Telehealth Concerns – HIPAA, Security, and More…

It’s the first question that pops up whenever discussing telehealth: “Is that compliant?” Conducting therapy sessions remotely clearly presents PHI risks, and your telehealth concerns – HIPAA, security, and more –  are valid & legitimate. 

How Do You Address Telehealth Concerns? 

Telehealth is being rapidly adopted to give providers and clients more freedom in their mental & behavioral health treatment protocols. There are lots of reasons why telemedicine might be considered:

> a patient is unable to come into the office due to illness or childcare restrictions
> the client lives far from their provider
> a raging pandemic makes patients feel unsafe to come into the office
> the client has time or mobility restrictions that make face-to-face sessions prohibitive

Telehealth, and telepsychotherapy / telepsychiatry specifically, are a way for clinicians to administer – and clients to receive – treatment that otherwise might not happen. However, telehealth concerns – HIPAA, security, and more – remain: does conducting a session via videoconferencing put the client’s PHI at risk?

Is there additional liability for the provider? Is it effective for mental & behavioral health, especially substance use disorders? How do you address additional training, insurance, and/or consent?

Conducting telehealth sessions includes considering:
> documentation to cover both yourself as the provider and your client / patient
> following evidence-based protocols to meet compliance regulations
> meeting legal and ethical requirements
> following current industry standards

Informed Consent

 The Society for the Advancement of Psychotherapy recommends that, when utilizing telemedicine for mental & behavioral health, informed consent should address factors such as:

• Privacy – the most private medium is a landline telephone call. Consider that the Internet is not regulated and not protected by privacy laws. The equipment & program utilized may offer more or less privacy & confidentiality.
• Fees
• Reimbursement
• Security and reliability of video & phone: not all applications used on the Internet are encrypted, which means the session may not be truly confidential. Skype is a good example of non-encrypted communication. Landlines are more secure than cell phones. 

Equipment & Program

There are methods of videoconferencing that aren’t safe: ie, they put the patient’s information at risk – and make the provider liable to HIPAA violations. For example, using Skype for telehealth sessions might put you at risk of HIPAA violation. (Although Skype partnered with MDLive, there are apparently still risks to using it for telemedicine).

The second step to successful telepsychotherapy is finding a service that follows HIPAA protocols. As you search for a system, be sure to communicate your telehealth HIPAA concerns and request compliance documentation from any vendor you consider.

The following factors should be taken into consideration for any telehealth vendor / service:
• Communication limitations
• Record keeping
• Termination
• Availability for emergencies / customer service & support access
• Cancellation policy

Malpractice Insurance

Providers should be sure their malpractice insurance covers telemedicine for mental & behavioral health.

Licensure

Clinicians should check their respective locations for regulations regarding telepsychotherapy and/or telepsychiatry.

Billing

Providers need to check with the insurance carrier, for each client, to be sure there is a proper provision for reimbursement for treatment via telehealth.

Client / Patient Types

The Society for the Advancement of Psychotherapy recommends “this type of work is only advised with clients not considered to be high risk. If psychotherapy will be provided at a distance, it is important that the treating psychologist establish clinical support in the patient’s geographic location in case of emergency so that standards of care can be met.”

Technical Issues

How many of us have suffered the pangs of technology? These problems are no different when conducting telepsychotherapy. As a matter of fact, the problems associated with using technology can exacerbate an existing problem with a patient. Practitioners should consider a contingency plan available for potential failure of the medium used. A stand-by phone call can be used as a back-up to online communication.

Training in Telehealth Skills

As with anything, there are skills necessary to using technological means of communication. These include not only the technical skills, but the more subtle interpersonal aspects of providing mental & behavioral health treatment remotely.

Does Telemedicine Really Work for Mental & Behavioral Health?

A common question that arises when discussing telehealth is “Does it work?” – especially for mental health and SUDs. Data demonstrates that virtual mental health counseling is at least as effective — and in some cases, more than — treating certain mental health conditions as traditional face-to-face. 

The COVID-19 pandemic might provide additional targeted data, over time, regarding the effectiveness & efficiency of treatment via telehealth.

Take Away

“Necessity is the mother of invention.”

As we transition into a new post-pandemic world, most of us are accustomed to using video platforms for many aspects of our daily lives, including mental & behavioral health treatment. If you are planning on utilizing a telehealth platform to conduct sessions, HIPAA concerns are valid and wise.

To see how PIMSY addresses telehealth, see our Features & Pricing. 

Donna Koger

Donna Koger is the HIPAA & Security Compliance Officer at PIMSY EHR. For more electronic solutions for your agency, see Mental Health Practice Management.

Leigh-Ann Renz

Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR. For more information about electronic solutions for your practice, check out Mental Health EHR.