Hello, and welcome to the Online Counseling Podcast. My name is Clay Cockrell. I’m glad you could make some time for us today to talk about Online Therapy. If you are a regular listener, you know that we are a podcast that is dedicated to learning how technology is changing and enhancing psychotherapy. Our goal is to educate and inspire online therapists from all over the world to expand their practices by using tools, and to do this in an ethical, legal and responsible way. With that in mind, we’ve started a new series where we interview some of the available platforms that therapists can use to connect with their clients. I think, by now, we all know that using Skype, and FaceTime, is not the way to go. Yes, our clients are familiar with these platforms, and sometimes they’re willing to use them, but they are not compliant with HIPAA. Now, of course, HIPAA is a law that applies to psychotherapists and other medical professionals in the United States, but I’m hearing from more and more non-US therapists who have expressed their concerns regarding the safety and encryption of these common services. So, this series is exploring the features of HIPAA-compliant platforms, with the idea of creating a list of resources that therapists can use with confidence.
CC: A few weeks ago, we explored doxy.me. And, today, we get to talk with zoom.us. And I’m really excited to share this very popular application for online therapy. But, before we do, let me give just a little education about HIPAA. And I learned this from my good friend, Roy Huggins, and he is a guru in this area, and you can find out more about him at personcenteredtech.com. And he says a platform cannot be HIPAA-compliant, because HIPAA doesn’t apply to platforms, it applies to health professionals. So a health professional can be HIPAA-compliant when using any platform, as long as that service offers what is called a Business Associate Agreement, or a BAA. The thing is Skype, FaceTime, etcetera, they don’t offer the BAA. Only the programs that we are exploring do that. It’s a nuance thing, but I think it’s important to be aware of. And Zoom, like doxy.me and VC and others, they offer the BAA.
CC: We are simply a listing service. So our goal is to connect online therapists with clients, and then you take it from there. These other guys are corporate-based, have an incredible amount of funding, and are profit-driven, while we are a grassroots organization created by a therapist, for other therapists. Our whole goal is to help grow your practice and to help the industry move forward. So check us out at onlinecounseling.com, and click on list my practice to learn how you can get your practice more exposure. Okay, end of commercial. On with the interview. From zoom.us, we get to talk with Derek Pando, who is in charge of the telehealth portion and outreach for this organization. He’s incredibly knowledgeable, and really generous with his time, and I think he does a great job of breaking down all of the great things Zoom has to offer. So let’s jump right in.
CC: Hello, and welcome. I’m really excited today to continue on our series of exploring some of the HIPAA-compliant platforms out there available for online therapists to use in their online therapy practice. And, today, we get to talk with Derek Pando of zoom.us. Derek, thank you so much for joining us.
Derek Pando: Clay, thanks for having me. Really excited to be here.
CC: Good, good. So tell me a little bit about your position at Zoom.
DP: Sure. So I work in product marketing, so I get the chance to work very closely with our marketing and our product teams as we think about how we make some better… Our strategy, as well as some… My emphasis is healthcare, which is probably the reason why you and I get to chat today. I’m actually relatively new to Zoom. I’ve been here for a few months, but it’s been a really fun ride so far, and happy to be here and tell you more about it.
CC: Excellent. Very good. Well, thank you for spending some time. I guess let’s just start into the history of Zoom, and when and why was it developed.
DP: Yeah, for sure. And I think our history, especially, is important to kind of understand where we are today. And the history is actually a big part of why I ended up deciding to come to Zoom. But our founder is, again, Eric Yuan… And he was one of the original engineers for WebEx, the web conferencing software, which was acquired by Cisco. And he stayed on at Cisco for a number of years, and become the head of engineering for over 800 engineers working for Cisco. And he… When I hear him tell the story, he talks about how he didn’t ever really feel super-great about the quality of the product they were building, and so he went to his leadership and kinda proposed to start from scratch. Video is really hard to do right, and he wanted to kinda start from the ground up, re-architect everything to create a better video conferencing experience. And as you’re probably guessing where this story is heading, they said, “No”. And so, he left, was followed by 40 engineers, and started Zoom about five years ago.
