[Transcript] Episode 434: Secure, Efficient, and Effective Ways to Record Client Sessions When Needed

 

Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients, remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user, go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Hello and welcome to Episode 434: Secure, Efficient, and Effective Ways to Record Client Sessions When Needed.

 

Liath Dalton 

Yes, this is a need that is coming up more and more frequently, it seems particularly in a group practice context. And so this is coming up, both in terms of supervisees needing to record teletherapy and in person sessions for their supervision purposes, and we’ve also been getting an increase in questions around recording, when a clinician, whether, typically a fully licensed clinician, is actually seeking an additional certification and need to submit session recordings in order to obtain that certification, or for actual clinical use with clients, for folks who do prolonged exposure therapy.

 

Liath Dalton 

So we thought it would be useful to tackle how to leverage tools that are in most practices’ existing tech stack or practice toolbox to meet this need in a way that is secure and HIPAA compliant and is also efficient. Because, of course, there are multiple ways that you can record sessions and do so securely, but they can end up being kind of cumbersome or just having a lot more steps involved that make it a headache or more prone to have a security lapse. And so since there is a great solution for how to manage this, we thought we’d speak to it directly.

 

Liath Dalton 

All right, so what is that solution for recording both teletherapy sessions and in person sessions that doesn’t involve adding additional hardware or adding additional services typically? Well, that answer is Google Workspace, and specifically leveraging Google Meet, which is covered by your BAA with Google Workspace and recordings of Google Meet sessions are also covered, I mean, that’s functionality that’s present, but it’s also functionality that’s covered by the BAA with Google, if you are using Google Workspace Business Plus, which is the tier that a group practice or anyone with multiple users in their Google Workspace organization need any way for the HIPAA security, configurability, for meeting the necessary and applicable standards, basically.

 

Liath Dalton 

So since I’d say 99% of the group practices that we work with have Google Workspace and have the Business Plus tier, when we get this question of, I’ve got a supervisee who needs to record sessions, or have a clinician who’s getting a certification who needs to record sessions, how do we do this, what hardware do I need? I know that, you know, this is highly sensitive PHI, kind of the highest sensitivity possible level of PHI, because it’s actual sessions and people’s voices and images, and it’s the whole context of of the session and the therapeutic interaction. So it really does need to be safeguarded.

 

Liath Dalton 

Now, what are you might be thinking: What does this actually look like in terms of teletherapy sessions? Especially if you are using a different video platform as your practice’s primary teletherapy platform. Like you use an EHR that has a video platform built in, and that’s what you use because that’s your your core system for client interaction and client data. That makes perfect sense. So what do you do when you don’t want to change that but you need to record and that platform doesn’t have recording functionality? Which is pretty typical across the EHR systems, I will say.

 

Liath Dalton 

Evan, what is the awesome way to record teletherapy sessions, leveraging Google Meet, but not having to use a actually different platform than the standard video platform, where basically you’re using both.

 

Evan Dumas 

Yeah, so the little trick comes with the screen recording feature or the sharing screen. So what you do is you, and of course, test this with a test user, because you want to get a feel for it, you start your session in your telehealth platform of choice, your EHR or whatever, and you will also open up a Google meet meeting.

 

Evan Dumas 

Now, in that Google meet meeting, you can turn off your camera. You don’t need it at all. You can turn off your microphone, because – actually, leave your microphone on, because you want that. But you turn on screen sharing so it just captures your screen, which will have, you know, the video of your client and your little picture in picture of yourself if you’re there too, and that’s what gets recorded along with your audio. So it does all the recording. It just looks at what’s coming in, and it saves it to Google Drive automatically, which is phenomenal. And you go about doing your telehealth session as you would normally in your telehealth platform of choice.

 

Liath Dalton 

Exactly so there is not a different interface or experience that the client has to have, platform wise. And one of the major security and efficiency benefits of having the recording done right through Google Meet, where it’s then storing the recording in Google Drive, is that you aren’t then having to navigate downloading the recording, or having the recording stored on the hard drive of the device that the session is being done from, and then uploaded to Google Drive or to whatever other place that it is. And of course, needs to be a HIPAA appropriate place if you’re using it or going to be placing it somewhere different to Google Drive or in addition to Google Drive.

