No company would ever do a HIPAA Business Associate Agreement for a free a product!
— Roy, until February 2016

Online Therapy Between Kid and Therapist

Client and therapist or kid and grandpa? You decide!

It’s a brave new era, my colleagues! The HIPAApotomus has finally thrown its weight around enough that companies who want to work with us are doing more to provide what we need for our HIPAA compliance.
Of special interest to mental health clinicians is low-maintenance, low-barrier online therapy video software.
The act of working with clients through the Internet has taken on the unfortunate moniker of “Skype Therapy,” despite Skype being a very poor choice for telemental health services (not sure why that is? See our article on How Skype Became Software Non-Grata→.) This is because Skype is free and is usually already there when we get our computers. This makes it easier on both clinician and client to use it.
There are a large number of things we need for our HIPAA compliance when we get a company’s software involved in our therapy services. The most obvious and concrete need is to execute a HIPAA Business Associate Agreement with that company (not sure what that is? See our article on What Is a HIPAA Business Associate Agreement?→)
In this article, we will review and compare online therapy software options that:
  1. Provide a Business Associate Agreement to health care customers for the free version of the software.
  2. Pass muster when we do an informal, non-rigorous but still much-deeper-than-just-reading-the-website audit/review of the software’s security; and of the company’s attitude towards both security and the usefulness of their product(s) to mental health clinicians.

What products are on our list for review? Colleagues of mine, I give you (in alphabetical order):

  1. Doxy.me
  2. VSee

Free Online Therapy Software With All the HIPAA Fixin’s? How?

Each product on our list has its own reasons for being willing to do a BAA for no cost. So I’ll just list what each company says about the subject and what you need to do to get that BAA executed with them:

Doxy.me

Doxy.me LogoI had a lovely conversation with Dylan Turner at Doxy.me in which I asked a lot of pointed questions for which he had satisfactory answers. His story, and the one described on their website, is that Doxy.me arose out of a grant-funded project to fill a gap in telehealth software services at the university where Doxy.me was born.

They state that the free version is for solo and small practices, and larger clinics can pay for a version with a lot more bells and whistles. Turner says that this business model is supporting Doxy.me, which is more important than it may sound at first — if a company can’t survive financially, it will disappear from under you. Turner indicated that there is little risk of Doxy.me going under in the near future.

Executing a Business Associate Agreement with Doxy.me is a part of the initial setup process. We have verified that no special process is required.

VSee

VSee LogoLong-time readers know VSee well, as we have long-touted it. Some disclosure: I personally use VSee for my own online therapy practice. However, Person-Centered Tech has zero business relationship with the company, and neither PCT nor Roy Huggins make any profit from referring you to it (other than the satisfaction of finding a good, affordable product!)

Recently I announced that the environment around HIPAA is such that even solo providers making light use of video software should not use VSee without a HIPAA Business Associate agreement. Quite happily for me, they responded by making one available.

The process is not as simple as signing up. To get a free VSee Pro account, with the BAA, follow these instructions:

  • Contact Samantha, the liaison at VSee. Email her at samantha@vsee.com. Do not use the word “free” in your subject line. Your email will end up going to spam and Samantha won’t see it.
  • Let her know that you are a solo mental health practitioner. The free Pro account offer is only for solo practices.
  • Make sure to tell Samantha that you are a Person-Centered Tech reader and you are requesting the free Pro account offer.

Usefulness

Excited Woman with ComputerTime to start ranking the software options on our list. We’ll start with usefulness.

By “usefulness,” I mean a couple things:

Online therapy software needs to be able to maintain image and sound quality such that you can track a client’s affect with little-to-no interruption. Eliminating interruptions is impossible, but software can be built to roll with interruptions to a certain extent.

Usefulness also encompasses the features offered by the software. I don’t simply mean that more features = more usefulness. Rather, I mean that software with more relevant features would be more useful than software with fewer relevant features.

With that basic rubric in mind, Roy’s entirely unscientific ranking is:

VSee Logo#1: VSee: VSee has screen sharing and the ability to type and draw on the screen built in. It also has file transferring and text chat.

The most useful feature, however, is in VSee’s proprietary software design. The software is designed to work with very low Internet bandwidth. In fact, it is used in such environments as the space station and remote medical sites that have only older-generation cellular towers available for Internet. If your clients are very far away and/or have poor or unstable Internet connections, this feature could be very important. If all your clients have stable, high-bandwidth Internet connections, it will be less important.

Doxy.me Logo#2: Doxy.me: If you want screen sharing you need to install a browser plugin, and Doxy.me does not appear to provide a file transfer function (you can do file transfer using other means, e.g. encrypted email, of course.) It does provide text chat, however.

One of Doxy.me’s main points of pride is the fact that you don’t have to download any software to use it. As long as therapist and client are both using Google Chrome or Firefox to browse the Web, Doxy.me will work right inside the Web browser without any downloads or special installations. That means easy start-up and also easy maintenance, as our Web browsers do a pretty good job of updating themselves these days.

