Comments for Adventures in telepsychiatry http://adventuresintelepsychiatryblog.patrickbarta.com A psychiatrist in a solo private practice experiments with telepsychiatry Tue, 22 Nov 2011 19:45:03 +0000 hourly 1 http://wordpress.org/?v= Comment on Is Skype HIPAA-compliant?, Part III by Eric Harris http://adventuresintelepsychiatryblog.patrickbarta.com/2010/05/is-skype-hipaa-compliant-part-iii/comment-page-1/#comment-7478 Eric Harris Tue, 22 Nov 2011 19:45:03 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=512#comment-7478 It is my understanding that electronic communications carriers, such as Skype, Gmail, etc are not required to be HIPAA compliant or sign business associate agreements. Receivers of information which is unencrypted are required to sign business associate contracts. Whether Skype is safe or not, is a question which this digital alien cannot answer. It is my understanding that electronic communications carriers, such as Skype, Gmail, etc are not required to be HIPAA compliant or sign business associate agreements. Receivers of information which is unencrypted are required to sign business associate contracts. Whether Skype is safe or not, is a question which this digital alien cannot answer.

]]> Comment on Is Skype HIPAA-compliant? by Ofer Zur http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6829 Ofer Zur Thu, 03 Nov 2011 23:07:27 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6829 Good discussion about cross state line. As my short paper at http://www.zurinstitute.com/telehealth_across_state_lines-zur.html explains, it is not always clear how to handle certain situations and how residency is established. Good discussion about cross state line. As my short paper at http://www.zurinstitute.com/telehealth_across_state_lines-zur.html explains, it is not always clear how to handle certain situations and how residency is established.

]]> Comment on Is Skype HIPAA-compliant? by Doug Ikelheimer, MD http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6828 Doug Ikelheimer, MD Thu, 03 Nov 2011 21:29:08 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6828 Hi Sarah - You will need to be licensed in the state where your patient resides and from where he/she will access you for most of the anticipated appointments. Telephone psychiatry does not allow for visual information about the patient's mental status. Telepsychiatry (with live VTC) allows for documentation of a complete mental status examination and therefore it becomes possible to meet the standard of care for traditional outpatient psychiatry. My opinion is that the sophisticated data encryption protocols employed by Skype allow for a level and security and privacy which exceeds that of a telephone call and even exceeds that of traditional outpatient visits (since the patient's neighbor won't run into him/her in the waiting room or parking lot of your office.) Breakthrough may claim to be HIPAA-compliant but I doubt that their encryption protocols are more 'secure' than what Skype uses. In any case, if you accept only cash payments you would not be considered a HIPAA 'covered entity' and although you should always maximize privacy and security for your patients, you would not need to comply with HIPAA. (See Comment #26 above.) Hope that helps, Doug -- Douglas Ikelheimer, MD, MA Voyager Telepsychiatry LLC http://www.telepsychiatry.com Hi Sarah –

You will need to be licensed in the state where your patient resides and from where he/she will access you for most of the anticipated appointments.

Telephone psychiatry does not allow for visual information about the patient’s mental status. Telepsychiatry (with live VTC) allows for documentation of a complete mental status examination and therefore it becomes possible to meet the standard of care for traditional outpatient psychiatry.

My opinion is that the sophisticated data encryption protocols employed by Skype allow for a level and security and privacy which exceeds that of a telephone call and even exceeds that of traditional outpatient visits (since the patient’s neighbor won’t run into him/her in the waiting room or parking lot of your office.)

Breakthrough may claim to be HIPAA-compliant but I doubt that their encryption protocols are more ‘secure’ than what Skype uses.

In any case, if you accept only cash payments you would not be considered a HIPAA ‘covered entity’ and although you should always maximize privacy and security for your patients, you would not need to comply with HIPAA. (See Comment #26 above.)

Hope that helps,

Doug

–
Douglas Ikelheimer, MD, MA
Voyager Telepsychiatry LLC
http://www.telepsychiatry.com

]]> Comment on Is Skype HIPAA-compliant? by Sarah http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6826 Sarah Thu, 03 Nov 2011 19:45:14 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6826 Hi. I have a couple of questions for anyone who might be able to answer. These are in the setting of a cash-only private practice psychiatry clinic: 1. I'm hoping to use telemedicine to help some of my patients in between sessions. This mostly applies to my college students who don't want to disrupt a semester at school, but who want to continue working with me. Do I need to have a license in each state in which my patients attend college, or does that not apply if their initial session (and majority of follow-up sessions) occur in my office? 2. How might this differ from a legal/privacy protection standpoint from phone sessions? 3. What are your thoughts on sites such as breakthrough.com, which claim to be HIPPA compliant? I appreciate any feedback on these questions. Thanks so much! Hi. I have a couple of questions for anyone who might be able to answer. These are in the setting of a cash-only private practice psychiatry clinic:

1. I’m hoping to use telemedicine to help some of my patients in between sessions. This mostly applies to my college students who don’t want to disrupt a semester at school, but who want to continue working with me. Do I need to have a license in each state in which my patients attend college, or does that not apply if their initial session (and majority of follow-up sessions) occur in my office?

2. How might this differ from a legal/privacy protection standpoint from phone sessions?

3. What are your thoughts on sites such as breakthrough.com, which claim to be HIPPA compliant?

I appreciate any feedback on these questions.
Thanks so much!

