Is Your Mental Health EHR Sabotaging Your Practice?

I never thought I’d basically be having a panic attack from sitting in my office chair reading a Terms of Service Agreement that would make me question everything about the foundation of my practice, but there I was, and what I discovered left me absolutely enraged, and it sent me on a journey that cost nothing.

Tens of thousands of dollars, many months worth of time and energy, but it was worth it because what was happening in there was absolutely not okay.

I’m Dr. Lisa Marie Bobby. This is Love, Happiness, and Success for Therapists where we are here to talk about the life and times of being a therapist and what you need to thrive and be okay in this challenging profession. And so on this episode, I really want to talk about one of the most shocking, and infuriating experiences of my entire career because this is a cautionary tale about how the tools that we all rely on to run our practices can actually turn against us and be even working against us in some very real ways.

Here’s where it all begins. Last year, my former EHR provider updated their Terms of Service Agreement, so I started getting all these banners showing up on my EHR platform, essentially demanding that I sign these new Terms of Service agreements.

or lose access to their platform. Now, I have a pretty big practice. At any one time, I have between 50 and 60 therapists running around here, and so this would not be an easy thing to get out of. So I felt like I had to sign this, which I did. I skimmed it, I signed it, I moved on, which, that’s, that is what we do.

Who reads every word of a terms of service agreement, right? We’re busy enough. But then I started getting outreach from other clinicians on my team. A couple of them were like, Lisa, did you hear about this whole new terms of service agreement thing? What’s going on? They had heard whispers about stuff from other people in their professional community.

And so then I was like, Okay, I am going to do a deeper dive. I printed the whole thing out. It was a Saturday. I will never forget. Saturday, big cup of coffee, sitting in my chair with the highlighter, and started reading word by word everything that was in there. And what I found left me absolutely shocked, horrified, and angry, so angry, and it led to me taking some pretty radical action.

And I wanted to share what is in there with you so that you feel empowered to read through your agreement for whatever platform you’re using and think about it just with a critical mind to understand what it means for your practice and whether or not you might need to take action too. And the reason why this matters so much is that we need trustworthy EHR systems.

So EHR, Electronic Health Care Records Management System. And I’ve also heard it called EMR, Electronic Medical Records, so it can go by a couple of different terms. But essentially, these are the platforms that we use. for so many things in this day and age. It is where we schedule our sessions. It sends our clients, appointment reminders.

It is also where we keep our case notes and documentation. These things can help us with billing, insurance, billing, super bills. Some of them have integrated telehealth and some of them do marketing services for clinicians as well. Ideally, these systems are ones that we need, depend on, and, theoretically, can really help us with so many different things.

Financial operations, marketing practices, being able to communicate with our clients, and additionally, they need to be HIPAA compliant systems that are secure, that are trustworthy, and that is what we sign up for. All sounds great, right? But what’s going on is that not all of these systems are created equal and that these, some of them at least, are big businesses with a lot of money and they have very smart CEOs, CFOs, roomfuls of lawyers sitting around thinking about how can we Basically get away with anything and everything we can legally with, with consent, but to ring every dollar out of not just our clients, the therapists who are paying us money to use this platform that we’re advertising, but there are a lot of associated opportunities that these platforms, the big data, all of the contacts.

that we are putting in them. All the information that we’re putting in them. And there are people thinking about ways to exploit all of this. It’s, it sounds crazy. I know it sounds absolutely bananas, but it is true. So here is my story. So I, got this big banner flashing up, sign this agreement or else you’re going to lose your service.

And so I skimmed, I signed and then people started reaching out. So I was like, okay, let me dig into this. As I mentioned, I printed it all out. I sat down, I started reading the thing and I started getting so upset because of what I was reading in here. So just highlight reel, horrible highlight reel is that.

My former EHR provider was claiming rights to exploit user data, which is anything that I’m adding to the system, and for pretty much anything that they want to. Additionally, fascinatingly, I came across things around if you host your website through our company, we have the right to place paid advertisements on your website.

on your website unless you pay us extra to not to, which was like, what? Additionally, at that time, there was language in that terms of service agreement about their owning any intellectual property that I might upload to said website, which would be very concerning for me because I’m a writer, I create a bunch of content.

So if I’m uploading my stuff to your site, now, You can use that for whatever you want. No, I don’t think so. But then there was also a big huge section in there around feedback and their soliciting of feedback, what they might do with said feedback. And it’s like a lot of language that’s we can do whatever we want with any feedback that we get related to you or your operations, et cetera.

So that was in there. And then additionally, all kinds of language about their having relationships with third parties that they are, doing other business things with and that they have absolutely no, responsibility to anything that any of their third party people might be doing that are in this mix.

