Episode 40 – Andrew Livingston Co-Founder Doxy Me

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Hello. And welcome to the Online Counseling Podcast – where we talk with online therapists and how online therapy has changed their practices. I’m your host, Clay Cockrell. It’s been awhile since we’ve had an episode, so I apologize for the delay. But one of the reasons is that I’ve been working on new series for the show. Now, one of the top issues that face online therapists is the decision of what platform to use when connecting with our clients. Now, if you’re a regular listener, you know that Skype, FaceTime, and Google Hangouts are all platforms that are not compliant with HIPAA. And while this is not an issue for our non-US therapists, there are also concerns with these platforms on encryption issues, these are issues for those non-US therapists. So what platforms are secure and compliant with regulations around the world? We wanted to find out, and then go talk to them.

 

CC: So our new series is going to be interviews with some of the creators of these platforms. And today we get to talk to Andrew Livingstone, who is a co-founder of Doxy.me. Andrew is currently in Germany, and I got to connect with him through his online therapy platform. And I have to say, it’s pretty impressive. The video is clear, the audio is clear, and it’s encrypted, and it’s compliant with HIPAA. And get this, drum roll, it’s free. Yeah, you heard that right. It’s free. And the free version comes with a business associate agreement. Now, that’s the document that allows it to be compliant with HIPAA, and it’s the document that most platforms charge extra for.

 

CC: Now, I’ve gotten to know Andrew over the last few weeks, and I have to say that he and his team over at Doxy.me are incredibly responsive. And their goal is really to facilitate the work of online therapists. They acknowledge the importance of telehealth, and they want to be of service as the field develops and grows. I’ve heard so many good things about them from fellow online therapist. And you know me, I always try and ask folks, what platforms do you use? And people will say, “Oh, I’ve tried this or I’ve tried that and they’re okay.” But it’s interesting, anybody who said that they tried Doxy.me were really passionate about them. It’s like once they found them, they never looked back. So I thought I gotta talk to these people.

 

CC: Now, again, I’ve been very impressed with Doxy.me, I encourage you to check it out. And Andrew has an incredible incentive to get you to try out their program, an exclusive offer for listeners of the podcast. So remember when I said the service was free, it really is. Everything you need really is included in the basic free version, but they also have a paid version that has several added-on features, not that you may need them, but they have this extra level that they charge for, and it’s called the professional level. Now, when you sign up for the professional level, you automatically get one month free trial, but Andrew is offering an additional two months of free use of the professional level, that’s a total of three months free for listeners of the Online Counseling podcast, that’s a $70 value that he’s giving away free, so I don’t know how you can beat that. And today in the interview, we talk a little bit about the differences in levels so, I mean between the basic level that is free and then the paid version, which is even, it’s pretty affordable when you get into it. So we begin to talk about those numbers in the podcast. And, of course, you can always check it out at Doxy.me.

 

CC: So in order to get that free version or the extra, all you have to do is send an email to Andrew, his email address is [email protected]. And DOXY is spelt D-O-X-Y.me, me, M-E. And put extend in the subject line and he will extend that professional from one month to three months, so that’s pretty easy too. And we’ll put all this in the show notes, so there we are. And as for the directory, we continue to grow, leaps and bounds actually, we’re doing quite well. Our new year-long membership has been incredibly popular, so we’ve decided to keep it running as long as we can, financially. And some therapist prefer the month to month program, which as a low cost, I think, of 24.95 a month, but the year-long membership does bring the feed down to around $12.47 a month, when you pay for the year, upfront.

 

CC: And I think there’s a lot of value here for the members. So please check us out, just go to onlinecounseling.com and click on List my practice to see all that we offer. Remember, we are a service created by an online therapist, me, for other therapists, you, with the sole purpose of growing your practice and bringing you new clients, and helping those clients around the world that are looking for a licensed certified therapist, we’re helping them find those therapists, so there’s that.

 

CC: So without further ado, ladies and gentlemen, Andrew Livingstone, co-founder of Doxy.me.