CC: Wow, just five years.
DP: Yeah.
CC: Okay.
DP: 2011. Five, six years ago.
CC: And, in that time, how has it grown?
DP: For the first two years, they didn’t even actually launch a product, they were just trying to develop it, going back to the difficulty of getting it right. And then once they did launch it, probably the best way to describe it is explosive, right? Video conferencing, by its nature, is a viral experience, in that you use it with someone else or lots of people. And so, after they publicly launched the product, and especially since we have a free version of the product, it just caught on like wildfire. And I’m in marketing, so we constantly have to update the number of companies that are using Zoom. And it’s like, every other week, we have to update that number, and it’s now up over 600,000 companies.
CC: 600,000 companies.
DP: Yeah.
CC: That’s phenomenal. In really just three or four years here, this is becoming one of the go-to platforms out there. And I keep hearing from therapists that use Zoom, and… That it’s becoming more and more prevalent in online therapy.
DP: Yeah, yeah. It’s definitely… The growth has been overwhelming, and we think it’s ’cause people like it. So, hopefully, that continues. And, as we make it better, we can even get more… More people to use Zoom.
CC: So let’s talk a little bit about how does Zoom work. A couple of things. Is this a downloaded app that I and my client both need to download something onto our computer, or is this a clickable… Like an encrypted room online?
DP: So it is… It is a downloaded app, whether it’s on your desktop or your mobile device. And the reason why that’s the case, it really goes back to the architecture, and when we were learning how can we create the best experience, having an application on your phone or device was the way that we were able to keep the highest quality. And it’s a pretty lightweight download. It’s not complicated or take up a ton of space on your computer, but if you… Yeah, if you wanna do a Zoom meeting, you just got to have a quick download on whatever device you’re on, whether it’s Mac, PC, or Linux, or mobile device, and you’re off to the races.
CC: And you work across all browsers?
DP: That is a good question. All the major browsers supported. I’m sure, in our support site, we have… Clarify exactly which versions, but the major browsers are supported.
CC: Okay, great. So, with that… Looking at how it works, do you… And again, I’m not a technical guy, so help me out here.
DP: Okay.
CC: I’ve heard of other online therapy platforms, that they will reduce the amount of information. Like say, I’m talking with a client in Guatemala, and maybe they don’t have a broadband. And some platforms have the ability to maybe reduce so that the video is maybe not HD, but it’s good, and I would never notice it, but it’s… You know what I’m talking about. Pick it up from there.
DP: Sure. Yes. Yeah. I think there’s two kind of key components of our architecture that allows us to be reliable, high quality, and then what you mention, work on low-bandwidth situations. One of it… The first part is what we call multi-stream technology, which is what you described. So imagine you’re on a call with six people, and one person is calling from their phone on the top of a mountain somewhere, and they have very weak bandwidth. We’re constantly gonna be optimizing, and not necessarily playing to the lowest common denominator, in the sense… Just because that one person’s having a poor experience, ’cause they’re bandwidth is low, does not mean everybody else will…
CC: Ah, okay.
DP: Which a lot of online therapy providers can’t do, they can’t make those adjustments on the fly. Another great example of this is to say you’re talking to three people, and you started sharing your screen to show something or to share a video, or whatever, your video… The video of that person’s gonna go to a thumbnail, right? To make space for seeing the whatever it is you’re sharing. We automatically adjust the bandwidth needs for that thumbnail, ’cause now it’s less, and so, we wanna free up the bandwidth to be able to focus on what’s taking up the most space on your screen.
