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3/20/2020

For therapists: HIPAA Compliant Video Resource Review and Recommendations

Now is the time for health care practitioners of all stripes to get online with video conferencing capability. It is not difficult and may not be optional in the coming days.

The U.S. Department of Health and Human Services (HHS) has announced a suspension of the HIPAA Telehealth rules in response to the COVID-19 emergency.
The OCR (Office of Civil Rights) will not penalize "health care providers that serve patients through everyday communications technologies ...
This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19."
In other words, for the time being, clinicians may use everyday video platforms without having a signed BAA (Business Associate Agreement).
However:  Public facing applications such as Facebook Live, Twitch, and TikTok "should not be used in the provision of telehealth by covered health care providers."
That being said, it appears from my research that a forward looking leap into this technology will land you on a platform with the HIPAA option available, which is probably where you need to be as telehealth becomes the new normal.

There are "hundreds of options" according to one reviewer. And it was not difficult to learn that  video is now a standard add-on for most all practice management systems on the market. So perhaps you should start there if you or your clinic uses such a system. But for ordinary practitioners ...

Simplicity is a virtue. 

The HHS list of "some of the vendors" is as follows:

  • Skype for Business
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet
My web searching did not uncover any hidden gem not on the list. So, in a saving-the-best-for-last order ...

My Observations:

Skype for Business is part of the Microsoft Office ecosystem - obviously not a tool designed specifically for telehealth. The support pages were of no help with respect to clarifying how the HIPAA compliance is managed. A reviewer says that it depends on which package you pick.
Rating: Maybe this works for you if you are a Microsoft Office subscriber.
Cost: $12.50 per month (what you pay monthly for Office).

Google G Suite is for people who use G Suite, not your everyday Google. This is an enterprise solution for organizational communications (email+) with video-conferencing as an add-on. I've been inside G Suite - there is a learning curve.
Rating: Good for you if you already use G Suite and have a good system administrator.
Cost: $6.00 per month - free to nonprofits, education and government.

Updox has salespeople! You can "request a demo." Their target is any profession medically related. To learn more choose either "provider" or "pharmacy."
Rating: I prefer the details up front. 
Cost: Click button to "Request Pricing"

VSee is a slick product with a lot of bells and whistles for patient management and after-session record keeping. The website says: "VSee powers NASA Space Station." You can pop an X-ray or brain scan up on the screen to share with patients. It is the choice of one respected colleague/reviewer; another colleague complained that she had difficulties with it. VSee's list of products shows the "clinic" option as the entry point, and they are also promoting its use as a software development platform.
Rating: Great if you have big plans and like to wear a white coat.
Cost: $49.00 per month.

Zoom is the hot platform for video conferencing. You can start out for free and then move up the ladder from there. It's the choice of the schools in my neighborhood and my wife connects through Zoom to yoga class. Like Skype and Google, Zoom does not have a telehealth look or feel. But wait, there's more! It is not "Zoom" that was recommended by HHS, it was "Zoom for Healthcare," which does feel like a Doctor visit. For a signed BAA for HIPAA compliance, please contact sales "and learn about 1, 2 and 3 year pre-paid packages."
Rating: Great for your clinic or your community mental health system, or if you plan to host webinars and teleconferences in the future.
Cost for Zoom Healthcare:  $200.00 per month.

Doxy.me is a mission-driven business that started with a grant to a university hoping to serve its community. From the ground up, it was intended for telehealth, with an emphasis on simplicity. Big selling point: patients do not have to download any app or install any extension - it runs in the browser, either Chrome or Firefox, and is mobile-friendly. Doxy.me was the winner in a Clemson University usability study (compared to VSee and two others). The paid version lets you "personalize your waiting room" (your picture and info) and use a custom url. Session history is automatically saved (time, date, duration). The free version does not access the best quality video, does not integrate text/e-mail notifications, and does not allow for groups. The BAA for HIPAA compliance is included in all packages, both free and paid for. There is a "clinic" option, but this is the only platform I looked at that had a button "for providers."
Rating: The packaging and the interface are easy on the eyes; the pricing is easy on the pocket book. Usability matters! Editor's Choice. 
Cost:  Free is Good; Better is just $35.00 per month, no contract.

One more thing! Training and education are always advised when clinicians start out doing new things. Beyond the technology, telehealth involves ethics, regulations and clinical concerns.

My recommendation (influenced by pre-existing collegial relationships with the instructor and CE provider) is for therapists to take the 2 hour online CE Telehealth 101 class at the Zur Institute:
"Clinical, Ethical and Legal Considerations of Online Psychotherapy."

As a follow-up, and for broader study, consider Dr. Zur's 8 hour course: Digital and Social Media Ethics for Therapists.



Copyright, Paul G. Mattiuzzi, Ph.D.