 

Liath Dalton 

But it just takes a whole step out of having to manage the actual download and upload process, and it’s reducing surface area of risk exposure by not having those recordings on the actual hard drive of the computer, the sessions being done from, so big pro there. And I do want to say there is one little sort of usage note here that’s really important, which is that clients, if you are doing it this way, or we have clinicians on your team who were recording sessions in this way, the client is not going to hear a notification of this session is now recorded or get a prompt telling them, you know, a pop up in the video platform, telling them that the session is now being recorded. So of course, this is all predicated on their having been informed consent for recording.

 

Liath Dalton 

And you know the additional guidance that we give and that Eric Strom, the HIPAA and teletherapy attorney that we collaborate with, really emphasizes regarding recording sessions is that in that recording consent that you also want to be specifying that the recording while it will be safeguarded according to HIPAA standards, because it is Protected Health Information that it is not going to be included in their healthcare record.

 

Evan Dumas 

Yeah, exactly.

 

Liath Dalton 

Right, and it is not going to be preserved. So as soon as the needed use of that recording has been realized, it needs to be deleted. It should not be maintained.

 

Evan Dumas 

Oh no.

 

Liath Dalton 

We don’t want to be adding it to the client record. They shouldn’t be having rights of access, that opens up additional security considerations. This is when we’re talking about recording for supervision purposes, not for the sort of other use case of sharing recordings of sessions with clients in limited cases, when it’s for prolonged exposure therapy purposes. But that’s a really important piece to to note when your practice is recording sessions, that clients are aware that this is not something they will have rights of access to. It’s not going to be preserved, but it will be safeguarded.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

So then, as Evan said, the process is just presenting the window that the actual video platform from your EHR, or Zoom for Healthcare or whatever you’re using is in, and again, just want to reiterate his great and important guidance of testing this out first, so that everyone who’s going to be utilizing it has an exact feel of what to click, how how it goes, and that the first time it’s being used it’s not done in a client session where they’re then, oh, wait, did I click the right thing, I’m not sure.

 

Evan Dumas 

Exactly.

 

Liath Dalton 

And I would actually recommend this as another case where it can be beneficial for those of you who use Loom for recording training videos for your team, or just there are lots of great use applications for Loom, that you could record a demo session of setting up a session that’s being recorded and what the order of operations for that is, and have that available in your training materials for any clinicians on your team who are going to be recording sessions.

 

Liath Dalton 

Now, do note, because Loom is not a tool that you can get a Business Associate Agreement for, that you don’t want to be displaying any actual client data when you’re recording this little tutorial. So, but tutorial, if you’re making one where it’s just a visual walkthrough of how to do this exactly, is one that should just be done with your own team members, like staff members or a dummy client account. Or, I don’t like that term, a test client account, not a dummy client account. Have to be mindful of the languaging, right?

 

Liath Dalton 

So, yes, a test client account or a mock client account can be used for that in your your EHR so that you can manage that. And I think most of you likely have a test client account anyway, for other demonstration purposes, for when you’re onboarding new folks and that sort of thing. So that’s what the process looks like for doing recordings of teletherapy sessions where you’re combining both Google Meet and your standard or primary video platform.

 

Liath Dalton 

Now, of course, what that looks like for teletherapy sessions where you’re just using Google Meet is even simpler and less steps. But I would say you want to evaluate the pros and cons of doing it just with Google Meet if Google Meet isn’t your primary video platform.

 

Evan Dumas 

Yeah, because they may not be used to it, yeah.

 

Liath Dalton 

Because then the client’s not going to be used to it, it’s going to feel differently. And so that’s important, but I think I actually need to go back to what I was saying about recording, because I got all into the informed consent piece and didn’t finish the train of thought and the sort of usage note around, because clients aren’t going to be hearing an audio prompt that the session is now being recorded and or getting a screen pop up, telling them that it’s really important that the clinician tell them before they click record, before the session starts being recorded, and then should also say, once the recording has been started, okay, this session is now being recorded.

 

Evan Dumas 

Oh, yeah.

 

Liath Dalton 

So that the acknowledgement of that is documented as part of the recording itself.

 

Evan Dumas 

Exactly.

 

Liath Dalton 

Right? Because then there can’t be any question later of oh, well, they said they were going to record, and I didn’t know they actually were or anything like that. It’s just good, good practice to be very explicit about that and to have that documentation.

 

Evan Dumas 

Yeah, exactly.

 

Liath Dalton 

So important usage note there. Now, what about recording in person sessions? Because those are still a thing.