DP: So, the bottom line is the multi-stream technology allows us to just optimize in real-time and operate at a much lower bandwidth than you might think. The second part of the architecture is it’s distributed, which means if you are talking… We have servers all over the world, and if you’re talking to someone in India… Say there’s three people in California, six people in India, a lot of video conferencing systems will route everything through California, right? And, obviously, if you’re in India, that is gonna create a little bit more lag, and impact the quality. Whereas, what we do is we will run concurrently through our Indian data center and in California, so that the people are drawn to the data center that’s closest to them, that will enable them to have the best experience. So, at a high level, those are kind of… Couple key parts of our architecture that enable us to have higher quality for the online therapists we serve.
CC: That’s interesting. I spoke with the president of the Chinese American Psychoanalytic Association several months ago, and she… It’s a group of Americans who speak Chinese, and they’re working a lot with Chinese therapists. And they particularly said that they use Zoom a lot because there were two independent servers in China, one in the north of the country, and one in the south, and that the connection was really good. So you’re saying that that’s what we’re talking about here. We’ve got servers all over the world.
DP: Yup, that’s what we’re talking about. So, yeah, if they’re meeting with people in other parts of the world, they will be routed locally through the China servers, and other people will be through other ones. So, yeah, that’s part of our secret sauce.
CC: And one of the things that… And we’re gonna get to all the bells and whistles of what Zoom does, but just because you mentioned having multiple people on a call, I know a lot of therapists are listening, and they’re going, “Hey, this might work for me when I’m doing group therapy, or when I’m doing marriage counseling, and I have… The husband and wife are living in two different areas. So, on the free version, are you able to have multiple people on the platform, or is that more on the paid?
DP: Yes, yes. So, on the free version, you can have multiple people, and the limits on the free version is gonna be length of time. So if you wanna have… We cap it at 45 minutes on the free version, for multiple people on the call. If you have… It’s a one-on-one call, it’s unlimited, but… Yeah. So you can do 20, 30, 40, 50 people on a group online therapy session on the free version. It would just… You would hit those time limits.
CC: Okay. So you hit 45 minutes, and then it cuts out?
DP: Exactly. Exactly.
CC: Alright. So let’s talk a little bit about telemental health. It seems Zoom is for everybody. People are using it to connect with family and friends, and certainly, for business video conferences, but telehealth… Telemental health online counseling is certainly growing. What are your experience with what providers are saying, and how Zoom meets those needs?
DP: Yeah. So, we’ve seen one of the… There’s lots of barriers that have probably slowed the growth of telehealth more than people like you and I would have liked to have seen over the past years, since it’s been technologically possible. We think part of that is difficulty to use, right?
CC: Yeah.
DP: If… Our founder… I was listening… Our founder, Eric, and our CEO was talking about how a lot of people tried to persuade him not to start Zoom, and they were saying, “Look, there’s already like 20 options. You have WebEx, you have Skype, and the list goes on and on.” And what he said was is he went and he got all of those products and tried to use them, and described how difficult the experience was, even for him, using a lot of these products, and that’s part of what made him confident that even though there’s a lot of people doing this, he could still be successful. And so I think when you think of… Ease of use is definitely one of the challenges that we try to address as we’ve built out our product, is to try to make it simpler and more intuitive, so that people who maybe they don’t have a ton of experience with video or even using technology, they can figure it out.
CC: Okay, so ease of use. And are you seeing the telehealth space growing?
DP: Yes, yeah, when we look at… We looked at who’s using our product, to what industries, and stuff, I think part of what’s driving our growth in healthcare is we’ve seen the telemental health adoption, everything from big companies like BAYADA, do things like home health, or small… Hey, I’m an online therapist and I do everything on my own. I’m a one-man or woman show. We’ve seen growth in both of those areas. And so, that kind of led us to start to develop this space and build features specifically for that use case. We really hope that we’re gonna be a catalyst to help drive it forward. The easier we can make to use the product… The better we can make it to work in low-bandwidth situations, we wanna be part of what drives telehealth forward.
CC: Absolutely. Absolutely. And are you getting any kind of feedback, from online psychotherapists, specifically, about… Is this meeting their needs, or do you not necessarily get that granular on the feedback that you get?
