Social Work Tech Talk: The Art of Telehealth
by Gina Griffin, DSW, MSW, LCSW
Hello, social workers!
For my fall column, I’m writing about telehealth. Providing services via video has become a part of my daily life, as it has for a lot of you. COVID lockdown forced many of us, myself included, to integrate video skills, software, and equipment into our lives quickly and organically. As a result, something that was viewed with a bit of skepticism and caution has now become as normal as tying our shoes. So, thinking about how to write about this requires a bit of deconstruction. I was hoping that I would find a fabulous guide that would make this very easy, but I don’t think most people are thinking of telehealth services in this way yet. When I set out to do research, I discovered that we’ve thought a lot about ethics and the ability to build a relationship with a client via video. But I don’t think there has been a lot written about the mechanics. So, I’m going to attempt to put together a guide.
The Usual Suspects: Platforms That You Know
I’ve been very spoiled and very lucky throughout the very rapid evolution of providing telehealth services during the COVID-19 lockdown. My agency did a lot of the heavy lifting for me. Initially, like a lot of people and places, my agency used a combination of what the agency could provide and what we had on hand. We had an in-house platform that grew from being wonky and slow to being a fairly reliable network. At the beginning, we sometimes relied on outside services as we expanded our own capabilities. On days when our own service provided challenges, we were provided with the instruction that we could use any non-public facing platform (HHS, 2020). That means that the platform or service, such as Zoom or Google, is meant to include just the intended parties.
Those definitely worked in a pinch, but there were concerns about privacy. For example, Zoom initially used point-to-point encryption (P2PE) as opposed to end-to-end encryption (E2EE). P2PE meant that the encryption keys for meetings were stored in such a way that they were accessible by outsiders, and meetings could be breached. So, Zoom has used E2EE since the fall of 2020, and meetings are much more secure. Users now have the capability to lock their meetings, and if anyone tries to enter the meeting who doesn’t have an encryption key (which is sent to all invited guests), everyone will know that something is wrong (Aver, 2021).
There are still some challenges to meeting security, but Zoom now offers a HIPAA-compliant option, which is available to users who upgrade to a Pro Plan and choose the Business Associate Agreement or BAA (Emerson, 2021). Google Workspace and Cloud Identity also report HIPAA compliance through acceptance of a Business Associate Agreement (Google, 2022). Webex also falls into this category (Webex, 2021).
New(er) Kids on the Block
There are also platforms that may not be as well-known. VSEE is a platform that was developed by Dr. Milton Chan and Dr Erika Chuang as PhD students at Stanford (VSEE, 2022a). They wanted to offer a telehealth solution that would function even over very low bandwidths and that was easy to deploy. The software can be integrated into an existing system with little or no coding, and it can be personalized (VSEE, 2022b). There is a free version that offers one-click video, a virtual waiting room, unlimited video calls, and HIPAA compliance via a BAA. The paid version, at $49 a month, offers additional features such as scheduling, consent forms, and credit card payments.
Doximity is a service developed for hospital services and physicians. Non-medical providers can join by being listed as part of a physician’s medical team. Communications are encrypted, and they offer HIPAA compliance via a BAA (Doximity, 2022). It can be used via smartphone or computer. There is the option to set your office telephone number as the call-back number, no matter where you’re calling from. The app also offers video calls and secure texting.
Conversely, SimplePractice was developed for private practice. The platform is HIPAA-compliant and offers an impressive array of features. There is a 30-day free trial. The lower tier is offered at $29 a month, with the option to add telehealth services for an additional $15 a month. This level includes features such as unlimited clients, paperless intakes, a client portal, progress notes, treatment plans, credit card processing, and automated invoicing and billing. There are two more tiers. At $69 a month, services such as appointment reminders, customized notes, secure client messaging, and insurance claim filing (at $.25 per claim) can be added. At $99 a month, you can add appointment requests, calendar sync, and additional team members.
I’m truly impressed by the variety of solutions available for offering secure telehealth services, and I would love the time to explore all of them thoroughly.
The Nuts and Bolts
I’m going to focus briefly on hardware. I’m going to say, almost flippantly, that it almost doesn’t matter what you use. I’ve used laptops, desktops, and smartphones. I’ve used built-in cameras and add-ons. I’ve provided telehealth from my office at work and from home. My personal feeling is that most reasonably current hardware will allow you to conduct telehealth.
At home, I would suggest paying for the fastest available wifi. Our system is fast because we’re set up for gaming, and I’ve never had any problems with providing telehealth from home. I also pay for unlimited service for my personal phone, with the option for a hotspot. My work phone has the same options. On occasions when work or home internet service was disrupted, I’ve been able to use my phone as a hotspot and continue to provide services. At one point, I got so good at it that I could switch to the hotspot before the video call dropped. And most services have improved drastically since then.
I don’t have a specific camera to recommend. Any good camera will help you to get set up. I used a Logitech camera until I switched to using a company laptop. Neither of them has given me any trouble. You might also want to consider adding a ring light. At home, I work in my colorful therapy/teaching corner, which I love, but it’s sometimes very dark. When that happens, I use an affordable ring light that I ordered online. It also evens out my lighting, and I can choose warm or cool lighting. I‘ve also started to use a good podcast mic. It does double duty, as I use it for podcast episodes. Mine cost about $30, and it’s been a workhorse. It makes a big difference.
Go to the Source
I hope that you’re feeling a little more comfortable at this point. If you still have questions, make sure that you check in with NASW’s Technology in Social Work Practice for more guidance.
Telehealth is certainly here to stay. And I’d love to hear about your own tips, tricks, and favorite services.
References
Aver, H. (2021). How Zoom moved toward end-to-end encryption. Kaspersky Daily. https://usa.kaspersky.com/blog/rsa2021-zoom-end-to-end-encryption/25012/#:~:text=Zoom%20has%20used%20E2EE%20for,decrypt%20the%20content%20of%20conversations.
Doximity. (2022). Our commitment to security. https://www.doximity.com/about/security#:~:text=Doximity%20is%20secure%2C%20facilitating%20encrypted,HIPAA%2Dcompliant%20communciations%20with%20patients.
Emerson, R. (2021.) Small healthcare practices can now go online to get Zoom licenses that enable HIPAA compliance. https://blog.zoom.us/small-healthcare-practices-zoom-licenses-hipaa/
Google. (2022). HIPAA compliance on Google cloud platform. https://cloud.google.com/security/compliance/hipaa
HHS.gov. (2020). What is a “non-public facing” remote communication product? https://www.hhs.gov/hipaa/for-professionals/faq/3024/what-is-a-non-public-facing-remote-communication-product/index.html
NASW. (2015). Technology in social work practice. NASW.
VSEE. (2022a). About the VSEE team. https://vee.com/aboutus
VSEE. (2022b). The engine empowering superhuman care teams. https://vsee.com/
Webex. (2021). Webex compliance and certifications. https://help.webex.com/en-us/article/pdz31w/Webex-Compliance-and-Certifications
Dr. Gina Griffin, DSW, MSW, LCSW, is a Licensed Clinical Social Worker. In 2012, she completed her Master of Social Work at University of South Florida. And in 2021, she completed her DSW at the University of Southern California. She began to learn R Programming for data analysis in order to develop her research-related skills. She now teaches programming and data science skills through her website (A::ISWR) and free Saturday morning #swRk workshops.