Photo by Torsten Muller on Unsplash
Free teletherapy video software is back!
Things have changed a bit, though. We have a newcomer to the stage: Vidhealth. And VSee has resurfaced with a free offering again!
Let’s take a look at what we have now.
First: What Do We Need From Our Software?
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, What Is a HIPAA Business Associate?→)
In this article, we will review and compare online therapy software options that:
- Provide a Business Associate Agreement to health care customers for the free version of the software.
- 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.
Friendly reminder: HIPAA compliance is a process not a product — so we at PCT don’t refer to products as “HIPAA compliant;” rather, we say HIPAA-secure.
The List
What products are on our list for review? Colleagues of mine, I give you (in alphabetical order):
- Doxy.me (free for solo practices)
- VidHealth (free for solo practices)
- VSee Clinic (free for solo practices)
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 HIPAA 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:
Our free, informative articles are brought to you by Hushmail,
who is offering our readers 15% off for life!
Wondering why this is here? See our sponsorship policy for details.
Roy says: Hushmail is one of several secure email options that serves health care practitioners like us. Hushmail is highly trusted, affordable, includes secure web forms that accept e-signatures, and has earned a recommendation from us for use by mental health professionals. Learn more about Hushmail for Healthcare and get 15% off for life.
Doxy.me
Long ago, Roy had a lovely conversation with Dylan Turner at Doxy.me in which Roy asked a lot of pointed questions for which Dylan 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. There is also a fee to perform calls with more than one client.
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.
VidHealth
VidHealth came into being in response to the COVID-19 pandemic, and immediately started offering free service for one-to-one video sessions. They now charge a fee for group practices. There is also an upgrade option to be able to do sessions with more than one client.
In testing Vidhealth, we discovered its ability to provide a clear connection with multiple clients was better than its competitors. This is significant because all of the free options on this page work in a way that has a harder time the more people are in a call. Vidhealth is no exception to that, but it seems to perform well as it works to manage the extra load. Note: getting more than one client on a Vidhealth call requires upgrading to a paid account.
Executing a Business Associate Agreement requires emailing the company, as explained on their HIPAA compliance page.
VSee Clinic
After a COVID-created hiatus, VSee Clinic is back with a free tier for solo providers. VSee has been building up their VSee Clinic offering for some time now — they’ve come a long way since the days of just producing VSee Messenger.
VSee Clinic has a waiting room and the ability to use it with the classic VSee software that you and the client download, or you can use it from inside your web browser. After signing up, a VSee staff member contacts you to sign the Business Associate Agreement with them.
Conclusions About Free Online Therapy Software
We see no obviously superior free online therapy software application, but we can see how for different practices one option may be clearly superior to the others.
And lastly, some links to help you find these options (once again, in alphabetical order):
An Important Note
The primary mission of this article is to guide therapists away from software like 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. Be sure to put some time into finding the best option for you.
Learn more about providing effective telemental health services:
17 CE Credit Hours
11 Legal-Ethical
Roy,
You’re awesome! Love your blog and thanks for negotiating with VSee to get all your subscribers free BAAs. Truly appreciate it.
You’re very welcome. Make sure to thank them, too. It was their idea! :)
I was very interested in virtual therapy connect in 2012 but I found that most of my patients did not have the internet strong enough to manage such intensely compliant softwares. Any feedback on how well these two hold up with regular to meh internet speed? Even our corporate internet was not strong enough to do VTC. So I went back to low bandwidth skype…I’d love to use something safer.
Well, take another look at my comments about the strengths of VSee. Working with meh Internet is where it especially shines.
aha!!! I see that when I was reading this article, my computer accidentally scrolled past that note. I can’t wait to go check this out…thank you for doing some research for us. I’ve been anxious about doing virtual therapy since 2012 using VTC when I could get it to work and skype. I wanted something secure and safe for my patients. Whew
Great to hear it’s helpful! VSee should definitely meet your needs, I’d say.