DP: Yeah, we definitely… We try… Our philosophy, as a company, is to make our customers happy, and part of that is being willing to listen. And so, I was at the American Telehealth Conference in Orlando a few weeks ago, and I had the chance to talk to a lot of different ways that… A lot of different companies and individuals that are in this online therapy space. And what I was actually surprised about was I saw a lot of kind of smaller organizations. You’re not these massive companies but, hey, we’re a group of five therapists. The behavior health was definitely an area of interest, ’cause I think, in some ways, the barriers are lower in behavior health, and that’s made it an area that we’re really excited about. We’ve seen a lot of our customers get excited for.
CC: Yeah. That’s a good point. The barriers really are low for my field, in that… Compared to a medical doctor who’s going to need ways of writing prescriptions and blood work, and all that kind of stuff. We don’t need that.
DP: Yeah, yeah, I think the physical… Some of the concerns around the physical examination and things like that… Yeah, you guys don’t… And even… I was reading an interview with one of our customers, they… Called Bright Heart Health, where they do eating disorder counseling, and they brought up a really interesting point in behavior health, in that if you were meeting with someone face-to-face, and if you were watching them the whole time, they’d probably… If you were making eye contact the whole time, they’d probably be like, “Okay, that’s a little strange. Maybe I feel a little uncomfortable.” But, in a video setting, that’s totally appropriate, right? To be able to…
CC: Yeah.
DP: To very… Scrutinize their reaction and the look on their face and their body language, and even… Also, if you record it, you can go back and say, “How did they respond when I asked this question and they were sharing this experience?” So I think that’s another kind of unique aspect when it comes to video conferencing and behavior health that will hopefully make it so that you and people that are helping push it forward will continue to be a bigger part of telehealth overall.
CC: I tell you what, I’ve been talking about this for years. I’ve been doing online counseling for a long time, and that had never occurred to me. This idea of if I made just zombie-like eye contact with somebody in my office, it would feel really weird, but when I am in an online therapy session with somebody, I’m looking into the camera, I’m looking into the screen, watching their face, that separation of a computer screen really does allow a deeper intimacy, to a certain degree, because we are making consistent eye contact. Yeah, I just learn something every day. That’s a good point.
DP: I’m glad, and I wish I could take credit for it, but it’s one of our customers who shared that with me. And, in that same interview, they talked about the environment as well. If you’re sitting in your living room, there’s some barriers that are gonna be let down, versus if you are in someone’s office. And then even add to the amount of stress that is reduced from running to a meeting, or having to go in person, sitting in traffic, like all the things that can happen that will inevitably impact your experience as you talk to them can be minimized in a lot of situations, through video conferencing.
CC: Okay. Yeah, absolutely. So, okay, let’s talk a little bit about the specifics of Zoom. First of all, it’s encrypted. Do you offer a business associate agreement so that therapists can be compliant with the HIPAA law?
DP: We do, yeah. Now, that, it is a minimum $200 a month spend, which translates to about 10 licenses, for us to take the extra liability of signing a BAA, but we do, and those are for our business licenses, for small and medium-sized businesses.
CC: Okay. So, on the free version, there isn’t the BAA.
DP: That’s correct.
CC: What do you get with the free version? Obviously, you said 45 minutes for a group session, and then unlimited time for one-on-one. What else is available?
DP: Yeah. So the free version is actually full-featured, right? Like you have the same security options, the same video quality. You can have up to 100 participants on the free experience. The… I mean, really, the limit is the time. And then also there’s some enterprise features, like if you have what’s called a single sign on, like if you’re working on maybe a little bit larger company, and you have lots of different software logins, they have something called single sign on that consolidates it, integration into like… Things like that are paid, and are business and enterprise licenses. But we tell people all the time, like, “Hey, just get the free one and beat it up, and you’re experiencing 99% of what there is in Zoom.” And, hopefully, it works out well, and if you have needs of doing group meetings or over 45 minutes, then we’d love for you guys to become paying customers, but if free meets your needs, like we… Even… I don’t know if you’ve seen the virtual backgrounds, where you can put a green screen behind you, and then you can make the background whatever you want it to be, right? You could make your apartment in New York look like a huge office, or the Himalayas, or whatever you want behind you. And that’s all part of the free product as well.
