· = 24 ports fo= r 384k

· = 18 ports fo= r 512k

· = 12 ports fo= r 768k

· = 9 ports 115= 2k

· = 6 ports for= T1

o&nb= sp; The bridge may also contact video u= nits within the network or with outside entities. The bridge may dial video endpoints using Annex O dialing or IP address. In some cases the bridge may need to cascade with another bridge at = an outside entity due to the nature of the outside entity network configuration. Cascading is n= ot recommended, but may provide a connection method when direct contact with a video endpoint is not possible.

PROCEDURE:

o&nb= sp; All Telehea= lth Bridged calls are scheduled with the following technology guideline:

§ Bridge will dial outbound to all locations 15 mi= nutes prior to event start time

§ Call speed: 384k

§ Network Layout: Standard, Voice Switched (unless requested otherwise)

§ FECC (far-end camera control on)

§ H.239 Graphics set to On

§ AES Encryption set to On

§ Auto Video compression (to accommodate current a= nd legacy video equipment)

§ Auto Audio compression (to accommodate current a= nd legacy video equipment)

§ The organizer of the video event should also spe= cify date, start and end times, lecture mode, continuous presence, or recurrence= of event. Speak to the person in charge of scheduling to learn how.

Appendix A

Well Known Port Numbers Used in Videoconferen= cing

AVI Systems, Inc.

Please note: this listing is a basic list of ports used for H.323 video conferencing. However, some m= akes, models, and codec software versions may require specific ports not listed here. In addition, registering video conferencing codecs to video conferencing infrastructure may require additional ports or configurations based on network design. Please refer to the latest whitepa= per for your specific make and model of video conferencing equipment.

Port	Type	Protocol	Application	Manufacturer
21	Static	TCP	File Transfer Protocol for endpoint software upgrades (must = be bi-directional)	Polycom and Tandberg
23	Static	TCP & UDP	Telnet (must be bi-directional)	Polycom, Sony, Tandberg
80	Static	TCP	Hypertext Transfer Protocol (HTTP) – web browser inter= face for codec control and menus	Polycom, Sony, Tandberg
161	Static	UDP	Simple Network Management Protocol (SNMP) Queries=	Tandberg
389	Static	TCP	Lightweight Directory Access Protocol (LDAP) – ILS registration	Polycom
962	Static	UDP	Simple Network Management Protocol (SNMP) Traps	Tandberg
963	Static	TCP	This port is not assigned, but Tandberg uses it for Netlog	Tandberg
964	Static	TCP	This port is not assigned, but Tandberg uses it for FTP/data=	Tandberg
965	Static	TCP	This port is not assigned, but Tandberg uses it for VNC	Tandberg
970	Static	UDP	This port is not assigned, but Tandberg uses it for Real-time Transport Protocol (RTP) for streaming video	Tandberg
971	Static	UDP	This port is not assigned, but Tandberg uses it for Real-time Transport Control Protocol (RTCP) for streaming video	Tandberg
972	Static	UDP	This port is not assigned, but Tandberg uses it for Real-time Transport Protocol (RTP) for streaming audio	Tandberg
973	Static	UDP	This port is not assigned, but Tandberg uses it for Real-time Transport Control Protocol (RTCP) for streaming audio	Tandberg
974	Static	UDP	This port is not assigned, but Tandberg uses it for SAP	Tandberg
1002	Static	UDP	This port is not assigned, but Vcon uses it for Lightweight Directory Access Protocol (LDAP) – ILS registration	Vcon

Range

Type

Protocol

Application

Manufacturer

1300

Static

TCP & UDP

This port is registered to Intel and is used to secure a H.3= 23 host call – h 323hostcsllsc (must be bi-directional)

Polycom

1503

Static

TCP

This port is registered to Databeam and is used for T.120 fi= le sharing

Polycom, Sony, Tandberg and Vcon

1718

Static

TCP & UDP

This port is registered to Intel and is used to secure a H.3= 23 host call – h 323gatedisc (must be bi-directional)

Polycom, Sony, and Vcon

1719

Static

TCP & UDP

This port is registered to Intel and is used foe gatekeeper = RAS – h 323gatestat (must be bi-directional)

Polycom, Sony, Tandberg and Vcon

1720

Static

TCP & UDP

This port is registered to Intel and is used to establish a H.323 host call using Q.931 call setup – h 323hostcall (must be bi-directional)

Polycom, Sony, Tandberg and Vcon

1731

Static

TCP & UDP

Audio call control –msiccp – for VoIP=

Polycom

1024 – 65535

Vcon

1024 – 65535

2253 – 2255

Dynamic

Sony uses an available port in this range for the exchange of H.245 call parameters. (Also known as RTCP)

Sony

2326 – 2373

Dynamic

UDP

Tandberg uses an available port in this range for video data streams

Tandberg

2326 – 2373

Dynamic

UDP

Tandberg uses an available port in this range for audio data streams

Tandberg

2326 – 2373

Dynamic

UDP

Tandberg uses an available port in this range for data trans= fers and Far End Camera Control – FECC