Thank you so much, Roy! You provide us with invaluable information! I really appreciated your teachings in Zur’s Telemental Health certificate course.
You’re very welcome!
Great post, Roy! Thanks for sharing with the community. I’ll send this to some of our clients who will be happy to hear about these options!
Sound great. Thanks, Becky!
We had major problem with VSee’s client list getting spammed with hundreds of contacts. Then some of these folks would begin random chats with us whenever we logged in. We asked VSee for help, but to no avail, so we switched to Doxy.me and are happy. However, we do miss the file transfer feature of VSee, but not enough to put up with the spammed client list.
Thanks for all this, and I used Vsee for a while, but I am not having a good expereince. Too often, the call drops frezes, had to switch to skype in the middle of the session. I am willing to pay if I knew it would make vsee work better. I am so dissappointed and now looking at other solutions, theralink, wecounsel etc, which are more complicated for clients… wondering if i’m missing something, since you say it works so great with low connections and in your practice. any thoughts?
( btw had similar expereince with doxy- but clients may not have been using chrome, i just read that in your blog. once it was the iphone app, and once safari, i think…)
All I can say is that I have not had that experience. I haven’t had it with doxy.me, either.
One thing to remember is that if you have Skype open at all, it will use your Internet bandwidth even if you’re not using it make a call. So even if it’s just in the background, it could eating Internet bandwidth and thus making your other calls degrade.
THANK YOU for helping me cut to the chase and choose a good platform.
You are so very welcome. :)
Oh, and I forgot to say: don’t forget to share this article with your colleagues!
I’m seeing that Skype now offers a BAA as part of their Online Services Agreement – seems they responded to that need. Here’s how it reads:
HIPAA Business Associate
If Customer is a “covered entity” or a “business associate” and includes “protected health information” in Customer Data as those terms are defined in 45 CFR § 160.103, execution of Customer’s volume licensing agreement includes execution of the HIPAA Business Associate Agreement (“BAA”), the full text of which identifies the Online Services to which it applies and is available at http://aka.ms/BAA. Customer may opt out of the BAA by sending the following information to Microsoft in a written notice (under the terms of the Customer’s volume licensing agreement):
• the full legal name of the Customer and any Affiliate that is opting out;
• if Customer has multiple volume licensing agreements, the volume licensing agreement to which the opt out applies.
I run a small counseling agency and we’re fully set up with Microsoft Online and thus Skype for Business (SfB). Would you agree that the BAA issue has been resolved? Are there other issues that you would think need to be addressed before Skype would become “persona grata”? ;)
Thank you for important research on all this!
Also, upon further exploration, it looks like VSee’s least expensive HIPAA compliant plan (where they offer a BAA) starts at $299/month. Can that be?
You need to make a special request. Check out the article again for the details. :)
I wouldn’t call Skype for Business, “Skype.” It’s actually Lync after being rebranded to “Skype for Business.” Many complain that Lync is not very good quality, but it does come with a BAA. So if you already are using MS 365, it has the potential to be a good option.
Hello,
You may or may not be able to answer this question.. but here it goes. I went through Breakthrough.com which uses VSee. During the demo and subsequent follow up “sessions” with the staff there, the clarity of voice and video were great. During my sessions, not so much. Very odd sounding feedback on my end even with headphones and fuzzy video clarity. They could not address my concerns. I have decided to try Thera-link hoping that it may be a better option. Based on the information you have provided, it appears as though they may use Doxy.me since you don;t have to download anything. Any ideas about why with the Breakthrough staff It’s a clear and lovely experience and not with my clients? It so unprofessional for my clients to experience stress and anxiety because the quality is so poor. Also, any recommendations for the best service to use? Thank you for your time.
Thanks for asking! Our best suggestion regarding the difference in quality between demo sessions and client sessions with Breakthrough.com is to contact the service provider directly for information and possible solutions. As for a recommendation for the best service to use, we don’t currently have anything published on that topic besides this article.
