Privacy policy for video therapy

These are the Privacy Notices that cover the supply of Cognitive Behavioural Therapy services provided online (the Service) through iesohealth.uk (the Site). The Site and the Service are provided by Ieso Digital Health (UK) Ltd (Ieso, we, us and our). For the purposes of data protection legislation, we are a data controller, ICO Registration no: ZA239229. If you don’t understand or require further information on anything below, please contact our Data Protection Officer h.simpson@iesohealth.com. Full details on how to contact us can be found in section 9 below.

By agreeing to the terms and conditions of the Service you have entered into a contract with us which forms the legal basis for most of the processing of your information including for research compatible with the original purposes of processing. Safeguarding and NHS minimum data set information is processed under legal obligation. Standard information sharing with GPs is by consent. Any information held in establishment or defence of a legal claim is processed in our legitimate interests. We process your special category data for medical purposes. As part of our contract with you, we are committed to continued improvement and development. Research supports us to provide you and all our patients with high-quality, evidence-based care. We publish our findings (which only ever include aggregated data) in peer reviewed scientific journals, satisfying the legal basis of the special category data processing being necessary for scientific research purposes.

Here we explain what personal information we collect, how it is used, shared, secured, stored, and how you can exercise choices and manage your data. These Privacy Notices reflect legal requirements, regulations, and best practice.

We understand that the privacy and confidentiality of all the personal information, especially the recordings of therapy sessions, that you provide and we handle, is important to you, and our internal policies and procedures reflect this and the need to share the minimum information necessary.

What these Privacy Notices cover

These Privacy Notices describe our treatment of personal and clinical information that we collect when you access or use our Service.

We describe here how we handle your personal and clinical information for the purpose of providing and improving the Service. We will not sell or share your personal information for direct marketing or other promotional purposes.

These Privacy Notices apply to any Site where they are referenced, regardless of the computer, mobile or other device you use to access or use the Service. The site and Service includes links to websites that are owned and operated by third parties. We are not responsible for the privacy policies or content of such websites.

We reserve the right to change these Privacy Notices from time to time by changing them on the Site and by notifying you through your account or by email.

We collect the following personal information about you in several ways:

a) Information you provide to us when you register and use our Service

This includes:

• Registration information - when you register, we collect contact information such as your name, date of birth, email address and mobile number. We also collect information to authenticate you as an eligible patient such as your date of birth, NHS number, GP details and address, and to authenticate your access to the Service by way of a password for your sign-in security.

• Assessment information - we collect information using standard structured patient assessment questionnaires both to initially establish what treatment plan is likely to be beneficial to your needs, and on an ongoing basis prior to each session of your subsequent care. Assessment information can cover a range of factors relevant to your experiences and how you are feeling in addition to your medical history, lifestyle, family, work and education.

• During the course of your treatment - This includes messaging between you and your therapist between sessions to arrange and provide you with information about your therapy sessions, the sessions themselves, the ‘homework’ activities and questionnaires completed, and the setting of goals. The therapy sessions are conducted face to face via video link, which is retained as an audio file (no video recording is retained) to which you can request access at any time during and after your course of therapy. This audio file is also automatically converted to text to facilitate supervision, questions, complaints etc, but where any decision is being made about you, there is a process in place to cross check this transcript with the actual audio recording. You will be encouraged to record goals within your account, and we generate information about these treatment goals and assessment score graphs to help you and us to monitor and understand your progress

• Any specific information required by NHS England and/ or contracts with our NHS payers. E.g. specific employment information for part of Improving Access to Psychological Therapies (IAPT).

• Your queries or comments - we will collect information if you contact us for example with a question or comment about the Service and/ or its content.

• You always have the option to refuse to submit personally identifiable information to us but note that without this information, the Services may be unavailable to you.

b) Information we collect from other sources

We add to the information we collect from you with information we receive from other sources.

This includes:

• Referral information - from your General Practitioner (GP) or healthcare provider, if you are referred by them for treatment to Ieso and the Service. This will usually include your name, date of birth, address, mobile number, email address, NHS number, reason for referral and any relevant assessment notes and questionnaire scores.

• Therapist notes - At the end of each session your therapist will produce a short set of clinical notes to summarise the session. For some of our NHS contracts, these summary notes are copied into your health record on your health care provider’s patient management system, but the recordings of therapy sessions will never be copied over.

• Supervision notes – a therapist may share some of your details with their supervisor per section 2 below and receive advice and /or feedback. Where this affects the treatment you receive, and/or the outcome, it makes up part of your medical record with us.

• Demographic information - that is publicly available and that enables us to understand anonymous health statistics at postcode level.

c) Information collected automatically from your use of the Service

Certain information is collected automatically from your computer or device about your engagement with the Service.

This includes:

• Session activity information - we collect information about you from your use of the Service. (E.g. when you log on, accept an appointment, join a session etc.)

