You already know your website is a powerful marketing tool, but you may not realize its power as a practice management tool. It’s not uncommon for us to get questions about emailing forms or other materials to clients. We simply tell them, “why not put it on the website?”
Your website is the hub of your online presence. Clients will see it as the authority on all things you in the Internet space. So why not use it to facilitate interactions with clients in ways that promote their confidentiality and autonomy?
In this article, we’ll explore a few of those ways.
Offering Clinical Forms Through Websites
A lot of time can be saved by offering your intake and other forms on your website. Clients often appreciate the convenience and it adds to a professional appearance to have such services available online. Clinicians may be concerned, however, about the idea of making clinical documents available for download over the Internet.
The first, and probably most important, point is that a blank form does not contain protected health information (“PHI.”) There is no likely no risk of confidentiality breach in this situation.
The main concern is in what clients should do or could do with the completed form.
Dramatization
There is a concern that when clients download digital forms, they have an opportunity to edit those forms before filling out and signing them. We have not heard any reports of this happening in the private practices we consult with. However, we can imagine contexts where it’s a genuine risk. So this is simply a risk management point to consider before your proceed.
Many clients may fill out the forms on their computers. Also, they may scan any forms that contain a hand-written signature. This would allow the client to give the completed form to you digitally, which is something that some clients wish to do.
A number of therapists ask clients to email the completed forms to them. The concern there is that the completed forms do contain PHI and are confidential. Even if your clients are competent to accept the risks of email and decide to do so, we strongly urge against sending intake forms by email.
Intake forms pretty much always contain pieces of information useful to identity thieves. They may also contain insurance info. The level of risk to that kind of information in the Internet transmission space is too high compared to the low cost of using a secure method of sending the forms, or of simply printing them and bringing them to the first session.
Of course, clients may choose to send their PHI to you however they wish. You may not be violating HIPAA at all if a client sends his or her completed intake forms by email. However, professional ethics codes and guidelines around the use of technology in professional practice generally require us to inform clients of the risks of using electronic communications. We all have some amount of responsibility to at least inform clients of the risks of emailing their completed forms to us if not proactively counsel them on the risks involved.
As such, a proactive approach to helping clients get those forms to you securely can help prevent harms. Options include a secure contact page on your website, encrypted email, a client portal on your online practice management system, or simply asking clients to print the forms and bring them to the first session by hand.
At Person-Centered Tech, we encourage therapists who like to get forms filled out ahead of time to use one of those methods.
Offering Self-Help and Other Therapeutic Materials Through Your Website
Bibliotherapy can happen anywhere!
It can be handy to offer handouts, recordings (such as relaxation scripts, guided meditations, etc.), and other materials for clients to use through your website.
We know of at least two potential concerns to be addressed:
- Copyright, if you use others’ materials
- Confidentiality, if you use examples from past clients
Most of these issues come down to the very important fact that anything you post on the public Web is legally considered to be published, much like if you put it in a book or magazine. A new aspect of the modern connected world is the need for the average person to think like a media producer thinks – do I own the copyright or have permission to publish this article/photo/handout? Who is the creator of this piece, and can I contact them for permission if I wish to post it? Etc.
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Copyright
Make sure you own the copyright or have permission from the author to post anything you put on your website. Common gotchas around therapist websites include:
- Posting useful handouts received at continuing education trainings. Do you have permission from the author to publish these on your website? Presenters commonly give permission to copy handouts for use with clients, but that is not the same as permission to publish the handouts. Even if they are only on the site for clients to download, they are certainly considered published if the client doesn’t need a password to download them.
- Reposting articles found on other websites or via email. When information is easily and freely available, as it is online, it can feel like that information is not protected in the same way that information in a magazine or book is protected. Legally, this is not the case. Articles found on other websites, photos found on websites or through Google Image search, and any other information you find online or in an email is all subject to copyright. Posting a link or attribution to the original article, photo, etc. does not protect you from liability for copyright violation. The advantage of this free flow of information, however, is that it may be easy to contact the original author and ask for permission to re-publish it on your own website.
Confidentiality
It is generally well known that we are ethically allowed to use examples of past client cases in presentations, consultations and publications so long as we “de-identify” them. “De-identify” means removing or altering enough details of the story that we could reasonably expect that no one will be able to identify who the client was. HIPAA also has rules regarding how PHI can be de-identified and thus legally published or sold to others.