And of course, I’m like, hey, wait what third party? But as I was reading through all of this, here is where it started to get really interesting. Crazy. And I, so I started thinking back to some other weird things that have happened to me over the last couple of years that actually sound really good.

So for example, and this has happened a few different times. You can look it up. My practice growing self has won awards. It’s like best online marriage counseling platform of 2022 or 23 or 24, whatever. It’s happened more than once. And so I get these emails and I’m like, Oh, we want to report how awesome and go to this page.

But then. And there’s interesting things on there. So like when I took a look at this review, one of the things was, and it says right in there that this review is based on a hundred current or former clients of growing self counseling and coaching and their feedback about their experience is that, wait, what?

How do they know who clients of my practice are? How would they possibly have? their contact information. And so I don’t know exactly what happened, but after reading this terms of service agreement, all this stuff about feedback was like, could that possibly be the case that, with third party providers doing different things, somehow their permission had been granted to Someone to be contacting clients of my practice in order to create this review of my company on a page that, by the way, was covered with paid advertisements to other providers.

So, it’s I’ll just take a deep collective breath here, but consider the implications. They were using my information from my clients that I’m uploading into their system, selling it to somebody who is creating content that draws a lot of eyeballs. search engine optimization, clients who are looking for online marriage counseling or whatever, finding these pages.

And then there’s all these paid advertisements on them. But the information from my practice had been used to develop that. content. It was crazy. And then the thing that started to upset me in the most, if you could imagine, I’m sitting there in my chair with my highlighter reading this stuff.

The other thing that I was thinking about is that I am paying these people a lot of money. Especially with the big practice. I was paying this company between 3, 400 and 3, 600 a month on average. That is over 40, 000 a year and thinking, wait, You’re doing what with my data? Potentially? You want to do what?

And you guys, that is not where this ends. There’s all kinds of weird stuff going on with marketing right now in our industry. I don’t know if you caught the latest podcast last week around Is your new therapy client a mystery shopper? on a mission being like a paid mercenary therapy client to come in, check out your practice, go back out and write a public review.

That has happened in my practice on numerous occasions. I have screenshots. It is absolutely wild. But Crazy stuff going on. But what was going on with my EHR didn’t even stop with the feedback thing. And that is not even the worst of it because after reading some of this stuff in the terms of service agreement, I was like, There’s a lot in here about the website, about marketing, about third party services, and I got just like this weird little hunch.

I wonder what would happen if I set up a little mini website through their service, which I did. It was easy to do. And then just scheduled an appointment with their online booking tool, which I don’t use in my practice. My website is hosted through WordPress,

but You know for I think an independent private practitioner to have an easy way to put together a reasonably professional looking website It’s a phenomenal service, right? but so I did this so just out of curiosity scheduled an appointment as a fake client and to my amazement Within five minutes, I received a follow up email from this company congratulating me on my decision to book my first therapy appointment complete with some tips for how to make my first session great.

It’s like how, what questions to ask in your first therapy appointment or something of that nature, which is fun. Great, fine, appropriate, except, so okay, why are you emailing my clients that, imagine, so I signed up as a fake therapy client through my own portal, so I signed the client side Terms of Service Agreement And then I essentially got this email from a company.

So when I clicked on the link in this email here’s questions to ask in your first therapy session, it took me to a page on their site that was Any guesses, anyone? Yeah. Covered in advertisements to other therapy providers, including the big box, deep pocket, therapy mill sites, essentially encouraging my prospective client who just booked a consultation session with me, encouraging them to check out these other people who could also be a great fit for you.

You guys. That was the moment when, seriously, my head almost fell off, because I work so hard, as you do too, to market my practice to prospective therapy clients. Explain my value, here’s what you can get from working with me at my practice. Connecting with them, getting them in the door, they book a consultation appointment, in that moment.

of trust. They say, yes, I’m going to do this. And then at that very moment, when they were taking action to book with me, my own EHR provider undermines me, sends them an email saying, great, yay, congratulations. And might you also consider These options, because think about it, these prospective clients are in a stage of change where they are taking action.

They are ready to do this. They’ve just booked their first consultation appointment and you don’t think that this room full of very smart people. CEOs and CFOs are like, this is a great opportunity to take somebody else’s advertising dollars and put that in front of a highly motivated client who’s ready to take action.

Except that I was paying them 40, 000 to be a trustworthy service provider that I could run my private practice with. And that was happening. I was so angry. I can’t even tell you how angry I was. And so it was at that moment, and just reading through all of the debaggery to be quite Blunt. I just, I had to leave, right?

And so then, now I have a new problem because transitioning to a new electronic health care records management system is a logistical nightmare. I had to find a new one, which I did a lot of research, kissed a couple frogs, and I’ll tell you about that. But the project in itself, I had used this old service provider for years.

