Telederm Troubleshooting

By on April 6, 2020

As telederm providers, it’s imperative to have excellent video and sound quality when online with patients. When we run into technical difficulties it often has us wondering: is the problem our internet, or our telemedicine platform?

With so many people working from home right now, our neighborhood and office broadband resources are under extreme burden. Reduced video quality is likely not a result of the number of users on a cloud-based telemedicine platform. It is more likely that others using your WiFi (in your home or office) or neighbors stuck at home watching Netflix and YouTube are burdening your internet service provider (ISP) with traffic.

Surging Traffic is Slowing Down our Internet

The New York Times, March 26, 2020


ISPs are known to throttle traffic during high congestion times. Bandwidth throttling is the intentional slowing or speeding of an internet service by an ISP to regulate network traffic and minimize congestion. It can impact a user’s upload and download rates on programs such as video and internet applications.

For the best patient-provider experience, you’ll need a consistent internet connection with at least 2MBPS download and upload speeds. You can check your network speed here.

If you suspect your ISP is throttling your traffic, contact your internet service provider and ask them to not throttle traffic to your cloud-based telemedicine application. They may give you special dispensation if you explain you are using it to provide a healthcare service. For a longer-term solution you may want to research a business internet server if that’s a service they provide.

If your internet speed is solid, there are a few more hardware and software recommendations for the best telemedicine results.

  • Use an ethernet cable -a physical network connection between your computer and internet router/modem (rather than wireless).
  • Make sure your Mac/PC/Linux/Chromebook is equipped with a camera, microphone and speakers.
  • Download the latest versions of your preferred search engine/browser, such as Google Chrome, Mozilla Firefox or Safari 11+.
  • Use the latest operating system for your computer (e.g. Windows 10 or MacOS Catalina.)
  • A newer computer with plenty of speed will yield the best results. Sending and receiving video takes a lot of computer power. Old or slow computers will have a harder time processing the video, which can cause choppiness.
  • Use headphones. Typically your computer will automatically eliminate echo or audio feedback so you don’t hear yourself talking. But if it happens, have the participant and yourself use headphones.
  • Close other programs that may be interfering with speed, sound or video.
  • Estimate call quality to predict your expected call quality based on your computer and internet speeds. If you are receiving high scores, then the quality issue is likely with your patient’s computer/ISP. Ask them to run the same test.
  • Run an internet speed test to determine your connection speed. Both you and your participant need 500kb/s download and upload speeds to have a good call.
  • Perform a network stability test to determine the stability of your network. If you get “Network Appears Unstable”, then your router or internet service provider (e.g. Comcast) is mostly likely the cause of your quality issues.
  • The old standby: Restart your computer.

Our providers are using Doxy.me for telemedicine. We’ve found these other hints and diagnostic tests to be helpful, specific to that platform.

  • Visit the Doxy.me status page to see if there is a known issue that they are working on.
  • Read article about how to improve your internet speeds at home.
  • Use doxybot pre-call test to make sure your speakers and camera are all setup and working.

In general, network speed or stability should be discussed with your ISP, who can recommend solutions available to you. Old or slow computers may need to be replaced for best results and to be able to run the latest systems and software. Your telemedicine platform should have on-call support and, as always, knowledge shared among colleagues is especially powerful!