Professional, welcoming experiences where doctor bedside manners and physical presence can be conveyed through the internet. This results in a trust relationship between patients and clinicians that are physically apart.

Video experience: Provider face should be in the center of the screen and filling ½ of it. It is recommended that doctors wear a white coat and use a virtual background with their credentials.

Recommended equipment:

Computer or laptop (15” minimum screen size)
Zoom client installed (recommended version: 5.12.9)
Two 27” monitors: recommended if provider has to use EMR/EHR systems
Over the ear headphones for remote auscultation (stethoscope)
HD External camera: installed on top of monitor or separate stand
Connectivity bandwidth: 2Mbps minimum (10Mbps recommended)
Virtual Background: org. name, logo, provider name and credentials

GALE Call Center

19Labs’ GALE platform for providers includes access to a Call Center that enables clinicians to manage their accounts and begin telehealth visits with remote patients. Also, through the use of Insights, providers are able to work along with on-site doctors, nurses, technicians, and community workers to view, control and export patient data. The combination of the Call Center and Insights patient portal ensures providers have a complete clinic experience.

To answer calls, you will log into, and monitor, the 19Labs Call Center. To do so, open a new browser tab and go to https://cc.19labs.com.

To log in: enter the credentials you chose or given to you by your administrator.

You may want to bookmark this site for quick and easy access in the future.

For more information, see the Call Center video on the 19Labs’ Support page.

Managing Your Account

Once you have successfully logged in, you can complete your account setup.

Manage your account by clicking on your name and selecting “Account Profile” from the drop down menu.

Here you can edit your name, professional details and upload images for the prescriptions/instructions feature.

Enabling Notifications

Ensure you are notified for calls assigned to you by completing the Notification section on your account profile.

Once logged in, click on your name and select “Account Profile” from the drop-down menu on the top right. Scroll down and fill out the fields to receive notifications as shown below.

Click Save on the top bar after you complete the form with your email or phone number.

For more information, see the Provider Profile video on the 19Labs’ Support page.

You may opt out of notifications at any time by deselecting the notification method and clicking Save.

Click here to view the messaging privacy policy and terms and conditions.

Pre Visit Info & Chat

Review personal and clinical information filled by the patient or operator during the intake prior to the visit, including medical conditions, allergies, and medications by clicking Pre Visit once an incoming call appears on the Call Center.

Use the Chat box on the right side of the screen to communicate with the patient or the operator prior to joining the call.

Providers use the chat feature to request more information or to simply advise regarding availability and waiting time. Once you join the video call, the chat feature is no longer available. To communicate via text with the patient or operator, use the chat on your Zoom application.

Joining a Video Call

You must have the Zoom application installed on your computer or smartphone. For desktop applications, click here. To get the Zoom app for your smartphone, click here (Android devices) or here (Apple/iPhone).

When you are ready to join an incoming call, simply click Join to open Zoom on your computer or smartphone.

For better visualization, select ‘speaker view’ on Zoom. For more on Zoom go to the section on page 15.

Using Insights

Insights allows you to view, control, and export patient data and measurements for a complete video visit. You can also write visit notes, and write and send prescriptions to the patient. There are two ways to join Insights.

The first is through the Zoom chat. At the bottom of your zoom video screen, click on the chat icon to expose the chat window.

Click on the link provided and Insights will open in your internet browser.

The other way to join Insights is through the 19Labs Call Center. Click on the View Insights button on the left side, inline with the appropriate call.

Note: if you need to write a prescription, you must join Insights from the Call Center (and not from Zoom).

Upon entering Insights you will be greeted with the Patient Summary page. If the patient has filled out details about themselves, they will be displayed in the corresponding panels. Any measurements taken before the visit will appear below the patient details.

To save a summary of the visit details, navigate back to the Patient Summary page. If you would like to add additional details about the patient, or notes about the visit, use the “Provider Notes” field at the top of the page prior to exporting.

Click Export Summary on the top right corner to download or share the visit summary.

Note: The PDF file must be stored in compliance with HIPAA regulations. Once the GALE user has ended the call and ended their session, you will have 20 minutes to export the summary before the data is no longer available.

