Web Real-Time Communication (or WebRTC) is an open source project released by Google in 2011. WebRTC enables video conferencing directly through popular web browsers, without the need for users to install additional software. In theory, there are many compelling applications for this — imagine having the ability to join a live video conference instantly, from any website.
Health care providers and systems adopting telehealth/telemedicine have flocked to WebRTC-based solutions over the past few years, citing accessibility, security, and ease of use. Those attributes are ideal for the adoption of WebRTC in health care, because telehealth patients range widely in terms of age and comfort level with technology, while hospitals and clinics impose strong restrictions on software installation.
OnCall Health hosts hundreds of healthcare consultations and online psychotherapy sessions each month through our custom WebRTC implementation. As a SaaS Telehealth platform, our number one priority will always be providing a reliable and secure video conferencing experience. After a year of relying on WebRTC, we have decided to transition to a primarily native desktop and mobile experience. Here is why we are making this decision, and why we believe WebRTC is not ready for clinical use (yet):
On paper, WebRTC has about a third of the bandwidth requirements of native desktop applications. In other words, users with poor internet connectivity should be more likely to have a reliable live video session on WebRTC than on a native application.
In reality, browser users tend to have multiple tabs open at once. Most browsers allocate the bandwidth between those tabs equally, while certain sites demand even more bandwidth than others (e.g. Facebook, Netflix). As a result, video conferencing reliability in browsers can be extremely variable if a user has multiple tabs open.
WebRTC is only compatible with Chrome, Firefox, and Opera web browsers. It’s easy to forget that 40% of all browser use is not on Chrome. Expecting users to download a compatible browser is not an accessible user experience, and can cause further confusion if their default browser remains set to Safari, for example. Unfortunately, it appears as though there are no plans for Safari or Internet Explorer browsers to support WebRTC in the foreseeable future.
After thousands of clinical uses, we found that WebRTC is only truly reliable when all parties in a video conferencing session are using an up-to-date version of Chrome. Browser updates are also an issue, as WebRTC will occasionally fail to function without warning if a user does not have an up-to-date browser.
All browsers also handle web camera and microphone permissions differently. Some users’ browser settings are such that they will automatically deny or never see a request for a browser to access their webcam and microphone. Many of our support tickets over the past year were related to assisting users in changing their permissions settings.
Why desktop is better
Bringing the video conferencing experience into a native application makes a big difference. With a desktop app:
- We have greater control over bandwidth allocation, resulting in a higher quality video stream every time.
- OnCall is now accessible from any web browser and browser updates are not required. Users simply download the desktop application one time and it will launch automatically for all video calls.
- Webcam and microphone permissions are set automatically in the desktop application. Users no longer need to go into their settings to turn on their webcam and microphone.
- New features such as screen sharing are also possible with a desktop application, while WebRTC does not support screen sharing without a plugin.
WebRTC will still be available as a backup in OnCall for Chrome users that want to get on a session immediately. Simply click “Join now via browser” when joining a call instead of launching the desktop app. However, we encourage all users to download our desktop application (available on PC and Mac) for a better experience. The OnCall support team is shifting its focus to making the process of downloading the desktop application simple and intuitive.
WebRTC has incredible potential in healthcare, but until it is reliably available across all browsers, it will be a lesser alternative to native applications. The team at OnCall is always looking for new and innovative approaches to accessible, secure virtual care, and we will continue to make state-of-the-art technology available to our users.
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