 

CC: Hello and welcome to the online counseling Podcast. I am very excited to have Andrew Livingstone join us all the way from Germany. Andrew, say hello. How are things there?

 

Andrew Livingstone: Hi Clay. How are you? Hello listeners. Things are good here, nice, sunny, no complaints, about 8 o’clock in the evening on Tuesday.

 

CC: Oh. Excellent. Excellent. Well, I am really excited to get to know you and have our listeners get to know you, because I’ve recently become obsessed with Doxy.me, and I’ve been playing around with it all day. Tell us a little bit about you and how you created this, how you got involved. Yeah, give us just a little background.

 

AL: Doxy.me was created by my business partner, Brandon Welch, he was a PhD student at the time, at the University of Utah, doing clinical trials for the prenatal women, and looking at how they would react to doing first, second, third trimester visits, some in person and some in telemedicine. And that was will they be happier, sadder, will it be more efficient? And the results were very, very positive, that they loved telemedicine even in the third trimester. And that’s sort of how it started, because he needed a solution for this study. And when he looked around, everything was either really expensive, like a Polycom or Cisco that universities and hospitals and big governments that do healthcare usually use, and those cost millions. You need grants, and they’re really complicated to use. They require special hardware and software.

 

AL: And the other versions available were really complicated to use, from a user experience point of view, both for the online therapy patient and the provider. And so he said, “There has to be something simpler available.” There wasn’t, and so we created what you see now, which is Doxy.me. We also wanted a free version, because we believe that anybody who wants to provide care should be able to provide care in cost to the technology, to do it shouldn’t be a challenge, ’cause care is a human right. And so we have a free version that we back for life, and if that’s all you need, you can use our free version forever. And as part of our commitment to helping telemedicine grow all over the world.

 

CC: Wow. So when did it start? When did Doxy.me start?

 

AL: Right around end of 2011/2012, we were in sort of private beta. There was a public version out. We didn’t really push a lot in ’12. 2013 was more research. At ’14, we had it out there, just the free version. And then what you see today really came to life in 2015, early 2015 and ’16. And we’re constantly… We have a goal to just keep things simple, so we’re always trying to make it simple.

 

CC: Incredible. Where did the name come from?

 

AL: Doxy.me means doc, like the doctor will see me. That’s where it came from. But Doxy is rooted in Greek. And so, for example, orthodoxy, and it means wisdom. And so we liked sort of the two meanings, like Doxy.me, like the doctor will see me, and also what it meant to be tied to Doxy, like orthodoxy, the Greek word. And so that’s where it was rooted from. And so I think the root word in Greek, it’s for knowledge, truth or wisdom. And we liked Doxy and Doxy.me, like doctor will see me, and it resonated, so we went with it.

 

CC: Absolutely. You’ve been pushing this thing for a year, a couple of years now, and that’s a very small amount of time. I keep hearing, and I’ve told do this privately, your name come up over and over. So online therapists will experiment with different platforms, but when they talk about Doxy.me, they talk about it with a brand passion. They love this stuff. They love the ease of use. So you’re doing something really right. People who stumble upon this and start using it, I don’t think they go back.

 

AL: Well, I’m grateful that you share that with us, and that people feel that way ’cause it’s really what we want. We want passionate users, who help spread the word that there’s a technology that exists that allows them to provide care on their terms and their patient’s terms, without a cost. And that’s really the big thing because healthcare is tough enough, and so if we make it difficult and we charge you money, it’s gonna be even harder. And so our goal is just to make things simple and it’s great to hear that’s resonating.

 

CC: Yeah, absolutely. So do you have any idea of how many users you have, currently?

 

AL: I do, and it’s not a number we give out publicly, but I’ll say it’s definitely over the 10,000 number, and 50% are in the mental health space.

 

CC: Really?

 

AL: Yeah. They were the early adopters.

 

CC: Oh, that’s good to know, that my fellow online therapists out there are early adopting something.