Awesome article Roy! I’d love to hear your input on our New Telemedicine Platform…. qvidity.vom
Hi BobbyB,
This article is for listing free telehealth video solutions that meet our needs for HIPAA compliance. Thanks.
I ask clients to complete forms/exercises on paper during sessions. Is there a convenient way of sending and receiving forms between client and therapist on VSee or Doxy.me?
I know VSee can do file transfers quite easily. I think Doxy.me does, as well, but you’ll have to ask them about specifics.
Hi Roy,
Great article. I am interested in starting a HIPAA compliant on line counseling support group for women. A self paced group. I’m uncertain if there are such platforms (virtual classrooms?) that could support this…sort of like a private Facebook group (but clearly NOT Facebook), any thoughts?
Hi Mari,
Glad you found the article useful! Roy would refer you to telementalhealthcomparisons.com to explore the various platforms available. Best of luck with your support group!
This article is a professional lifesaver. Thank you so much. I notice you don’t mention FaceTime. I’ve found confusing information about FaceTime & would love a clarification of how to use it in a HIPAA-compliant way, which would also be simple for the client on the other end. I get confused as soon as I see “WPA” or any terminology like that, and I imagine that my clients do too.
Hi Jessica,
Thank you for your message and appreciation; we’re glad you found the information useful. Roy doesn’t mention FaceTime as an option because it is not, and never has been, HIPAA secure. Unfortunately, all the information online that indicates FaceTime can be HIPAA secure if using WPA2 Enterprise Security is not correct and stems from an initial misleading memo by a reporter and then that misinformation spread like wildfire. In order to be HIPAA secure, we recommend using either VSee or Doxy.me for your video software needs.
Doxy.me professional account includes file transfer (along with screenshare, payments, 3way calling, and photo capture)
Thanks, Brandon.
For those reading this, Doxy.me professional would be the paid version of Doxy.me.
Love the article; the comments have taught me more. Thank you for sharing your expertise in such an engaging way.
You’re very welcome. :) Please remember to share it with your colleagues. Sharing it with email groups or on social media are both great ways to spread the word! :)
Thanks again for another outstanding article!
I have been using doxy.me for the past month or two because of the ease of connecting with new clients and not having to walk them through downloading Vsee and signing up for an account. Unfortunately the video and audio quality has been somewhat erratic and can be very disruptive. I tested out Vsee a bit and it seemed even more choppy and grainy than doxy.me. All of my therapy is conducted online, so I really want this to be the best I can get it. I actually purchased a new MacBook, professional video camera and microphone, as well as upgraded my internet speed, but I’m still stuck on (relatively speaking) mediocre quality.
Any thoughts or suggestions would be helpful.
Keep up the good work!
Give this article a look: https://dev-personcenteredtech.com/2016/05/27/online-therapy-video-sessions-go-glitchy-tips/
If that’s not eneough, you’ll want a to get help from a techie who can sit at your computer with you. Best of luck!
Thanks, Roy! This article is invaluable! And the part about a free BAA with Vsee is just wonderful…thanks for collaborating with them and making arrangements for solo practitioners to contact them for this special deal. With your help, I think I’m finally understanding all of this.
Well, I’m glad we’re helping. And thanks for the kind note! :)
AWESOME Article – THANK YOU!!
We’re happy you found it useful! Thank you for the positive feedback :)
I’d love to hear about your experiences with Thera-Link. I am looking to try it myself.
Hi Tammy,
Thanks for your interest. Roy does product reviews during his weekly Office Hours sessions for subscribers to our Person-Centered Tech Support service. For each Office Hours session, you can submit all your questions and then either join the session via live webinar or watch the recording on demand like a podcast — we even send you an email with the recording of just your question(s) being answered so that you can receive your answers without viewing/listening to the full session. It’s a great way to have continued, affordable access to regular consultation with Roy. You also get access to recordings of all past Office Hours sessions and our extensive video help library.