For more information, see the Insights video on the 19Labs’ Support page.

Troubleshooting Stethoscope Auscultation

If you are having problems listening to the stethoscope sounds, try the following steps.

If the stethoscope is too quiet

Use headphones: To ensure you can hear the low frequencies captured by the stethoscope, ensure you are using a good pair of headphones. Laptop and computer speakers do not have the correct frequency response to recreate these signals.
Turn off reduced volumes during conferencing: By default, Windows PC’s reduce all other media volumes by 80% during a conference call such as zoom. To turn this feature off and better hear the stethoscope:
1. Open Sound from the windows control panel or by right clicking on the speaker icon in the taskbar and selecting Sounds.
2. Select Sound Control Panel
3. Click on the Communications tab
4. Select the option Do nothing
5. Click OK.

Adjust volume using Insights Volume Control: Use Insights built in Volume Control to boost the volume in the browser.

Adjust Insights Sensitivity Control: There is a built-in sensitivity control on Insights allowing you to control the Gain of stethoscope. Change the sensitivity between Low and High to produce the best sounding signal (available in the 1.15 Release [March 2022]).
1. LOW: Use when the signal is very loud and distorted / Clipping. Example patient has a very loud heartbeat after exercising.
2. MEDIUM: The default value set.
3. HIGH: Use when the signal is very quiet and increasing the audio level is still not loud enough.

Install a volume booster extension: If after steps 1 and 2 the stethoscope is still too quiet, install a volume booster extension to Google Chrome. Once installed, pin the extension for easy access. Click on the extension button next to the search bar and click the pin icon for the volume booster app. Click on the volume booster icon while using the stethoscope to increase its volume.

Note: Boosting volume too high may introduce unwanted distortion into the signal.

If there is no stethoscope audio at all

If the sensor status says live streaming audio but nothing is heard from Insights, try the following.

Unmute the Stethoscope: If there is a speaker icon on the insights tab but no audio is heard, ensure the stethoscope is not muted. Try toggling a few times if issues persist.

A muted stethoscope looks like this.

An unmuted stethoscope looks like this.

Google Chrome user gesture required: Due to changes in Google Chrome's autoplay policy, some interruptions may be experienced while trying to live stream audio from the stethoscope.
1. Resolution: Google chrome’s autoplay policy now requires a user gesture in order for webpages to play sound. To combat this issue, 19Labs resumes the live stream of the Stethoscope when the insights user presses on the stethoscope tab.If the stethoscope is connected and the status says Live streaming and no audio is heard, try pressing the stethoscope tab once more to resume the audio context or try Refreshing the page.

For more details on Google Chrome’s autoplay policy, click here.

Try using a different browser: If you still cannot hear the stethoscope, try using a different browser such as Firefox as default.
1. Download and install Firefox
2. Change your computer's default browser to Firefox through Computer settings -> Default Apps.
3. Reopen the insights link with Firefox and confirm the stethoscope is heard correctly.
4. Note: It is not recommended to use Internet Explorer for viewing Insights.

Zoom Experience

19Labs’ GALE solution integrates Zoom for Healthcare as its video conferencing platform. In provisioning and operating the Zoom HIPAA Services, Zoom complies with the provisions of the HIPAA Security Rule that are required and applicable to it in its capacity as a business associate. For a better experience, see the following sections.

Recommended setup with a green screen

Virtual Background with a green screen provides the best virtual background effect and uses less system resources during the meeting. This method requires you have a solid-colored screen, curtain, or wall behind you, which Zoom will replace the selected color with the image or video you selected. This method improves the sharpness and definition of the virtual background effect around your face, head, ears, and hair.

For best results:

Use a very bright and distinct color, such as a green or blue screen. The contrast in colors makes it easier to distinguish you in the foreground from the bright background. Recommended physical green screens from Webaround or Amazon.
Higher quality cameras result in a better virtual background. See camera recommendations for details.
Use uniform lighting and color.
Do not wear clothing that is the same color as the virtual background.