 

AL: They were. They early adopted because it was easy to use, and in a lot of cases, there was a requirement to have a visit with someone in the office first, they’d meet this way, ’cause they didn’t have to take blood or do other things that you might have to in a doctor’s office, where you’re getting a physical exam versus mental healthcare. Not to say that’s not part of the process, but it was mental health, social workers, care providers, a lot of non-profits in Texas who help children who can’t afford care otherwise, and they were covering 400 miles, now they could speak with people, so mental health.

 

CC: Absolutely. Okay. Well, talk a little geek to me. Talk about the encryption, HIPAA, the business associate agreement. Tell me a little bit about under the hood of Doxy.me.

 

AL: I’ll start off with the business associate’s agreement, ’cause we get asked about that a lot. In every account we have, every free account, under account settings, there’s a tab that says BAA, and we offer free business associate’s agreement, it’s already signed with my signature, and all you need to do is just type in your information. It’ll save there forever, and you can print out a copy for your records, but we wouldn’t be doing our job if we gave you a free solution that wasn’t HIPAA compliant. And so every free version, every person gets a BAA.

 

CC: Okay, yeah. That’s incredible, because a lot of the platforms that are saying, “We’re free to use for online therapy, but we’re now gonna charge you for the BAA,” and yours is…

 

AL: We see that. We see that and we hear a lot of feedback, and I think that I can’t speak for those brands, and there’s a lot of great companies out there, but it’s one of those things you do to get people used to it and then, “Oh, if you want to be compliant, then you have to pay for the BAA,” that just doesn’t sit right with us. So we said the BAA is required, we can’t make somebody pay for this, so we included it.

 

CC: Okay. And everything is encrypted?

 

AL: Correct. The geek a little, everything’s encrypted with what’s called an AES cipher, and so it’s 128-bit keys that encrypt the audio in the video, and it doesn’t go through a server like a Skype or FaceTime. What happens is that we make this secure, encrypted connection from your device to your patient’s device. So everything is 100% private.

 

CC: Yeah, it’s incredible. And so what I’m seeing now, we’re recording the audio portion of this, but the picture is crystal clear. And do you somehow reduce the picture, like if the Internet becomes a little clogged, are you monitoring that to make sure that this is going to have a really good connection, or is it just incumbent upon the user to make sure that they’re not using their broadband in other directions?

 

AL: It’s a combination of both, Clay. Were constantly… Our algorithm is monitoring the background to see what your bandwidth is and adjust the audio and the video based on your settings. But a lot of it really has to do with the user and we will give you getting started tips. And one thing is don’t have a lot of browser windows open, because they all use bandwidth on your computer, don’t be donating big files, or don’t be on shared wireless network. So there’s things you can do to make sure you have a good call with your patient. And if anything happens, we have a support team that’s there, almost full-time, to support your patients and you, as an online therapist, when you need help so you can focus on care and let us focus on any tech questions.

 

CC: Yeah, I found that really interesting that there is somebody there immediately, for any kind of customer support.

 

AL: And I won’t say immediately all the time, because if it’s like 2:00 in the morning, Eastern Standard time, you probably won’t hear back from this right away, but we have someone on the West Coast, and so you probably would get a message. And so we have people all over the world that are part of our team, and so we can keep responding, maybe there’s six to seven hours a day where it might take a little while, but most of the time, we get back to you pretty quick.

 

CC: Yeah. I also found it interesting. There’s a couple of different ways that different platforms out there are using. One is that the user, the therapist, and the patient need to download some kind of program, put something on their computer, it’s an extra step, and then we have to activate said program, set it up, put our information in, and then that program, I guess you kind of meet inside that program. Doxy.me is a little different. So talk to me a little bit, you create a room on the internet, there’s nothing to download, they can click a link, and boom, you’re right there and you’re connected.