Thanks Roy, this is awesome! The cost to upgrade my Zoom account to be HIPAA compliant was $200 per month. Yikes. I just contacted Samantha at VSee.
Yeah, I wonder why Zoom still hasn’t developed a package that’s appropriate for small and solo therapy practices.
Correct me if I’m wrong, though: Zoom’s license is for 10 seats, right? Couldn’t you share the account with 9 colleagues?
Thank you for this vital info. I wrote as you suggested re Vsee and ‘we shall see’. Hopefully they do not get so many of the free requests given your article that they stop doing it. Can you get payments and send forms to and from clients?
I’m sure it’ll work. Just make sure you don’t put the word “free” in your email subject line. :)
Hi Carl-
I’d like to use Skype for teleconference therapy sessions. Just to clarify…you’re saying that I can email Skype and inform them that I’m a therapist wanting to keep my sessions HIPPA compliant, and they will make that happen?? I’ve tried VSee and been underwhelmed. Thanks-Rose
Hi Rose,
Carl was referring to Skype for Business, which is a different product (and not free.) Most people who’ve used it say it’s not very good, but I haven’t used it myself.
-Roy
Just tried the doxy.me app and was underwhelmed by the almost blurry video quality and lagging, as well as the audio quality with pops and clicks. Off to try VSee now…
Hi Chris, the underwhelming experience could well be a result of internet connection quality and other settings. Please check out Roy’s article “When Online Therapy Sessions Go Glitchy: Some Tips” for some problem solving help. Best of luck!
Just emailed Samantha. I have gotten a few requests for online client sessions and really want to be very secure in these transmissions!
Great! Glad you’re getting your security ducks in a row before beginning online sessions :)
I just wanted to add a little information to this thread. I emailed Samantha at Vsee for the free video platform and she told me how to get started. She also mentioned the waiting room will be free for one year, once I put that I am using Vsee on my website, but after a year the waiting room will be around $100 a month.
Thank you, Suzanne!
Hi Roy! What platform would you suggest to use to set up online group therapy? I apologize if you already answered this.
Thanks
Take a look at Regroup: https://www.regrouptherapy.com/
Nice review. We’ve been using Doxy.me for a year or so, and have been very happy. Attentive staff, reliable connections. Haven’t tried VSee yet.
By far the biggest problem with any video platform is a lousy connection, which is not the fault of the connection provider, such as doxy.me. Many clients try to use a cell phone in a poor reception area, or using a DSL connection when somebody else in the house is watching Netflix.
Agreed about connections. In fact, we have an article about it here: When Online Therapy Video Sessions Go Glitchy: Some Tips
Here is a quote from another website about Skype for Business being HIPAA compliant: “Skype for Business states on their website that they are HIPAA compliant, so you can trust their word. The Federal Trade Commission makes sure that companies don’t make false claims about being compliant with federal law. Just be sure to get a Business Associate Agreement and be compliant with all related policies and your written policy statements. If you are not sure about those details, you may want to take some of our CE courses, such as this one about HIPAA and telepractice Legal/Ethical Issues I: Rules, Regulations & Risk Management or if you’d like it less expensively, as part of a package, as can be seen on this TBHI Certifications page.”
Skype and Skype for Business are not the same. And Skype for Business is not free.
