This article was significantly updated on July 22nd, 2016

Skype Logo with red x spray painted over itBy now, most of us are aware that Skype is not suitable for online therapy. What isn’t clear to everyone is why. Also unclear is how it indicates a general trend in tech that will continue on forever and ever, and even now is affecting which email services we can use and how we back up our data.

Skype didn’t change – the environment around it did. When secure, no-cost alternatives to Skype were released, and later when the HIPAA Omnibus Rule was released, Skype was rendered obsolete for mental health professionals.

This pattern will happen again, so it’s important for us to be aware of how it happens.

Reasonable Alternatives

Online Therapy Between Kid and TherapistBefore some time in 2012, one could argue (and at Person-Centered Tech, we did) that Skype was fine for online therapy so long as one took steps to reduce the risks of its use to reasonable levels. It wasn’t perfect, and paid telemental health platforms were available with better security and quality. For many professionals, however, Skype passed the cost-benefit test of reasonable security vs. cost.

Around 2012, we started to finally see the introduction of videoconferencing software that was easy like Skype and free or cheap like Skype. Unlike Skype, these options offer security that meets federal standards and even provide better video and sound quality. VSee was an early example of such a software option, but we now have a whole array of them available to us. See our reviews of free options here→

Before these low-cost, high-quality, telehealth-oriented options appeared in the market, Skype was a viable option for us to use. Now that these other alternatives have lowered the barrier between small mental health practices and high-quality health care video software, Skype becomes a nonsensical choice. All of the reasons to to use Skype are mooted because various, far superior alternatives are just as easily adopted.

HIPAA Changes

Stone HippoThe 2013 HIPAA Omnibus Rue also threw in a monkey wrench to Skype’s market dominance by making the Business Associate rule tighter, and causing Skype to clearly become a HIPAA Business Associate. Because Microsoft (Skype’s company) won’t do Business Associate Agreements for Skype, that means we can’t use Skype and be strictly HIPAA compliant.

Some Conclusions and Prognostications

I propose an equation: Standards for Technology = Available Technology + Real World Environment. Skype fell below the standard when more suitable alternatives emerged and especially when the real world environment (HIPAA rules) changed.

Roy Huggins with CoffeeIn 2013, we saw the same effect with email and online data backup providers. Email providers like Google and Microsoft 365 are now willing to offer Business Associate contracts to heath care customers who pay for the service, which makes it very difficult to justify using email services that don’t provide those Business Associate Agreements. The same is true with online data backup providers.

This trend will continue, and best-choice technologies will change as a result.

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This article is part of our 2 CE hour Guided Reading course titled: "An Online Therapy Primer: Legal, Ethical, and Technical Issues in Starting Telemental Health Practice"
We predict that text messaging will be next. At the moment, nearly all of us who texting with clients use the text messaging features provided by our phone companies. We do this despite the lack of Business Associate Agreements with those companies (and the lack of transmission security for the majority of our messages.)

At the time of writing, smartphones are starting to become accessible to a larger portion of the US population, including low SES individuals. Additionally, secure texting apps designed specifically for health care professionals are getting less expensive and better suited to meeting our needs in mental health. Look for basic text-messaging through one’s phone company to become a professionalism no-go as these apps improve and smartphone ubiquity increases.

We, of course, will keep you abreast of any such changes here.