Tandberg

2979

Static

TCP & UDP

This port is registered to ACM for H.263 Video Streaming

Polycom

3230 – 3247

Dynamic

UDP

Polycom uses an available ports in this range for audio and video

Polycom

3230 – 3235

Dynamic

UDP

Polycom uses an available port in this range for the exchang= e of H.245 call parameters. (Also known as RTCP)

Polycom

5004 – 6004

Dynamic

TCP

There is no registered port for this application, Vcon uses = an available port for H.245 (Call Parameters)

Vcon

5004 – 6004

Dynamic

UDP

There is no registered port for this application, Vcon uses = an available port for Real-time Transport Protocol (RTP) for streaming video= .

Vcon

5004 – 6004

Dynamic

UDP

There is no registered port for this application, Vcon uses = an available port for Real-time Transport Protocol (RTP) for streaming audio.

Vcon

5004 – 6004

Dynamic

UDP

There is no registered port for this application, Vcon uses = an available port for Real-time Transport Control Protocol (RTCP) for stream= ing video and audio.

Vcon

5555-5556

Dynamic

TCP

Q.931 Call setup

Tandberg

11720

Static

TCP & UDP

This port is registered to Cisco and is used as an alternati= ve for call set-up – h 323hostcallsigalt (must be bi-directional)

Polycom

22136

Static

TCP

There is no registered port for this application, Vcon uses = an available port for remote Vcon endpoint administration

Vcon

26505

Static

TCP

There is no registered port for this application, Vcon uses = an available port for Remote Console

Vcon

Range

Type

Protocol

Application

Man.

49152 – 49159

Dynamic

UDP

Sony uses this range of ports for audio and video data strea= ms

Sony

49152 – 49239

Dynamic

UDP

Sony uses this range of ports for multipoint

Sony

= ;

PORT

TYPE

PROTOCOL

DESCRIPTION

= 224.0.1.41:1718

= Static

= TCP & UDP

= h323gatedisc (must be bi-directional)

= 1719

= Static

= TCP & UDP

= h323gatestat Gatekeeper RAS (must be bi-directional)

= 1720

= Static

= TCP & UDP

= h323hostcall Q.931 (Call Setup) (must be bi-directional)

= 1731

= Static

= TCP & UDP

msiccp Audio Call Control (VoIP)

= 3230 – 3247

= Dynamic

= UDP

= Audio and Video (must be bidirectional)

= 3230 – 3235

= Dynamic

= TCP

H.245 call control: aka RTCP (must be bidirectional)

Other:

PORT

TYPE

PROTOCOL

DESCRIPTION

21

= Static

= TCP

FTP allows upgrade of endpoint software (must be bidirectional)

= 23

= Static

= TCP

= Telnet (must be bidirectional)

= 80

= Static

= TCP

Web browser interface to codec controls and menus

= 389

= Static

= TCP

ILS Registration (LDAP)

= 1300

= Static

= TCP & UDP

= h323hostcsllsc H323 Host Call Secure

= 1503

= Static

= TCP & UDP

= T.120 (Data Channel in a multipoint)

= 2979

= Static

= TCP & UDP

= H.263 Video Streaming

= 11720

= Static

= TCP & UDP

= h323callsigalt H.323 Call Signal Alternate

PORT

TYPE

PROTOCOL

DESCRIPTION

= 1718

= Static

= TCP

= h323gatedisc (must be bi-directional)

= 1719

= Static

= TCP

= h323gatestat

= 1720

= Static

= TCP

= H323hostcall

= 2253 – 2255

= Dynamic

= TCP

= H.245(Call Parameters)

= 49152- 49159

= Dynamic

= UDP (RTP/RTCP)

= Audio & Video Data Streams

= 49152 – 49239

= Dynamic

= UDP

= Multipoint

PORT

TYPE

PROTOCOL

DESCRIPTION

= 1719

= Static

= UDP

= Gatekeeper RAS

= 1720

= Static

= TCP

= Q.931 (Call Setup)

= 5555 – 5556

= Dynamic

= TCP

= H.245(Call Parameters)

= 2326- 2373

= Dynamic

= UDP

= Video Data Streams

= 2326- 2373

= Dynamic

= UDP

= Audio Data Streams

= 2326- 2373

= Dynamic

= UDP

= Data/FECC

= 21

= Static

= TCP

= FTP

= 23

= Static

= TCP & UDP

= Telnet & NTP listening socket

= 80

= Static

= TCP

= HTTP

= 123

= Static

= UDP

= NTP

= 161

= Static

= UDP

= SNMP (Queries)

= 962

= Static

= UDP

= SNMP (Traps)