May I ask specifically why you believe FaceTime (FT) is not HIPAA-compliant. I have seen three arguments against FT’s being HIPAA-compliant, and all are incorrect. The first is that FT is not encrypted. Per Apple, FT uses AES-256 encryption and has been validated for compliance with FIPS 14-2 Level 1 compliance. The second is that Apple possesses the encryption key and therefore does not qualify for the business associate (BA) “conduit” exception to the requirement for a Business Associate Agreement (BAA). Per Apple, a pair of encryption keys are created: one public and one private. Only the public key is sent to Apple’s IDS service, and so Apple cannot decrypt the data. This is different from Skype, which by law is required to possess the encryption key due to it’s ability to connect to landline phones. The third is that Apple does not qualify for the BA conduit exception because the actual audio and video data do not pass through Apple. If I’m not mistaken, I believe this is correct because, per apple, FT connections are “peer-to-peer.” However, this would mean Apple does not need to either qualify for the conduit exception or sign a BAA because, since the data does not pass through their servers, they would not meet the definition of a BA to begin with. For more information, see https://www.apple.com/business/docs/iOS_Security_Guide.pdf. Am I missing something? Thanks!
Hi Dave,
Great question. Peer-to-peer is not enough to qualify as a conduit. I would be happy to explain in further detail in a phone conversation if that interests you. We offer a free 10-minute consultation to see how Person Centered Tech can help you with your current therapy tech and HIPAA needs and point you to our resources that address your specific questions and considerations. Please email me at [email protected] or call 503-893-9717 to schedule that free consultation. I look forward to connecting!
Roy thank you a million times over for the invaluable information you provide. Your thorough knowledge of the Counseling field helps us better serve our clients.
You’re very welcome :)
Hey Roy, I think it is important to note that Skype for Business can’t possibly be HIPAA compliant, nor can any software make the claim that they are HIPAA compliant. The reason is because Skype for Business is not a Covered Entity. Also, it is not possible for technology alone to provide all of the administrative, technological and physical controls to be HIPAA compliant on its own. This may sound like a technicality, but it is an important one. There are a LOT of companies claiming “HIPAA Compliant” for marketing purposes when they really only mean they have 1 or 2 of the HIPAA Compliant items covered. While your statement regarding the FCC is technically true, to my knowledge the FCC does not investigate the extent of HIPAA compliance for these statements. Also, the FCC and ONC (who enforces HIPAA) is a responsive organization, meaning they only investigate complaints and don’t proactively investigate public claims. It is very possible (likely, in my opinion) that many false claims are made that are never investigated. Those looking for HIPAA Compliant video for telemental health should ask the video company which of the 18 ePHI they protect and how they protect it (particularly the IPA address – which 90+ % do not protect, including Skype for Business) and how they protect that information. Note, a BAA and encryption are not sufficient for HIPAA compliance. The “HIPAA Compliant” video vendor should also disclose how they are not a Covered Entity and state the responsibilities of the provider using their service to actually become HIPAA Compliant. Finally, a BAA does not protect the provider from liability, it simply puts the vendor on the legal hook with the provider. From my investigations into vendors, which is pretty extensive, I have found that MOST vendors are pretty ignorant of HIPAA. No matter what a vendor promises, the provider is still reap the consequences of a breach from the vendor. Thus the provider should be doing their due diligence to identify the extent of the vendor’s knowledge of HIPAA and what and how ePHI is specifically protected. I hope that adds some clarity to the conversation.
Hi Jay,
As usual, we are in complete agreement on all points. :)
I’m wondering if you intended to post this comment in response to one of the other comments here, though? The article doesn’t mention the FCC or talk about software being HIPAA compliant, but there are comments from others on this site that do.
Hi Roy,
Thank you for your helpful review. I was attracted to Vsee because of your review saying that it works well for those in the rural areas with not so great internet connectivity. That was the information that I needed the most and had a trouble finding elsewhere.
I also want to add some information for those who are interested in trying out the free Vsee Pro account as I found their naming of the products and accounts confusing.
What is included in the Vsee Pro account that you can get for free following Roy’s instructions (and some) is the Vsee Messanger, NOT the Vsee Clinic that has the patient waiting room.
Glad you found the review helpful and that it provided information you needed!
And yes, you’re correct that the free Pro account they offer to our solo practitioner readers does not include the waiting room feature.