 

AL: Yeah, Clay, we saw how much patients hated downloading something onto their computer, when it comes their private healthcare, so we made a pledge to make it easy, and we call it “click and connect care technology.” And it creates just a web address that the provider sends to a patient, patient clicks it and they connect right into the waiting room anonymously. Only the doctor sees their name and knows who’s there. We don’t have any knowledge, and we designed it that way. They’re not our patients. They’re yours, their care providers.

 

CC: Wow. So like I said, I’ve been playing around with it today. It’s really cool. You get to design your waiting room, make it nice, put up my logo, put my picture in there, the patient would click on that and they go to my virtual waiting room, and then I can be notified that they are there, and I can send them a message saying, “Hold still. I’ll be there in a few minutes,” that type of thing. That’s just a great little added sophistication, I think, to the whole process more conducive to online therapy.

 

AL: I appreciate the feedback, and we really tried just to keep it… How can we replicate the in-person experience? If somebody comes into your office, they’re buzzing the door, or the front desk person is gonna notify you. So we have notifications to let you know when the patient checks in. Waiting room design, it’s like you’re gonna have stuff and you’re waiting when you want your patients to see This is your virtual waiting room, so this is where you communicate experience, and how long until I’ll be with you, and what to do if I’m that online. And so it’s a really great place to customize, and every free account is able to customize their room with their own photos, their own videos, and their own text, they’ve got their hours, their prices, whatever they need to.

 

CC: That’s just incredible. And all this is free. People get this incredible program, it’s free. We’re gonna go into some of the bells and whistles of what comes along with the free and what comes along with the paid subscription. First of all, what about if I have a need to have more people than one on a call, how many people can participate in this?

 

AL: Up to three people can participate on a call, with three-way calling.

 

CC: Right. So I could do a couples counseling and the husband and wife don’t even need to be in the same area, we can all hear and see each other.

 

AL: Correct, and it’s interesting you bring that up. That is actually a big use we see with people who do couples counseling, is that it’s so hard to have both people in the room at the same time. This has been working better, and maybe schedules are easier, and so the wife, when they can’t get in. So we see this, and it’s helped, ’cause they can all see each other, but you don’t have the physical energy there that you do when you’re in person.

 

CC: Yeah, absolutely. So let’s talk a little bit on the free version. We get the audiovisual, you’ve got the capacity to do three-way call, you have to go to a waiting room, what else comes with the free version?

 

AL: You get a personalized URL, and so your address that you send the patient. So it’ll be www.Doxy.me, if I was the doctor, /Dr.Livingstone. You get browser notifications, so when a patient checks in, you get an on-screen notification and a sound. We also have an iOS app for iPad and iPhone, and you’ll get push notifications on there too if you have it opened an on, and same with your Chrome. And so there’s browser notifications, the verified BAA, and the waiting room, and we also just added badges. And so badges are a little snippet of code that your IT folks or if you design your website, you can cut and paste and there’s a video that shows you how to do it, that creates a button, that when your patients come to your website, it’ll say they can click it and check into your waiting room. And so it helps you promote the fact that you now offer telemedicine.

 

CC: Wow. So it’s like that they are connecting through your website. I talked with an onlinetherapist in Atlanta that had this, that it was just seamless, that she had a little button on there and people clicked, and it wasn’t like they were going to Skype or FaceTime or something. It was on her website was her virtual office as well.

 

AL: Exactly. And so the reason we do this is because we find patients, you wanna be open to allowing them to connect how they normally would. They would go to your website in the email contact form, in this case, they can check in. And in a lot of cases, people will attach on some of the paid versions, maybe the front desk for admin person to it, and so they can get some of the information you need for the EHR or EMR when they start, but we try to really think of the office workflow when we design this.

 

CC: Okay. I’m sorry, I interrupted you. So what else comes with Doxy.me?

 

AL: So that’s it. And also when you sign up for the free version, it is forever, and there’s no strings attached, no advertising, we don’t sell your data, none of this, and you get exceptional customer support. And so whether you’re free or paid, your support level is exactly the same, and that’s important. Now, the big accounts might have a dedicated team for all their users, but you get access to the same real-time support that they do, and there is no difference in wait time or anything. So I think those are the advantages, and you do get 30 days of our paid features for free when you sign up, and so people can try and see if they need any of that. If not, the free version, we have folks who’ve been using it for years, and that works just fine for them.

