Zoom compared to Secure-Mail as a virtual care platform
While Secure-Mail and Zoom play different roles in your virtual care system, they do overlap and compliment each other to support complete virtual patient management.
Introduction:
Zoom is a communication platform typically used for video conferencing that also supports voice calling. It is typically run through an application that is downloaded onto a user’s computer and can work through a web browser like Chrome or Firefox. It can be used for one-to-one or group meetings.
There are a few tiers of service available, all the way up to a HIPAA compliant version used for healthcare. Anyone can use Zoom for free with privacy terms that put patient privacy at risk by collecting private information for the purposes of sharing it with advertisers (only ever use the HIPAA version in a healthcare setting). The compliant version solves the data collection issues starting at $270/month, and as a paid subscriber, the people you invite aren’t’ required to pay.
Secure-Mail medical-grade email does not support video connections, but is built for file exchange (including any diagnostic imaging files), and asynchronous collaboration with colleagues and patients. There’s no need to schedule appointments. Secure-Mail works on any device, doesn’t require a download and is easy for new users to figure out right away – all they need is an email address. Patients and new professional users can be invited to have free accounts that are quick and easy to activate.
Integration:
Zoom states integrations with EHRs and medical devices but isn’t clear which ones beyond Epic.
Brightsquid Secure-Mail can send and receive messages directly with Telus HEALTH EMRs through an integration with Telus MedDialog.
Encryption:
Zoom does come standard with encryption, but it is important to remember that encryption is only one requirement of privacy compliance. Even encrypted messages transmitted over the Internet can be intercepted and decrypted. Compliance requires the ability to audit who accessed the data. Sending messages over the open Internet does not provide that level of certainty.
Secure-Mail keeps patient data safe inside a secure and compliant server that does not send information across the open internet. It is HIPAA compliant, PIPEDA compliant, and accepted for use under the HIA of Alberta.
Collaboration:
As much as video consults appear in the forefront of most discussion about virtual care, the reality is that the majority of virtual care in the world is conducted over text-based services. You will want to avoid many of the services used, such as traditional email and SMS, for privacy reasons. Text-based services such as Secure-Mail are excellent for many standard clinic-to-patient interactions such as collecting patient histories in advance of a video call to focus physician time.
Zoom is a collaboration platform that offers ad hoc and scheduled meetings for either groups for consultations with a care team, or one-to-one interactions such as virtual patient visits. This works for remote patient visits that require a real-time visual connection. The challenge with video visits is there isn’t a record of interactions outside of what is entered into the patient record after each visit and managing the video consultation schedule can be cumbersome.
Zoom is much easier to use and more reliable than applications we were used to a few years ago. But the technology can be out of reach for some limited by technical understanding and access to the hardware required to download and run, such as elderly populations.
Video might not be the best use of a clinician’s or a patient’s time. Secure-Mail messages can be sent and responded to as necessary/available. It is not a channel for urgent care, but can be used to manage many patient inquiries.
As a subscriber, you can invite anyone to have their own free Secure-Mail account. So no matter who you need to connect with, Brightsquid supports the exchange of information without requiring any scheduling.
Clinical file sharing:
Zoom does have the ability to share files through a live video meeting but not when the end-to-end encryption is turned on. So there is no ability to share files through a privacy compliant session.
When you communicate with colleagues and patients using your Secure-Mail account, you can attach as many files per message as you need. Up to 500MB per file. Recipients can view the files within their Secure-Mail account or download them securely. There is no limit to the amount of storage you get with your Secure-Mail account.
Files clinics typically send through Secure-Mail:
- Pre-appointment questionnaires
- Lab reqs
- Records
- Notes
- Treatment plans
- Imaging
Files patients send through Secure-Mail:
- Pre-appointment questionnaires
- Histories
- Photos related to complaints
- Videos of events not able to be scheduled to be seen in clinic or on a video consult, e.g. seizures, etc
Features:
Zoom for healthcare (HIPAA), comes with high quality HD video and claims quality maintains “even in low bandwidth environments” such as rural areas or during a pandemic when demand is high. This is helpful for examinations when an in-person visit isn’t possible, or to determine if an in-person visit is required.
Recordings of zoom appointments can be saved to a local desktop for transcription and review.
Secure-Mail has several features built for clinic communication with patients and other providers:
- Shared inbox allows clinic staff to jointly monitor and triage incoming messages.
- Read receipts show if and when a message was read.
- Message recall allows you to remove any message and its attachments from all recipients.
- An authenticated directory of professionals and patients helps you connect with the right people.
Privacy compliance:
Zoom is compliant when you use the HIPAA version. As long as you turn off some of their data capture mechanisms. Some regions might require additional paperwork, such as Alberta where Zoom would have to sign an Information Manager Agreement (IMA) to comply with the Health Information Act, and you will have to file a PIA amendment. They do not list IMAs on their site, only BAAs the American sort of equivalent (but I’ve submitted one to them for review and will update this article once I hear back).
Using Secure-Mail to share patient information and conduct virtual care is compliant with privacy regulations that protect patient information in the USA, Canada, and Europe.
Fee-for-service Reimbursements:
Zoom only qualifies for reimbursement in Alberta if you have completed a PIA amendment stating how you will keep patient information safe and submitted a signed IMA to the Office of the Information and Privacy Commissioner (OIPC).
Secure-Mail does qualify for reimbursement where codes for secure email or virtual exist. In Alberta you will need to submit a PIA amendment outlining how you’ll protect patient privacy (Secure-Mail is accepted by the OIPC) and a signed IMA which we are happy to do.
In Alberta, Secure-Mail can be used for codes: 03.01S, 03.01AD, 03.01O, 03.01R, and potentially more.
Is Zoom appropriate for virtual care?
The HIPAA version of Zoom is appropriate for care when appropriate and when patient access allows. There are several precautions to take before initiating a virtual care visit, such as making sure the patient is in a private location. Also, be sure you have the necessary documentation complete and submitted before you begin use.
Not every patient contact requires a video session. Secure-Mail was purpose built for virtual clinic communication with input from clinicians and staff. It was created on a platform that is proven to be compliant and facilitates communication with anyone at any time, from anywhere.
Create your virtual care system with the right tools.
Services like Zoom and Secure-Mail are both important parts of a complete virtual care program in any clinic. Secure email easily manages many basic and standard patient interactions. When an escalation to video is required, Secure-Mail helps patients and clinicians show up prepared.
Just like healthcare takes a team, you need a suite of tools to appropriately provide virtual care in your clinic. Secure-Mail and Zoom work well together with your EMR to do just that.