 

Evan Dumas 

Yep.

 

Liath Dalton 

And not every supervisee is doing teletherapy either.

 

Evan Dumas 

Oh, no.

 

Liath Dalton 

So sometimes it is absolutely still necessary to be recording in person sessions. And you know, it used to be that the easiest way to do that would be from a smartphone or computer and using the built in recording functionality there, making sure that device was hardened.

 

Evan Dumas 

Of course.

 

Liath Dalton 

Which should be in place anyway.

 

Liath Dalton 

But then you’ve got the physical recordings on the device itself, they need to be uploaded. And so that just creates more steps and is less efficient than this other way of doing it, but those, those sort of updated physical ways of doing it, are still far preferable to using a actual like digital camera or camcorder to record in person sessions, because those devices are not encryptable, right? They normally have a certain amount of onboard memory, so even if you’re removing the SD card or whatever the recording medium is, where the recording as being saved on a digital camera or camcorder, then you still have this process where you have to manually move it over and where there’s not the encryption standard  being able to be met. So that’s why we prefer the smartphone or computer that’s been hardened if we have to go the physical route.

 

Liath Dalton 

But thankfully, Google Meet, you can just have any clinicians that need to record in person sessions set up their screen with their their camera to be facing into the therapy room in such a way where it will capture both them and the client, and you just record the session, it doesn’t have to have anyone in the session, like a second person, in order to be able to record. Though, I should note that there is a setting that needs to be changed within Google Meet and within the session recordings for it not to automatically end the meeting when no one else has joined within the 15 minute time marker.

 

Evan Dumas 

Oh yeah, you don’t want that.

 

Liath Dalton 

Because you don’t want the recording get getting cut off, and ideally once the recording is started, and this is something that the wonderful Dr. Tara Sanderson from Supervision Smorgasbord and one of our CE presenters, shared as the solution, or the manner in which she manages this within her group practice that has a lot of supervisees, was that once the session recording has been started, and of course, again, saying this session is now being recorded, once the recording has been initiated, is to actually just turn the display off on the screen so you and the client aren’t seeing yourselves.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Because that’s going to be disruptive as as well, and kind of create a different inhibition level that’s not necessarily therapeutically conducive. So that’s just kind of a additional tip on on managing that so it doesn’t feel conspicuous or or unnecessarily obtrusive, and those are the basics of how to do this.

 

Evan Dumas 

Exactly.

 

Liath Dalton 

Anything you would add, Evan?

 

Evan Dumas 

Well, I think we covered a lot of the bases of alternative tools and the risks that they have, because you may have a setup in mind, but if you do, just take a look at it from a HIPAA angle of, hey, is this device hardenable, or where does the PHI go? Is it being backed up, taken care of? And is it too much setup? Like, how teachable is the setup for people doing it? Because, you know, you want to get them either self sufficient, you don’t want to have to have be incredibly complicated, etc, but you may have some things in place. And if you do try out this Google Meet recording style, see if it’s a good fit for your group.

 

Liath Dalton 

Exactly. And it’s not to say that this is the only way to to manage it for sure. And like Evan says, it’s a matter of however you’re going to be recording, making sure that you are identifying the life cycle, sort of the journey that that PHI takes, and making sure that it is safeguarded according to HIPAA standards, at each juncture, each leg of that journey, and that you’re able to to manage that and control that.

 

Liath Dalton 

So finding finding the kind of common friction points or where the points of failure may be either behaviorally is important, because we always want to be applying that risk analysis lens, right? That’s, that’s Evan’s primary domain, right?

 

Evan Dumas 

It is, it is.

 

Liath Dalton 

It is applying the risk analysis lens and then, based on the results, finding what the path of least resistance is going to be for managing the identified needs and making things as easy and streamlined and user friendly as possible, because we don’t just want to have HIPAA security compliance in place. We want things to be efficient and effective and not too complicated in terms of involving multiple systems and processes. So wherever things can be streamlined and simplified, that’s going to make it better all across the board.

 

Liath Dalton 

So hopefully this has been helpful. And of course, if you have different recording considerations or system needs, that’s something we talk through with folks quite frequently in our Group Practice Office Hours, that’s part of Group Practice Care Premium, so we are accessible in that way to you too.

 

Liath Dalton 

So thanks for joining us, and we’ll chat to you next time.

 

Evan Dumas 

Yeah, talk to you next time.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.