There were thousands upon thousands of records that all needed to be migrated, how to manage all of that. This is a months long project, but staying was not an option for me after what I had learned. And this turned into many months of trying to fix this and find a provider that wasn’t as gross.

And I evaluated many of them. My practice operations manager and I, we did discovery calls, we reviewed things, we read all the fine print. And interestingly thought that we had found one. And it all sounded good, read through their stuff. And I was like, I should probably, show this to my attorney before we sign on.

But I also met with a CEO and I just, really directly was like, is there any part of your business model that is seeking to earn revenue by exploiting my data by remarketing anybody else’s services to my clients? Let’s just be real. And he was nice enough to meet with me. And I felt better about that and I don’t know that is what they were up to, but nonetheless, when it came time to pull the trigger on this, they sent me a terms of service agreement.

I read all the way through. It was like, I don’t know about some of this and so I sent it to my attorney and she followed right up with me and she was like, Lisa, do not sign this agreement. You cannot sign this agreement. I have seen a lot of tech platform service agreements and this is among the worst and she listed out all these reasons like they could just completely stop providing services and sign it.

You would still be on the hook to continue paying them until your agreement has ended. Crazy things. It was like, yeah, that doesn’t sound good. She was like, you cannot sign this, do not do this, and she suggested here are the specific things in this agreement that would need to be changed in order for this to be even a reasonably sensible thing for you to do.

And so I did actually, I sent it back to the CEO. And I don’t know what may have happened with that, but in the meantime, I had continued researching other platforms. There were a couple of contenders and then there was one that had a non shady terms of service agreement. My attorney was like, yeah, that’s fine.

So that’s ultimately the one that I went with because that’s how important these terms of service agreements are. But anyway, so we did finally find a new provider and then started the migration process Which was horrible. It took months. It cost thousands of dollars. It was really a slog, but it was worth it.

I feel like we’re safer now. There aren’t people following back up with our clients or using a lot of exploitation language and their service agreements. Our new clients aren’t being encouraged to book appointments with somebody else. And I’m paying about a third of what I was with this old company. But so after going through this whole experience, what wound up happening, which was fascinating, I thought, I need to be telling other therapists about this and what I just went through because I think that therapists don’t know.

I’ve talked to a number of people about did you know that unless you pay them extra, they have the right to show other people’s advertisements on your website? Website that you’re hosting through them. They’re like, oh my god. I had no idea so like even just these little details, but it can make a big difference because you’re putting so much into your stuff and these people are like Using these as opportunities to put advertisements in front of interested therapy clients Yeah, anyway, it’s really creepy.

But I wanted to get all the way through this migration project this summer, which we did, finally, successfully. I think we were done with them by probably May or June of this past year. And then I recorded a podcast episode let me tell you what just happened, so that you can do your own research, make your own choices.

And I released a podcast, a YouTube video, and I got a lot of attention from other therapists, actually I had no idea that some of this was going on. And so that was good, just feeling like we need to share information because again, I think these companies will get away with anything they can, unless they get pushback, right?

But fascinatingly, The black helicopters came for me after sharing these experiences. Over time, somebody from this former EHR platform actually contacted me. They’re like, we saw you posted a YouTube video about our service and you’re spreading lies about our organization. We’re going to seek damages because you’re telling therapists that you’re That we might be up to some stuff that’s a little bit shady.

So I thought that was so interesting and they were like, that’s what’s in our terms of service agreement. And they sent me a new link. So here’s what is actually really cool. Clicked on the link and I reread the terms of service agreement. And as I did, I thought to myself, you know what? This language has been softened.

I had a visceral reaction the first time I read this because, among other things, like, how often they used the word exploit in their agreement, and looking through it, I was like, oh, they’re not using the word exploit anymore. That’s good. And so I thought to myself, you know what? They must have gotten some friction.

I could imagine. And especially when they first updated their terms of service, I think it upset a lot of people. My guess is that they started losing customers, losing revenue, and that got their attention. And so then they started. Putting out communications and messaging no, that’s not what we’re doing.

They may have modified their terms of service agreement a bit to make it a little bit less dramatic, but the core issues still remain. There’s a lot of information around what they are allowed to do with your user data how they’re able to work with third party. companies marketing stuff on your website, all the things about feedback.

It’s still in there. It’s just not quite as harsh as I think it was. And so of course I invited them to come on my podcast. Let’s talk about this. Tell us your story about how maybe you shifted some of these things in response to the feedback that you were getting from your customers, who I’m guessing were voting with their feet.

Like I did, right? But they didn’t want to do this, but still the big takeaway here is that, and I think that this is the main message of the whole thing is that we do have power collectively. I know that you and I, we are values driven people. We are running ethical businesses. We have integrity.