]]> Comment on Is Skype HIPAA-compliant? by Doug Ikelheimer http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6455 Doug Ikelheimer Fri, 14 Oct 2011 15:36:18 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6455 The CMS document referenced above (in comment 26) clearly states that you are not a "covered entity" if you do not electronically send "covered transactions". Data representing live VTC is not a "covered transaction" as defined in the above CMS document - not even close. If you are not a "covered entity" then HIPAA is irrelevant. If you believe I am incorrect, please provide the reference within the primary legislation. The CMS document referenced above (in comment 26) clearly states that you are not a “covered entity” if you do not electronically send “covered transactions”. Data representing live VTC is not a “covered transaction” as defined in the above CMS document – not even close. If you are not a “covered entity” then HIPAA is irrelevant.

If you believe I am incorrect, please provide the reference within the primary legislation.

]]> Comment on Is Skype HIPAA-compliant? by Marlene Maheu http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6454 Marlene Maheu Fri, 14 Oct 2011 14:58:03 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6454 Unfortunately for those of us who seek to practice using technology, HIPAA is triggered by a single email to a patient or client, and not only if insurance reimbursement is involved as Doug has suggested. Unfortunately for those of us who seek to practice using technology, HIPAA is triggered by a single email to a patient or client, and not only if insurance reimbursement is involved as Doug has suggested.

]]> Comment on Is Skype HIPAA-compliant? by Doug Ikelheimer http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6438 Doug Ikelheimer Fri, 14 Oct 2011 05:11:43 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6438 HIPAA does not even apply to practitioners who only accept cash payment and do not bill insurance. By definition, if you do not transmit any 'covered transactions' electronically then you are not a 'covered entity', where 'covered transactions' are defined loosely as requests for reimbursement from insurance programs. See https://www.cms.gov/hipaageninfo/downloads/CoveredEntityCharts.pdf This helps confirm my theory that Skype telepsychiatry will eventually explode among the population of cash-only private practitioners. I do not dispute the inherent need for security and privacy in the use of any VTC equipment for telepsychiatry. And I believe that Skype is HIPAA compliant. But for many, it won't matter either way. HIPAA does not even apply to practitioners who only accept cash payment and do not bill insurance. By definition, if you do not transmit any ‘covered transactions’ electronically then you are not a ‘covered entity’, where ‘covered transactions’ are defined loosely as requests for reimbursement from insurance programs. See

https://www.cms.gov/hipaageninfo/downloads/CoveredEntityCharts.pdf

This helps confirm my theory that Skype telepsychiatry will eventually explode among the population of cash-only private practitioners.

I do not dispute the inherent need for security and privacy in the use of any VTC equipment for telepsychiatry. And I believe that Skype is HIPAA compliant. But for many, it won’t matter either way.

]]> Comment on Is Skype HIPAA-compliant? by Can you hear me now? Can you see me now? By Kjrstin Walters, Licensed Associate MFT | New Haven RTC http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-6257 Can you hear me now? Can you see me now? By Kjrstin Walters, Licensed Associate MFT | New Haven RTC Wed, 05 Oct 2011 02:27:58 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-6257 [...] is a list of guidelines for assessing whether or not a client is suitable for online therapy. And here is a blog post and lots of comments about HIPAA issues and Skype, the follow up articles are [...] [...] is a list of guidelines for assessing whether or not a client is suitable for online therapy. And here is a blog post and lots of comments about HIPAA issues and Skype, the follow up articles are [...]

]]> Comment on Is Skype HIPAA-compliant? by Marlene Maheu http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-5602 Marlene Maheu Tue, 23 Aug 2011 04:08:14 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-5602 For HIPAA and Skype facts from technical and risk management experts, come to the FREE webinar Tuesday, August 23 at 11 AM Pacific. 2 PM Eastern time. See this page for details: http://telementalhealth.com/webinars Also available for 1 CE and recording downloads will be available after the FREE live event for a minor fee. For HIPAA and Skype facts from technical and risk management experts, come to the FREE webinar Tuesday, August 23 at 11 AM Pacific. 2 PM Eastern time.

See this page for details: http://telementalhealth.com/webinars

Also available for 1 CE and recording downloads will be available after the FREE live event for a minor fee.

]]> Comment on Is Skype HIPAA-compliant? by Doug Ikelheimer http://adventuresintelepsychiatryblog.patrickbarta.com/2009/10/is-skype-hipaa-compliant/comment-page-1/#comment-5600 Doug Ikelheimer Tue, 23 Aug 2011 03:30:16 +0000 http://adventuresintelepsychiatryblog.patrickbarta.com/?p=121#comment-5600 But it can be argued that use of Skype's baseline sophisticated encryption techniques in fact does ensure confidentiality - perhaps more so what might be expected when a patient waits in a small waiting room and bumps into his neighbor. What percent of the population do you believe has the technical capacity to intercept and decode a Skype transmission? On the other hand, what percent has the capacity to eavesdrop on a private conversation - even without listening equipment from the local spy shop? HIPAA does not "approve" any given VTC equipment. It is up to the provider to decide whether a given platform complies with the intentionally vague Privacy Rule. And lab rats do not provide informed consent. But it can be argued that use of Skype’s baseline sophisticated encryption techniques in fact does ensure confidentiality – perhaps more so what might be expected when a patient waits in a small waiting room and bumps into his neighbor.

What percent of the population do you believe has the technical capacity to intercept and decode a Skype transmission? On the other hand, what percent has the capacity to eavesdrop on a private conversation – even without listening equipment from the local spy shop?

HIPAA does not “approve” any given VTC equipment. It is up to the provider to decide whether a given platform complies with the intentionally vague Privacy Rule.

And lab rats do not provide informed consent.

]]>