Network Requirements

Provider Access User Authentication

Users launch the Provider Access Software from their desktops and login to begin consults. Users have a unique username and password for their Provider Access accounts, which is created at registration.

Enterprise login allows users to use their company credentials to login to the Provider Access Software. If your system is configured to use Enterprise login, your system may automatically login to the Provider Access Software.

Users should make sure to comply to HIPAA standards by ensuring that they log off when away from their computers for extended periods of time. Users must log into Provider Access Software using their Teladoc Health username and password. After a period of inactivity, users are logged out automatically as a security feature.

Firewall Requirements

The Teladoc Health Telehealth System uses bidirectional communication under TCP and/or UDP. The Teladoc Health Telehealth Network consists of connections made through either our SharedComm or SIP servers. For optimal connections using SharedComm, Patient Access Devices and Provider Access Software require outgoing UDP access on ports 9000-9101 with reflexive UDP access (‘UDP Replies’) enabled. (Note: UDP replies are enabled by default on most firewalls). For optimal connections using SIP, Patient Access Devices and Provider Access Software require outgoing UDP access on ports 35000-35500 with reflexive UDP access (‘UDP Replies’) enabled.

For training and support purposes (including software upgrades), Teladoc Health routinely makes use of remote desktop applications (Kaseya, GoToAssist & GoToMyPC). Teladoc Health requires access to all Patient Access Devices and Provider Access Software via one of these applications.

For a detailed list of IP addresses and ports to white list, please refer to the document: Network Configuration for Teladoc Health Devices (MB-15513). Additional modifications may be necessary for use with a Web Filter and/or Stateful Packet Inspection.

Video Information

Frame rate: Video is captured at 30 frames per second but can be reduced for low bandwidth connections.

Codec (video and audio compression): Teladoc Health uses the standards-based H.264 AVC codec for video and the Opus or Speex codec for audio.

Dynamic Video Quality provides the ability to dynamically adjust resolution and video quality during a live session without user interaction. Advanced users can specify preferences for adjusting resolution. Video quality depends on factors such as robot motion, available bandwidth, and user preference.

Bandwidth Requirements

The ideal bandwidth required is 700 kbps in both directions from any Provider Access Software or Patient Access Device. For Provider Access Software located in homes, lower bandwidths such as home cable broadband can be configured with good performance effectively utilizing 300 kbps. For installations where higher audio and video quality is desired, higher bandwidths above 700 kbps can be allocated.

For HD video, your Provider Access Device must be configured to allow 2000-3000 kbps.

Line Quality Requirements

Network performance is critical to maintaining a responsive Provider Access Software to Patient Access Device session. Metrics cover a range of network characteristics which impact delivery of complete correct data in the proper order in a timely fashion. Teladoc Health runs tests using proprietary and third party software tools to determine if a broadband connection meets a sufficient level of network performance to maintain a session. Teladoc Health can provide these tools to customers upon request.

NOTE: During any particular session, quality may be degraded or the session may be disconnected if the network performance limits described below are exceeded, even though performance measurements were within limits at another point in time.

There are five important network characteristics affecting connectivity:

Data rate: A connection must have the required up-stream and downstream bandwidth, as discussed above.

Latency (delay): Average network latency on a connection should not exceed 300ms.

Maximum Transfer Unit: The Maximum Transfer Unit (MTU) must not be set below 1400 bytes.

Reliability: A connection must be reliable, without significant packet loss. A connection should experience no more than 3% packet loss.

Jitter: Jitter is variability in latency. Jitter on a connection should not exceed +/- 50ms during 95% of the duration of a session.

NOTE: Teladoc Health's software is fully capable of dealing with the normal variability of data over the Internet. It is the quality of the endpoint connections which is critical and must be tested.

Wireless Network Requirements

The Teladoc Health System is compatible with 802.11 ac, a, b, g, and n protocols. The Maximum Handoff Threshold time must be less than 150ms.

In environments which experience network congestion, the Teladoc Health application requires Quality of Service (QoS) or priority of traffic to ensure a successful connection.

Satellite Networks

The network characteristics detailed above (bandwidth requirements, packet loss, jitter, and MTU) are strongly recommended to achieve an audio/video session of functional quality over a satellite network. The one notable exception is the expected latency typical of satellite networks.

The Teladoc Health System can maintain an audio/video session of functional quality with latency up to 900 ms if all other network characteristics are met. Please note that this delay will be evident on both sides of any audio/video/command communication as is typical of satellite net-works.

If utilizing a satellite network with latency above 600 ms, the delay in drive commands may hinder the operator from maintaining safe control over the movement of mobile devices. Teladoc Health therefore does not recommend utilizing mobile devices, such as the Teladoc Health 7i, on a satellite net-work.

Encryption

The Teladoc Health System incorporates encryption methodology utilizing a combination of RSA public/private key and 256-bit AES symmetric cryptography. The following is a brief summary:

Each time a Provider Access session is initiated, a symmetric key is created using AES 256-bit cryptography. The encrypted data is then transmitted using RSA 4096-bit public-private key cryptography. PHI and other sensitive health information is further secured using SSL/TLS and other different forms of authentication.

Virus Protection

TrendMicro’s OfficeScan is installed on every system. This software automatically updates as soon as new virus definitions are available. Teladoc Health staff monitor software updates as they be-come available. Teladoc Health staff install all necessary security updates on Patient Access De-vices.