Recommended setup without a green screen

Virtual Background without a green screen provides the same effect as when using a green screen, only with less sharpness and definition around your face, head, ears, and hair. This is because without a solid, contrasting color behind you, the system is less likely to accurately distinguish you in the foreground from the background. This method requires more system resources, so it has higher system requirements.

For best results:

Higher quality cameras result in a better virtual background. See camera recommendations for details.
Use uniform lighting and color.
Make sure not only your face is illuminated, but also some of your background as well, as the contrast can help distinguish you from the background.

Video and image specifications

Background image dimensions

There are no size restrictions when adding your own virtual backgrounds, but we recommend cropping the image to match the aspect ratio of your camera before uploading it.
For example, if your camera is set to 16:9, an image of 1280 by 720 pixels or 1920 by 1080 pixels, both being the same 16:9 ratio, would work well.
24-bit PNG or JPG/JPEG image format
If you're not sure about your camera aspect ratio, use a background image with a minimum resolution of 1280 by 720 pixels.
Browse some of the virtual backgrounds Zoom has collected, or use these sources for other royalty-free images: Pexels, Unsplash, Pixabay.

Background video

A MP4 or MOV video file
Minimum resolution of 480 by 360 pixels (360p) and a maximum resolution of 1920 by 1080 pixels (1080p).

How to enable Virtual Background

There are a few ways to get started with Virtual Background features. You can enable virtual backgrounds during video conferencing on the account, group, and individual user level.

Note: Users must sign out of the Zoom desktop client and sign back in for Virtual Backgrounds to take effect.

To enable the Virtual Background feature for your own use:

Sign in to the Zoom web portal.
In the navigation menu, click Settings.
In the Meeting tab, navigate to the Virtual Background option (under the In Meeting (Advanced) section) and verify that the setting is enabled.
Notes:
- If the setting is disabled, click the status toggle to enable it. If a verification dialog displays, choose Turn On to verify the change.
- If the option is grayed out, it has been locked at either the group or account level, and you will need to contact your Zoom administrator.

How to apply a Virtual Background

Changing the Virtual Background on desktop

Sign in to the Zoom desktop client.
Click your profile picture, then click Settings.
Select Backgrounds & Filters .
Note: If you do not have the Virtual Background tab and you have enabled it on the web portal, sign out of the Zoom desktop client and sign in again.
Check “I have a green screen” if you have a physical green screen set up. You can then click on your video to select the correct color for the green screen.
Click on an image or video to select the desired virtual background.
(Optional) Add your own image by clicking and choosing if you want to upload an image or a video.
If prompted, click Download to download the package for virtual background without a green screen.

Notes:

To disable Virtual Background, open the virtual background options again and choose the option None.
Ensure that you are using a solid background color when “I have a green screen” is checked.
After you select an option, that virtual background will be used for your future meetings.
For more information about the Blur option, please refer to the Blurred background article.
If your account admin sets a default virtual background, they can also enable it to reset back to the default if you changed your virtual background during a meeting.

Speaker view

Speaker view must be enabled for the best experience with GALE and its recently launched InsightsAR. It means your video will be smaller at the top and the patient video will appear below.

The new patented GALE InsightsAR© simplifies the clinician experience by overlaying EMR data, vital signs, and pertinent patient information onto a single Zoom Meeting, eliminating the need for multiple applications and browser windows.

To switch to Speaker view, click View on the top right corner of the screen and select Speaker.

If for any reason the InsightsAR panels are blocking your view of the patient, ask the operator to turn this off (on the point-of-care unit, there is an icon on the top right corner labeled “Overlay” that turns the panels on and off).

Floating thumbnail window

The floating thumbnail window allows you to minimize the main Zoom window, but keep the video on top of other applications you have open like GALE Insights or an EMR system. You can move the window around your screen as needed, or hide the video entirely.

To switch to floating thumbnail view:

Click on the minimize icon, located at the top-right corner for Windows, or top-left corner for macOS.
Once in mini-window view, you can collapse the video by clicking on the arrow on the left side. Click the arrow again to expand the video thumbnail.
While in this mode, you can also easily mute/unmute yourself or turn on/off your video by clicking the and buttons respectively.
To close the floating thumbnail window and return to the full Zoom window click the arrow on the right side.