The difficulty of using past client cases in articles or recordings on your website is that the highly public nature of websites sometimes makes it easier to identify who the client was despite your efforts to de-identify them. The client him or herself may read the article, or people close to the client could potentially identify him or her purely from the circumstances described. A common flaw in de-identification strategies is that although we change names “to protect the innocent,” those who can view a client’s social media presence (e.g. Facebook, Twitter, etc.), or who just know him or her personally, may be able to put the pieces together and determine who the client was from your article.
We encourage you to always collaborate with clients and get informed, enthusiastic permission before publishing on your website anything significant to their case. This gets the client involved and knowledgeable of what’s happening before potential hurts happen, and includes them in the process.
Resources
This article quickly made mention of a number of resources that deserve a little more attention. So here’s a list of recommended, helpful places to find the things you need for your powerful website.
Our Articles
- Email and HIPAA Compliant Practice: Is It Possible?: Our article about email includes a discussion of secure email services and using secure contact pages on your website.
- Therapy Website Legalities: “Posted” = “Published”: A further exploration of copyright and materials your use in your website
- Roy’s Top 10 Mistakes in Marketing Your Practice Online: A survey article on methods of online marketing, including information about setting up websites.
Secure Contact Tools and Services
- Hushmail is a secure messaging/email service that includes a feature whereby you can put a secure contact page on your website.
- Tame Your Practice helps clinicians get set up with Hushmail accounts and also with secure contact pages that help with initial contact and intake.
- Brighter Vision is a company that makes therapist websites. They offer an add-on that includes a Hushmail account and custom-made pages for your site that include secure contact and intake forms.
Many online practice management systems also include a “client portal,” which is an online space where clients can make contact and exchange files with you. If you’re interested in exploring this route, we recommend Rob Reinhardt’s excellent Cloud Practice Management System Review Series.
Roy, Great article as usual. One thing you might add that REALLY burned me as a newby web developer was the use of photographs from the internet. I ended up paying a great deal of money for using a copywrited photo. We are all used to social media and cutting a pasting pictures or links to our Facebook page. But when we do this to our for profit websites those photographers want their royalties. I now have a “only if I took it” policy on my site. The web host provides many beautiful photos that come with my subscription so I can use their photos or I can use my own. But I can’t go snag what may appear to be “free” photographs off the internet. I know this isn’t a HIPPA or Ethics issue, but it can be an expensive issue. It was for me. But a great learning experience (I guess.)
~Mary
Any thoughts on services like Adobe Echosign?
Thank you Roy. While all of your articles are so helpful, I found this one to be especially pertinent to my situation right now, and basic information that we all need. I have a question that may seem obvious to some, but if the client downloads the forms and then mails them back via snail mail, would this be a potential confidentiality problem?
Well, I’m glad then. :) I can tell you that it isn’t a HIPAA problem. For confidentiality, all the classic issues apply, of course. Snail mailing forms ahead of time is, so far as I know, a time-tested tradition.
Remember to share the article!
Thank you!
Interesting article with great information as always. During your office hours, you’ve said that once a therapist has given actionable advice, they have created a patient. I’m wondering if that holds true for offering self help materials? Like are therapists creating patients if they share an ebook on “5 Ways to Beat the Winter Blues” or something?
Hi Kat,
Great question! Since you’re a PCTS member, would you like to submit that as a question for Office Hours and Roy can gladly address your question in detail? You can submit questions here: https://dev-personcenteredtech.com/office-hours-home/submit-questions-for-office-hours/ (you’ll need to be logged into your user account.)
Yeah, you have to be thoughtful about how you approach those articles. Keely Kolmes has a lot on the subject of “media psychology”: http://drkkolmes.com/2010/06/28/an-introduction-to-media-psychology-for-bloggers-and-tweeters/
If I post a list of recommended books (linked thru Amazon), or article titles and authors and source–like an APA citation, or URL links to ted talks, ancillary websites, etc., do I need permission to do the listings (not the content of an article or extended quote, just a reference list)? Does doing this necessarily put me in the role of advice-giving with ethical and legal responsibilities? Can I put a disclaimer to protect myself and put responsibility on clients for what they choose to read/view/think/feel?
Hi Karen! Thanks for the thoughtful question. This is a great example of a question we can answer through our membership benefit “Office Hours.” Check out what membership with Person Centered Tech entails here!