CC: Oh, okay. So what is… Is there levels to go up, as far as monthly membership?
DP: Yeah. So there’s the basic, which is our free experience. Then there’s Pro, which removes the time limits, which is 14.99, and then there’s the business license, which is 19.99 a month, and that’s the license where you would use if you wanted to sign a BAA. And lots of different kind of options, in terms of audio, and having, and having company-specific branding, and things that you can imagine would be more part of a company. If you want Zoom to help represent you publicly, as part of a company, ’cause you’re engaging with customers frequently, that will help you shape it the way you’d like it to be.
CC: So we’ve got three levels: One is the free, then Pro at 14.99 a month, really affordable, and then the business level at 19.99 a month, and you can get some branding that goes along with that. Where… ‘Cause I guess I got confused on the $200 for the Business Associate Agreement.
DP: Yes.
CC: Tell me where’s the $200 figure coming in.
DP: So that’s… You have to have… So, to have a business license, you have to have a minimum of 10 hosts… Or you have to have 10 licenses, essentially, which means you’ll be spending 200. So, basically, if you get the business license, you’re gonna be able to have 10 people that are scheduling meetings, which means you’re… The minimum spend’s $200, and, with that, we will sign a BAA.
CC: I see. Okay. So it would be like if I had a group practice, and I had 10 people…
DP: Yes.
CC: In my group practice, each paying, each of those 10 sign-ons would be 19.99. That’s gonna add up to that $200 figure.
DP: Exactly.
CC: And that’s when the business associate agreement, that’s when you go into an agreement with that level of business.
DP: Correct.
CC: Ah. That clear up, ’cause I was going, “He said 200, but I don’t know where that went to.”
DP: Yeah, and there’s… If you’re a one-man show, and if you were to buy 10 licenses, we would still sign an agreement, a BAA with you, even as an individual. You just have access… That’s why I kind of put it as a minimum of $200 a month spend.
CC: Yeah. Yeah, that makes sense.
DP: Because, yeah, it’s fine. You don’t have to have 10 people in your online therapy practice for us to do that, but that’s just where our business license starts, and where we’ve… When we think of the extra liability we’re taking on with a BAA, that we’re able to sign.
CC: Absolutely. Absolutely. So, now I did… Now I’m remembering, now that you’ve clarified this, I saw on one of the forums in the industry, in the psychotherapy field, somebody had mentioned this 10, had said, “Would it be possible for 10 of us, we’re one-man shops, we’re gonna get together and we’ll go in together and buy a… I guess, the business level. Is that something that you would do, 10 independent people coming together and buying something like that?
DP: You know what? I don’t know. I would have to check. My guess is… And please reach out to me or our support organizations to confirm, if some of your listeners have questions… Is that could potentially work if you guys have a common corporate structure umbrella or parent company. But the BAA is between us and a corporate entity, right? So if you guys are all separate and have your own organizations, maybe some of you are sole proprietors or LLCs…
CC: So that workaround would not… Not be advantageous to Zoom, ’cause you’re just signing 10 separate BAAs with 10 different people.
DP: Yeah, but, like I said, I’m not 100% sure. I’d probably need to check with our legal team to make sure, but…
CC: Okay. Alright. So anything else we need to know about your different levels and what you offer?
DP: I think that’s kind of the… There’s a lot, where there’s very feature-rich products, so that’s what I’d call the high 10,000-foot view. But I think, for your listeners, it’s important to know that, “Hey, they can do so much with just the free experience. And so, if they’re thinking about it, they should just get on there and test it. We don’t limit the features for the free experience.
CC: Yeah. Absolutely. Okay. So what are your thoughts on how the industry is growing? Telehealth, telemental health. We’ve touched a little bit about it, but it seems that it’s becoming more and more common. And what is your take on this?