Inviting participants to join an ongoing Zoom call

Use Zoom’s invite feature to connect with other providers, specialists, language services and/or family members.

More about Inviting others to join a meeting on the Zoom Support website.

Start or join a meeting.
In the meeting controls, click Participants .
Click Invite at the bottom of the participants panel.
Choose from the following invite options:

(A) Contacts

Click the Contacts tab.
Select their name from the list or search for a contact.
Click on the individual you would like to invite. You can select multiple contacts.
After selecting contact(s), their name(s) will be highlighted in blue and they will appear in the list at the top of the window.
Click Invite in the lower right corner.
Selected participants will be immediately invited to the current meeting, which will appear on their desktop or mobile screen.

(B) Email

Click the Email tab.
Select an email provider:
1. Default Email: Invite others by using your default email application for your computer.
2. Gmail or Yahoo Mail: Invite others by using the Gmail or Yahoo website. You will be prompted to sign in to your account. Your email service will be opened, either as through your desktop mail application or through your default web browser.
3. Add recipients to the email and send it.

Note: A new email will be composed automatically with the meeting information in the email body.

If enabled by your administrator, you might call from Zoom directly to any phone number. Ask your administrator about this feature.

Click the Call Out tab.
Enter the name of the invitee. This will be used as their display name in the meeting.
Enter their phone number.
Review and enable the following options:
1. Require greeting before being connected
2. Require pressing 1 before being connected
Click Call to have Zoom call the provided number. When the invitee answers the phone, they will be connected to the meeting as an audio-only participant.

URL or invitation text

On any of the tabs so far, click Copy Invite Link or Copy Invitation if you want to send your instant meeting information elsewhere.

Copy Invite Link: Copy the meeting join link.
Copy Invitation: Copy the full invitation text.
Paste the URL or invitation using Ctrl + V on Windows, or Cmd + V on a Mac. You can also right-click and click Paste. This URL or invitation can be pasted in an email, other chat thread, or other messaging service.

Troubleshooting Zoom

If Zoom recognizes your selected video camera, but your video either shows up as a black screen or is distorted, learn how to troubleshoot these issues.

How to troubleshoot issues with a black screen in place of video

This may be due to anti-virus or network security applications blocking Zoom's access to your camera, such as Kaspersky.

Disable security applications on the device

Disable the anti-virus or network security applications on the affected device.
Launch a test meeting to see if that helped resolve your video issue.

Remove Zoom from the webcam access blocklist

Open any anti-virus or network security applications on your device, and search for the webcam access blocklist.
Remove Zoom from the blocklist.
Launch a test meeting to see if that helped resolve your video issue.

For additional troubleshooting, submit a request to Zoom Support if you are still experiencing this issue.

Troubleshooting Virtual Background issues

If you are experiencing issues with Virtual Background, try the following troubleshooting tips:

If you do not have the Virtual Background tab in your desktop client settings after enabling it, sign out of the client, sign back in again, and check the settings again.
Manually pick the background color to ensure the correct color is selected. This option is only available after you click an image and have “I have a green screen” selected.

Click the color selector box and the virtual background will disappear temporarily, so that you can click on the color in your background that you want to replace with the virtual background. Zoom will automatically make a best guess as to which color should be replaced, but sometimes there are too many choices to accurately guess the correct one. This is why sometimes the virtual background will cover some of your face, as the color it selected was too close to your own skin tone.
Ensure that the background is a solid color with minimal shadows. Also, ensure the background is uniform in lighting. A 3-point lighting setup is ideal.
Ensure that your green screen color does not match your shirt, hair, or eye color.
Black bars on the sides of your video when virtual background is enabled? Ensure that HD video is enabled in your Video settings.
If you are using VDI, some plugins do not support virtual backgrounds and less powerful thin client machines may also be unable to support the feature. Support for additional VDI platforms is in development and customers should check with their sales representative for updates.