 

CC: Okay. Let’s talk about the paid version. What extras do you get?

 

AL: There’s two paid versions. I think the one most applicable to your audience is probably… I don’t wanna say, it could be. There’s a professional version, which is $35 a month, and what’s included in that is the three-way calling. You can take payments, live payments from a patient when you’re on a call, co pay or cash pay, the ability to share your screen with the patient or request access to this; maybe they’re showing you notes from another doctor. You can send files to your pain, maybe you have to get them to sign a consent form, and you can request them back. And then you get text and email notifications when a patient checks in. And this is all in our professional account, which is for one user, a single provider, and it’s $35 month to month. And there’s no contracts, we don’t believe in contracts. If you’re not happy, you tell us, and we cancel. It’s really simple. We don’t make things difficult. So if you pay for the year in advance, it drops the price to $29 a month, on average, but we don’t steer you one way or the other.

 

CC: Okay. And then you have an online therapy clinic version.

 

AL: Correct. And this is for anybody who wants a branded solution. It’s for more than one provider. We have folks who have just two or three users, and then we have folks who have several hundred users, or a thousand users on there, like a large hospital or healthcare system. And it has all the features that are in the professional, plus you get the ability to give access to your room, so sort of shared workflow access. As I was mentioning before, let’s say a nurse or an admin or a PA or MA sees that patient before you do, which is a normal workflow, you can attach somebody to your room, so they can see the patient first, put them on hold, and then the doctor can pick them up. You get a personal subdomain, so it’s the name of your practice.Doxy.me. And it’s just really easy, and then you have somebody you can call at all times. All of our other support is really done online, the instant chat message, but on the clinic version you’ll have someone you can phone if you need to. We don’t find a ton of support needed.

 

CC: Yeah, I would imagine. And the cost for the clinic version?

 

AL: So it’s $50 per provider, per month, no contract, and there’s a one time setup fee for branding, customization for the whole account, not per provider, a one-time fee of $300. And if you pay annually, it drops to 50 or 42 per provider, per month. And if you have 50-100 providers, we do offer discounts for scale. We have some large organizations that have 500-1000 users, and we work with them on the price, so that’s not a problem at all.

 

CC: Okay.

 

AL: But I think people like it ’cause it’s simple and there’s no contracts.

 

CC: Yeah, that’s incredible. I’m sitting here thinking I pay almost $2000 a month for my office in Manhattan. I know the people in Kentucky or somewhere else are gonna pay a little less than that, but it takes a chunk out of my budget every month. You were saying that for free, or if I want $29-$35 a month, even $50 a month, it’s a lot better than $2000 a month.

 

AL: It is. And it’s not to say this replaces in-person visits. You probably still need… You have patients who aren’t gonna wanna do this, they wanna see you, but it does help. ’cause maybe then now you go to a a shared office space instead of a dedicated one, where you use it a couple days a week for those clients who wanna see you in person. We see a lot of that, and we see professionals who maybe wanna move to a different part of town and still take their clients. There’s a lot of different reasons. They help reduce online therapy no-shows, a lot of people call and cancel the last minute, weather. Well, now you can say, “I have a HIPAA-compliant way for us to meet.” It helps you reduce revenue for cancellations. So everyone’s got their own reasons for needing it. But the truth is, it just helps. And I also recommend, don’t go spend money on this right away. Just use the free, get used to it. If that’s all you need, just use it. There’s no rush. It might take a month, it could take a year, it’s up to you. But it’s not gonna go away, that’s why we wanna support the industry and the product.

 

CC: Yeah. So tell me a little bit about what you were seeing, trends in telehealth and telemental health. I imagine you’ve got your finger on the pulse of how things are changing and growing. What are you seeing learning from being in this space?