= 963

= Static

= TCP

= Netlog

= 964

= Static

= TCP

= FTP/data

= 965

= Static

= TCP

= VNC

= 970

= Static

= UDP

= Streaming/RTP Video

= 971

= Static

= UDP

= Streaming/RTCP Video

= 972

= Static

= UDP

= Streaming/RTP Audio

= 973

= Static

= UDP

= Streaming/RTCP Audio

= 974

= Static

= UDP

= SAP (Stream is directed to 224.2.127.254:9875)

PORT

TYPE

PROTOCOL

DESCRIPTION

= 1718

= Static

= UDP

= h323gatedisc (must be bi-directional)

= 1719

= Static

= UDP

= Gatekeeper RAS

= 1720

= Static

= TCP

= Q.931 (Call Setup)

= 5004 – 6004

= Dynamic

= TCP

= H.245(Call Parameters)

= 5004 – 6004

= Dynamic

= UDP (RTP)

= Video Data Streams

= 5004 – 6004

= Dynamic

= UDP (RTP)

= Audio Data Streams

= 5004 – 6004

= Dynamic

= UDP (RTCP)

= Control Information

Optional:

PORT

TYPE

PROTOCOL

DESCRIPTION

= 389

= Static

= TCP

= ILS Registration (LDAP)

= 1002

= Static

= TCP

= Site Server Registration (Windows 2000 Built-in LDAP)

= 1503

= Static

= TCP

= T.120 (Data Channel)

= 22136

= Static

= TCP

= VCON MXM – Remote VCON Endpoint Admin

= 26505

= Static

= TCP

= VCON MXM – Remote Console

Appendix B

Polycom CMA and Polycom PVX System Requiremen= ts

The two white papers are provided from Polycom and were retrieved May 19, 2010.

Please refer to the Polycom website for the most curre= nt documentation.

Web cam recommendations may become outdated. Therefore a make and model will no= t be specified in this document. Today’s technology allows for better web conferencing with advances in web cam manufacturing. To obtain the best experience it is recommended to avoid using a web= cam older than 5 years old.

Range	Type	Protocol	Application	Manufacturer
1300	Static	TCP & UDP	This port is registered to Intel and is used to secure a H.3= 23 host call – h 323hostcsllsc (must be bi-directional)	Polycom
1503	Static	TCP	This port is registered to Databeam and is used for T.120 fi= le sharing	Polycom, Sony, Tandberg and Vcon
1718	Static	TCP & UDP	This port is registered to Intel and is used to secure a H.3= 23 host call – h 323gatedisc (must be bi-directional)	Polycom, Sony, and Vcon
1719	Static	TCP & UDP	This port is registered to Intel and is used foe gatekeeper = RAS – h 323gatestat (must be bi-directional)	Polycom, Sony, Tandberg and Vcon
1720	Static	TCP & UDP	This port is registered to Intel and is used to establish a H.323 host call using Q.931 call setup – h 323hostcall (must be bi-directional)	Polycom, Sony, Tandberg and Vcon
1731	Static	TCP & UDP	Audio call control –msiccp – for VoIP=	Polycom
1024 – 65535				Vcon
1024 – 65535
2253 – 2255	Dynamic		Sony uses an available port in this range for the exchange of H.245 call parameters. (Also known as RTCP)	Sony
2326 – 2373	Dynamic	UDP	Tandberg uses an available port in this range for video data streams	Tandberg
2326 – 2373	Dynamic	UDP	Tandberg uses an available port in this range for audio data streams	Tandberg
2326 – 2373	Dynamic	UDP	Tandberg uses an available port in this range for data trans= fers and Far End Camera Control – FECC	Tandberg
2979	Static	TCP & UDP	This port is registered to ACM for H.263 Video Streaming	Polycom
3230 – 3247	Dynamic	UDP	Polycom uses an available ports in this range for audio and video	Polycom
3230 – 3235	Dynamic	UDP	Polycom uses an available port in this range for the exchang= e of H.245 call parameters. (Also known as RTCP)	Polycom
5004 – 6004	Dynamic	TCP	There is no registered port for this application, Vcon uses = an available port for H.245 (Call Parameters)	Vcon
5004 – 6004	Dynamic	UDP	There is no registered port for this application, Vcon uses = an available port for Real-time Transport Protocol (RTP) for streaming video= .	Vcon
5004 – 6004	Dynamic	UDP	There is no registered port for this application, Vcon uses = an available port for Real-time Transport Protocol (RTP) for streaming audio.	Vcon
5004 – 6004	Dynamic	UDP	There is no registered port for this application, Vcon uses = an available port for Real-time Transport Control Protocol (RTCP) for stream= ing video and audio.	Vcon
5555-5556	Dynamic	TCP	Q.931 Call setup	Tandberg
11720	Static	TCP & UDP	This port is registered to Cisco and is used as an alternati= ve for call set-up – h 323hostcallsigalt (must be bi-directional)	Polycom
22136	Static	TCP	There is no registered port for this application, Vcon uses = an available port for remote Vcon endpoint administration	Vcon
26505	Static	TCP	There is no registered port for this application, Vcon uses = an available port for Remote Console	Vcon