And we have every right in the world to expect that the companies that we work with and depend on also have integrity. And that we, when we stand up to them, honestly, and start talking about this, sharing information with each other, and Stop agreeing to participate in some of these exploitative practices.

When we refuse to accept these terms, we can make a difference. Obviously protecting our own practices, but I think that we are then placing some pressure on these big companies to rethink what it is that they’re trying to do. I think my former EHR provider did soften their terms a little bit after the backlash because they lost some business.

Again, you have more power than we have more power as a collective. So I think that was a really important takeaway, but there are still all kinds of weird things in our service agreement and it likely in, in that of a lot of others. So here’s the thing. What I think is also really important for you is like just to be thinking critically around what are these people going to be doing?

as my service provider. What all else is going to be part of that? What are they trying to do? So here are my tips. I don’t know if you’ve done this because you may have been like me, just skim the damn thing and sign it because who has time to read it all? But slow down, take a Saturday morning, pour yourself a cup of coffee and read Your agreement.

Read the fine print. So dedicate time to understanding what it is that you are actually agreeing to and think about, if this was true, what could this mean? And think about, experiences that you have been having in your practice or that your clients have been having and try to understand it.

Additionally, if you are evaluating an electronic health care records provider, or perhaps even your own, start asking some tough questions, like inquire about their business model. Are they finding ways to profit off your data? How do they earn money? Is it just your subscription fees to use their operating system?

Or are they taking advertising dollars from other people and finding opportunities to place advertisements on your stuff? Or other things? Are they doing something to de identify the data that you’re putting into their system, but then bundling it up somehow and reselling it to another person and I think it’s so challenging because again, there are smart people running these companies there are You know red meat eating attorneys that work with them and know what to say They probably know how to answer these questions in a way It’s like a bunch of squid ink and you’re still not quite sure what’s going on but just to be thinking this all the way through and Doing some tasks So test your own system as a client.

Sign up with a fake client account to see, what communications are being sent. What happens next, right? Take a look at your own website from an incognito browser. Is there weird stuff on your website? But also be looking at what are they saying they have permission to do with my intellectual property or any of the data that I’m uploading into their system.

These are the kinds of things that you need to be thinking about, and if you are finding things in your terms of service that are making you feel uncomfortable, don’t gloss it, right? Do something about it, but also share that information with other people, because I think therapists You know what?

We’re busy. We have our heads down. We’re trying to do all this thing, take care of so many people, run a practice, right? And we need to stick together, share information so that we all know and can be like, Oh, because that way too, we can collectively be pushing back, putting pressure on these systems and hopefully changing them for the better.

Now, very lastly, before we wrap up, I did want to say, When I posted this information the first time I had a lot of people reaching out to me being like what companies were you talking to? Which provider did you wind up going out with and going out with? It is dating, isn’t it?

But going with and I am happy to share all of the details with you, but I’m not going to do this publicly because black helicopters, you guys, originally when this happened and that company was like, you can’t say this about us. I was like, you know what? I sure can as a independent business owner I can absolutely talk about the experiences that I had with your service and the impact that had on me, how much time, energy, and money it wound up costing me, irregardless of the lost business costs.

So yeah, I’m going to talk about this. But then my husband was like, they have, Billions of dollars of funding don’t do this. I was like, ugh. Fine. I’m going to re record this podcast and I’m going to omit some of the, usual suspects identifying details, but if you would like to know more, get in touch with me as a friend on LinkedIn.

We can have a coffee together. I will tell you. What is going on? You can direct message me on LinkedIn, or you can track me down on my website, growingself. com. Be like, hey Lisa, and I’ll get back in touch with you. We will talk. And then, Additionally, because there’s other weird stuff going on in our industry, you guys, if you’re on my website, growingself.

com, be sure to take advantage of another resource that I’ve created for you, which is scams targeting therapists. I have had so much weird stuff happen to me personally and other clinicians on my team over the years. And I will tell you. All of it, give you all the details so that you know what to look for so that you can protect your practice.

But I’ll also send you a Like playbook that I’ve put together like these are the things that I have changed in terms of the way we operate to harden our Operational processes and procedures so that we’re not accidentally handing over HIPAA compliant information to somebody masquerading as a insurance claims rep, right?

So that I’m not handing over my colleague’s bank account information to a payroll processor. Like I can’t even tell you the crazy things that have happened. So come to my website, growingself. com, go to the main nav, the four therapist section and take advantage of the free resource that I’ve created for you.

Eight scams targeting therapists. You’ll get all the info. All right. Thank you so much for spending this time with me today. I hope it was helpful and not overly triggering. I was very triggered, but we have to be with some of this stuff. But thanks again for listening and I’ll be back in touch with you next time.