 

AL: We’re seeing the need to keep things simple, from a provider standpoint. And by simple, I mean there’s no need to change the way you do things, just because you’re offering telemedicine. And we see a lot of solutions suggesting you need their scheduling system or their EMR, or you have to switch, and it’s really not needed. Simplicity is the key, and don’t change the way you schedule, don’t change the way you bill, just put in the telemedicine CPT cards, or if it’s a cash pay. But the simpler you keep it, the easier it’ll be for patients to adapt to it. And we also see the folks succeeding in this, they educate the patients about what the experience is gonna be, just like you when they walked in the office. “This is what a waiting room for, is online therapy. I’ll be with you in 10 minutes. If I’m not online, you can call me here.” So just setting expectations like you would expect as a customer in any business, where you are getting a service.

 

AL: We’re also seeing groups of care providers to come together, virtually, which is interesting, so they might sort of team up with folks all over the state, and maybe they will create a website. And now with the power of telemedicine, they’re able to have this sort of virtual clinic for mental health. Whereas as you mentioned before, the cost of doing a physical office would be really expensive and they’d have to sign leases and guarantees, and they can do the same thing with less risk and they can combine the power of their contacts and their expertise in some cases.

 

AL: We see a lot of feedback or hear a lot of feedback from providers that using telemedicine gives them a unique window into their patient’s world. They get to see into the home or office that they’ve never seen into before they’ve heard about, maybe it’s accurate, maybe it’s not, but it opens up a different point of view. And maybe some of them are now asking their patients, “Hey, why do you take me to the bedroom? Why don’t we go to your office that you told me was clean,” whatever it might be. I think they like that, and especially with kids, kids have been a lot more receptive to speaking with the therapist when they’re in the comfort of their room or closet, or bathroom, whatever is their safe space, wherever they feel comfortable, versus the care provider’s office.

 

CC: Yeah, fascinating. It certainly is changing the online therapy industry. I think what you had said earlier when we spoke last week was that you were not really going to providers and saying, “This is a disruptor, this is something new.” This is just an adaptation, I think was the word you used, or augmenting.

 

AL: Yeah, augmenting. It’s just adding a couple of extra lanes in the freeway of healthcare to just take some pressure off where it’s been hard to provide care because of physical limitations. This allows you to open up your mind and your care to people when it’s easiest for them. And especially these days, everybody’s so busy, time is valuable. You don’t wanna have to drive or get a babysitter for the kids, or take time off work. And if you could do this on a lunch break from your car, well, why not?

 

CC: Yeah.

 

AL: And so it takes some of the pressure and stress off too, and especially in the mental health space, the wellness space, the West pressure the patient has, the better it is for the care experience. And so we just try make it and keep it simple. But no, we’re not trying to disrupt or change, we just wanna help, augment, just help. Add one more tool, a simple one, to the care provider’s pocket, that is literally in their pocket when they need it and a patient is in need.

 

CC: Yeah. Well, it’s an incredibly well thought out platform. It’s simple, certainly effective, it’s easy, and of course it’s new, for me. So it was just fun to play around with today. So you’ve done an incredible job creating this.

 

AL: We appreciate it, but we like bad feedback too, we like all feedback, and it’s how we learn, is that, and I will say, all the owners of the company, myself, CEO and co-funder, I spend hours a day on customer support because we always wanna have the ear of our customer, we wanna know what’s going on. So for anyone listening, you might get me, and that’s cool, and it’s great for me because I learn. I learn every day from the providers, how we can improve and make this better and simpler for them and for their patients. And so we love feedback, good or bad or in the middle, it’s the only way we can make it simpler.

 

CC: Yeah. Well, congratulations. I’m hoping that our listeners will certainly check you out. It’s Doxy.me, it’s easy to sign up with a free version. It just took me maybe 30 seconds, and boom, I was there. So check them out. And Andrew, thank you so much for telling us a little bit about it.

 

AL: Thank you, Clay, I appreciate your time. And thanks to our audience for their time, and have a great day.

 

CC: You too.