How to troubleshoot speaker or microphone issues

Check the device

Make sure the cable connection with the microphone is fully inserted into the appropriate port.
If Zoom fails to detect your microphone, unplug the device and plug it back in.
If it’s a bluetooth device, ensure that it is turned on and connected properly.
Make sure that you are using a supported USB device for Zoom.
Note: USB devices not listed within the above article may still work with Zoom. However, the devices listed are what we recommend for the most optimal experience. Supported USB devices less likely encounter audio issues.
Ensure the microphone is not on mute.
- If you see the muted Audio icon in the meeting controls, click it to unmute yourself:
  If you are still muted, the host may have muted you upon entering the meeting. Ask to be unmuted by sending a chat message to the host.
- Some microphones or headphones have a physical mute button, switch it off to unmute yourself.
Increase the volume on your computer or laptop using the volume buttons or notification panel. Even if the speaker is turned on in Zoom, your device's volume might be set to mute or vibrate only.

Check audio settings

Sign in to the Zoom desktop client.
Click your profile picture, then click Settings .
Click the Audio tab.
Under Speaker, you can do the following:
- Test your speaker.
- Select the speaker you want to use in the drop-down menu.
- Use the Output Volume slider to increase or decrease the output volume.
Under Microphone, you can do the following:
- Test your microphone.
- Select the microphone you want to use in the drop-down menu.
- Use the Input Volume slider to increase or decrease the input volume.

Windows users may also try disabling the Signal processing by Windows audio device drivers option within the advanced audio settings.

Notes:

If your audio device does not appear within Zoom, it’s possible that Zoom has not been given permissions to access it. Ensure that you have enabled access to your microphone for Zoom.
To change the microphone or speaker during a meeting, on the controls toolbar, click the upward arrow beside the Mute option.

Common Issues

Here you will find some of the common issues you may encounter while using the call center, connecting to a patient, and joining Insights.

Contact 19Labs Support for additional resources or assistance.

No notifications for incoming calls

If you suspect you are missing incoming calls, or the operator has mentioned they placed a call and you were not notified, check the following.

First, refresh your browser to ensure you are still logged into the call center. This should be done automatically but in some cases it may appear as if you are logged in but your session has actually expired.
Next, check that clinics you’d like to receive notifications from, and be able to join, are selected in your account. Check this by selecting your name, then Account Profile and use the checkboxes to select the desired clinics under Participating Clinics. Press save to complete the changes.

If you have subscribed to SMS notifications but are not receiving them, this may be due to carrier filtering. If this problem persists, try receiving notifications through WhatsApp.

Can’t join calls

You may experience a situation where you join a call from the call center and Zoom displays the message “please wait for the host to start this meeting” or there are no other participants.

If this happens, this particular call may no longer be valid.

In time, the call should be removed from the call center automatically.

Can’t enter Insights: Not Authorized

If you cannot join Insights, try using an alternative path.

If you entered through the Call Center, try the Zoom link. If you entered through the Zoom link, try the Call Center button.
If you still cannot connect to Insights, the GALE user may need to end the call, then the session and try again.
If there remains an issue after trying the previous, contact your IT department or 19Labs technical support as there may be a network issue preventing the connection.

Can’t enter Insights: Provider deauthorized

If at any point the user deauthorizes your access to Insights, you will be unable to enter Insights for the duration of the session.

If you still require access to Insights the user will need to end the call and the session and begin a new visit.

Can’t connect to sensor

Bluetooth sensors are easy to use but, because they rely on a wireless connection, sometimes problems arise.

The solution may be as simple as restarting the sensor. When the GALE user does this, ensure the sensor is positioned within 10 feet of GALE and affixed correctly.

If you still don’t see a measurement, ensure the device is turned on, the batteries are charged and/or installed correctly.

If you are having issues starting the sensor from Insights, allow the GALE user to try from their end. You will still be able to see the results through Insights.

For more information and assistance, do not hesitate to contact 19Labs.

+1 (669) 209-8600

support@19labs.com

https://support.19labs.com

Recommended Provider Setup