The other pride point is that even the free version includes a waiting room. If you’re not familiar with online therapy video waiting rooms, it’s a feature whereby you can send a client a link to your waiting room page and that’s all they need. With Doxy.me, the client doesn’t need to create an account — they just click through to your waiting room and declare their presence.

Mind you: this means that when you get a text chat in your Doxy.me waiting room, you need to be careful about assuming you know who you’re talking to. Make sure you can be confident of the identity of the person on the other end of your Doxy.me text chat before you acknowledge any therapeutic relationships. Once you start the video, you’ll be able to see their face and hear their voice.

Comparatively, VSee’s ways of producing video and sending it across the Internet were designed to be especially useful for performing telehealth activities even when the Internet connection is poor. Doxy.me takes advantage of some wonderfully advanced software that comes already installed in our Web browsers, but which doesn’t provide the telehealth-specific advantages of VSee software.

I believe the fact that Doxy.me uses software that’s already there on your computer is one reason why they can afford to offer their product for free without any special promotions, and good for them! They’ve leveraged what’s readily available in our world to provide something we need. And they made sure they didn’t have to sacrifice anything vital to do it.

Ultimately, VSee’s video and feature set is likely superior. Whether the things that make it “superior” actually matter in the end, however, varies from practice-to-practice.

Both are available on laptop/desktop computers, iPhones, iPads, and Android.

Ease of Use & Support

Kid Pushing Mom in Toy Car Wearing SuitsHere I’m going to talk about how easy it is to get set up and to use the software. Ease of use is not just essential for therapists who don’t feel tech savvy. Every time a client gets started with online therapy, they have to figure out the software. The easier it is to use, the less pain you go through with each of your first online sessions.

I rolled support from the company into this one, because good support = easier to use.

So Roy’s once-again-not-scientific rankings are:

Doxy.me Logo#1: Doxy.me: Doxy.me provides customer tech support, even for the free version. According to Mr. Turner at Doxy.me’s operations team, they have even spent long periods of time with individual therapists helping them get set up with the software. I find it odd that they would invest significant human-hours in support for a free product, but it seems to be part of the company mission.

The lack of downloads and the waiting room feature also make it very easy to use. When we tried it out, we were up and running in about 5 minutes.

VSee Logo#2: VSee: VSee does not provide human tech support for their free software. Once again, it’s an issue of costs.

The upside is that the software is as easy to use as Skype, and in some cases it’s even easier. In my time using VSee, I’ve only had one client struggle with setting up the software.

Comparatively, while both applications are simple to set up and use, Doxy.me is the simpler of the two. The fact that Doxy.me provides human support for the therapist is quite a coup for them, as well. That can make a huge difference for many health care providers.

Security & HIPAA

Spies

When it comes to security, these two therapists don’t mess around!

Now here’s the meaty bit that long-time readers know I love to get into!

Firstly and very importantly: both products provide good security in the sense that the security of all products reviewed in this article are up to snuff for our needs. Also essential is that both companies will do that all-important HIPAA Business Associate Agreement with us.

There are interesting nuances, however, which will be explained in the rankings. While this ranking is also not “scientific,” I feel confident in it:

VSee Logo#1: VSee: VSee has a very strong security profile. Without getting too geeky about it, VSee’s way of securing calls meets the standards of the National Institute of Standards and Technology (geek alert: I mean to say it is “FIPS 140-2 Validated”). That means VSee is legal for use in US Federal Government agencies and is, in fact, used in several high-profile government agencies.

Importantly: in my interactions and interviews with the company, it is clear that their culture of security is trustworthy.

Doxy.me Logo#2: Doxy.me: Doxy.me’s security relies mainly on that software it leverages — the one that comes in Chrome and Firefox (geek alert again: that software is called WebRTC.) Fortunately, that software is quite secure. It isn’t National Institute of Standards and Technology-secure, but it is pretty darn secure. It is also a very active Open Source project, which means it is frequently updated and likely to be kept at a high standard of security.

In my interview with Dylan Turner at Doxy.me, I also got an impression of a healthy culture of security at the company.

A Little Lost?

You may not believe it, but you do already have a lot of knowledge of this whole security thing. I know because you’re a mental health clinician, and we know security.

Also hard to believe: we offer 2 hrs. of free continuing education courses, here on this site, to get mental health clinicians oriented to HIPAA Security, tech, and ethics.

The courses are open to all who subscribe to our (also free) newsletter. Not subscribed? Click here to change that now→

Conclusions About Free Online Therapy Software

I see no obviously superior example of free online therapy software, but I can see how for individual practices one option may be clearly superior to the other. I hope I’ve given enough information to choose.

And lastly, some links to help you find these lovely free, HIPAA-friendly options (once again, in alphabetical order):

  1. Doxy.me
  2. VSee

An Important Note

Day PlannerThe primary mission of this article is to guide therapists away from Skype and Facetime by providing appropriate options that are similarly easy to access and use (i.e. free and simple.)

The fact is, there is a multitude of options out there for performing online therapy, including a number of platforms that provide much more than just the simple video connection provided by the options in this article.

For those who are seriously thinking about getting into telemental health, you owe it to yourself to also check out the options at Telemental Health Comparisons.