Thanks so much for the info! As a clinician in a rural area, “meh internet service” is usually the best-case scenario. =) As a result, I’ve become quite the VSee (& Doxy.me, to a lesser extent) evangelist, and have passed the info on to many colleagues. So many people have barriers (poverty, transportation, weather, safety, etc.) to accessing (especially mental-)healthcare in this area that it really helps open up possibilities for them.
Keep up the great work!
Si
Thanks, Si. As someone who works across the Pacific with clients, I’ve done the same! :)
Hi there-love the info. I work for an HMO and have started doing video counseling and I found using cell phones and tablets seem to have easier connectivity than laptops and desktops. I don’t know if that helps at all because I’m not a techie but thought I would mention it.
Hi Stacey,
Thanks for the comment. Different circumstances create different experiences to a very wide extent. So I imagine there are others who notice a similar outcome and still others with the opposite experience. :)
Thank you for the information
I met with a VSee manager to set up the free account today and then 2 hours later she emailed me and stated that her colleague said the Person-Centered tech promo is not applicable for nurse practitioners. Thus they wont extend the BAA for free. but I would have to pay for it whenI give $300 for a 1 year subscription.
Hmm, that’s too bad. I know they want to limit it to solo psychotherapy practices, so they may see even a PMHNP as not limited to that role. Remember, there is always Doxy.me!
Hi Leann,
One more thought, Regroup Therapy is another good option and they may also be able to connect you with work — as I know they’re looking for prescribers to do contractual telemental health work.
How do clients sign informed concent forms for online therapy. Must they print form, sign then fax or scan? Is there a way to do this onine without paying another party for ability to do electronic signature. Can they just type with keyboard that they concent? I will be practicing in NJ and ID.
Hi Suzanne!
That’s a great question. There are a number of different ways to securely handle getting signed informed consent and other intake paperwork over the internet for online clients. There are a lot of considerations and nuances at play with this question though, as the answer is about much more than electronic signatures — such as securing PHI, and using secure and HIPAA-appropriate/ethically appropriate services for any means of receiving the consents that involve the internet. Even without the electronic signature component, the means utilized for you to receive the signed consents must be assessed for their security and HIPAA/ethical appropriateness. (For example, if the client prints, signs and scans the document — then how are they sending that scan to you? Is it as an email attachment, are they uploading it to a client portal for your practice management system (if you use one)? If they’re faxing it to you, is the fax you’re receiving it at a classic landline fax or an online fax service?)
We have extensive resources devoted to this very topic for our members, and part of what we help members with is identifying what solutions will best meet their particular needs. There is no one sized fits all prescription of what will work, as there are a number of variables to take into account, so we want to help you find the best solution for you that will be ethical and effective (cost-effective too!) for your specific needs and wants.
I invite you to schedule a free resource consultation with me so that we can discuss your particular practice considerations related to this question and how we can best be of help. You can schedule a time with me directly here. I look forward to connecting.
As of August 2018, even solo practitioners are expected to pay $25/month for the BAA.
Hello Roy,
VSee still offers the free VSee Pro w/BAA accounts to solo behavioral health practitioners that mention that they are Person Centered Tech readers. In addition to letting them know that you’re a Person Centered Tech reader, in order to obtain the free account w/BAA, they also require a social media post and will give you instructions for what the parameters are for that. (I was in contact with their leadership last week and verified that the free offer to our readers still stands.)
I too got frustrated with VSee and quit using it. I live in a small town/rural area in MA where it is hard to even get my cell phone (with internet support even) to reliably hold onto a call. Also had difficulty with Doxy. I have also used Zoom in the effort to find a stable, free alternative. Facetime has been the most stable, even though my clients and I know there is no BAA to be had with it. We all get frustrated with needing to stay still so reduce the platforms freezing.
Hi Becky,
It sounds like you’ve really been trying to find the best fit for your work! I’d invite you to look at all of our “HIPAAppropriateness” Reviews of videoconferencing platforms here. We also offer Telemental Health Tech Select Consultation services here if you feel like you need additional support.