DP: Yeah, I think back… I think, about three or four years ago, I spent a summer in-between my first and second year business school, working for a VC firm, and we evaluated a telemedicine dermatology company, and I remember, at the time, thinking, “Okay, the inflection point’s got to be soon, like this is gonna just become so prolific.” And fast forward to when I joined Zoom, and started to look at this industry again, I realize that I don’t know if that inflection point happened when I thought it would, when I first looked three or four years ago. I would describe the growth as… From my perspective, as consistent, but maybe not the hockey stick up into the right curve quite yet. And I think it goes back to some of the things we’ve discussed. I think there’s been technology issues. I think there’s been legislation issues, like I just saw this morning that Texas finally passed a bill, so that you don’t have to meet with someone in person before a physician could start…
DP: Could start… I think maybe the 46th state to pass that bill. And they’re a big one, and the one with a massive… And I’m from Texas. I grew up in Round Rock, in Austin. There’s massive rural needs from a… From a medical and a behavioral health standpoint. If you live in a rural city in Texas, you’re not gonna drive 100 miles, twice a week, to visit your therapist. And so, I think we’re making progress on a legislative front. And so, I’m definitely more bullish on the next year or two, is when we see that. And then also to the explosion of technology with smartphones. There are people who are not comfortable using a desktop device, but they’re completely comfortable using their phone, and that… I think that’s gonna continue and will enable the growth to accelerate. So bottom line is, I’m very bullish, a little sad I didn’t see the inflection point, ’cause I think it’d be great for people on the provider side for online therapy, and also for patients, but, yeah, it’s going.
CC: I think so. I think that we have certainly reached a point to where this is becoming more and more common, and it’s being asked for by the clients. And I know the listeners have heard me talk about this before, is that so many of the therapists that I talk to say that they got into behavioral health, telemental health because their clients have asked for it.
DP: Yeah. And I think… I think, as I was kind of prepping for our discussion, Clay, I thought about a family member of mine who I know is meeting with a therapist over video conference, and the biggest reason why was traffic. It’s… He couldn’t get to where he wanted to visit with his therapist because traffic in the area that he lives, in a major metropolitan area, like every major metropolitan area in the US… So even though you’d look on a map and say, “Oh, of course you can come in, no big deal,” traffic is part of it.
CC: Yeah.
DP: I think another… A customer of ours, when I was kind of reading their story, I think another thing that was driving using therapists over video conferencing was just how many more people are working these days, and the difficulty of leaving the office. Whereas, yeah, you can find a conference room for 30 minutes and jump on your laptop and get the attention, the help that you need. And people are thinking like that now because they work remotely, so they’re like, “Wait, I can work remotely. I can do this for my job. I should be able to do this with my healthcare provider. So I think, a little bit at a time, we’re getting trained through other experiences, and through uses of other technology, to ask for it, for us and patients to say, “Hey, I’m gonna be traveling, but can we still meet?” And so, I think it’s coming from a lot of different angles.
CC: Well, I’ve been impressed with Zoom. I think that it’s a really powerful tool, and the online therapist that I’ve talked to, that have been using it, are really big fans. So I just thank you so much for kind of walking us through what you all offer, kind of looking at the nuts and bolts, and if they have any questions, I’m sure they can just head over to zoom.us, because all of it is so clear, you’ve got a great website, and it’s really gonna answer all your questions.
DP: Thank you. Yeah, thank you, Clay. And also, I just wanna offer my personal… Offer for your listeners to reach out to me personally. If you have questions, or you have some feedback, from a product perspective, or ideas about what we could be doing better, my email is [email protected]. You can also find me on LinkedIn, on Twitter. I wanna hear from your listeners if there’s anything I can do to help.
CC: Excellent, that’s wonderful. And we’ll put that in the show notes so you can definitely find all the information there. Derek, again, thank you so much for spending some time with us today.
DP: No problem. Thank you, Clay.