• Device information - this includes information about whether you are using the service on a mobile, tablet or computer. This helps us understand how people interact with our service so that we can ensure the Service is optimised for different devices.

• Log information - we collect technical information such as your Internet Protocol (IP) address, (the unique address that identifies your device or computer on the internet), your browser type and when, how often and for how long you interact with the Service.

See here or read below for further information on cookies

We use the personal information we collect to ensure that we provide you with the best possible treatment both now and in the future. We have appointed a Data Protection Officer and Caldicott Guardian to seek to ensure that our procedures for handling patient information meet with our obligations.

We use the personal and clinical information that we receive under our terms with you and in connection with providing treatment to:

• Assess your suitability and eligibility

• Register you with the Service - to consider requests for use of the Service and to enable sign-in and verified access and use of the Service.

• Assess your treatment needs - to place you with an appropriate therapist, and to aid selection of exercises and questionnaires.

• Provide your treatment - your personal information is shared with your therapist to support your treatment and evaluate your progress, including messaging to arrange sessions, conducting sessions, assessing progress against treatment goals and maintaining your case file. It’s your choice to decide what to share with your therapist, but the more information that your therapist has about you, the more likely it is that they will be able to provide you with highly effective treatment. Your therapist only has access to your personal information during your treatment and for 6 weeks after discharge to allow for reflection and/ or to consider any feedback from you.

• Subject to appropriate safeguards, some of the details of your case may be shared in your therapist’s routine clinical supervision with their Clinical Supervisor if they wish to obtain advice or assurance on the work you are doing together. The British Association of Behavioural & Cognitive Psychotherapies (“BABCP”) requires that all therapists must receive clinical supervision. A Clinical Supervisor is a therapist who has received additional training and is generally more experienced than the therapist. This is to ensure that the therapy you are receiving is the most helpful it can be and remains faithful to best practice evidence. Clinical supervision includes case discussions (and may include looking back into therapy sessions) either individually or within a group of therapists, all of whom are bound by confidentiality.

• Communicate with you

  • via email or messages between sessions if/ when appropriate, to confirm appointments, remind about incomplete questionnaires, about Service availability and related Service updates or notifications, or reply to your enquiries, requests or complaints.

  • via text message to remind you about upcoming appointments

  • via voicemail (where you have consented to this) for missing information or questionnaires

  • via post at assessment and /or the end of treatment

  • Where you have indicated to us on a questionnaire or in response to an email that you would be happy to participate in user experience feedback or evaluations, or to share your experience of receiving therapy for therapist training purposes, we will use your contact details to give you more information and process your information further for this purpose if you subsequently give us your consent in connection with this.

  • We also contact you after you’ve completed treatment to ask for feedback and to check on your wellbeing.
• Protect you and/or others - and seek to maintain a confidential and safe environment.

These measures include:

• user authenticated access controls to the service

• restricted access to patient identifiable information. Access to patient records within Ieso is limited on a strictly 'need to know' basis and wherever possible processed by reference to indirect rather than directly identifying information, such as case reference numbers.

• ongoing review of the care and help our professional therapists provide to make sure it meets our quality standards. This includes training, case management support, moderation, supervision and monitoring of messaging and treatment sessions;

• developing learning/ training programmes for our therapists.

• administering our professional compliance duties and obligations.

• Conduct analysis and research to improve our service delivery, patient recovery rates and service development. We are passionate about learning from these data by conducting high-quality scientific research to feed into treatment to further improve outcomes. We believe research can help provide a greater understanding of both the causes of mental illness and the effectiveness of treatments for different subgroups of patient. We have internal procedures in place to safeguard your privacy so that only the minimum necessary information is used to conduct the research on the most de-identified data possible.

Much of our research is based on the NHS Minimum data set (see section 3 below), but we also use machine learning, natural language processing (NLP) and artificial intelligence (AI) on the communications between you and your therapist. Click here for more information about how Ieso uses your data for research.

We only ever share the minimum information necessary to provide the best treatment, care and protection for yourself or others, or to satisfy legal requirements. For example, depending on your referring healthcare provider, your data may be provided to update their records and/or as part of the Minimum Data Set required nationally by NHS England for all its patients. We have specific processes in place regarding recordings of therapy sessions which are only shared internally or externally in very limited circumstances, for example we may facilitate joint viewing of specific recordings with the contracting NHS service in the case of a serious upheld complaint, see section 3 'When we share your information'.

We will always seek your permission ahead of disclosing any information that identifies you directly to any other person or organisation, or, for any other reason not set out in this policy unless we have an overriding legal duty to do so.

We appreciate and respect that the confidentiality of your interactions with the Service are of utmost importance to you. Information is only shared on a strictly ‘need to know’ basis. Anyone receiving information about you will be under an equal legal duty to keep it confidential.

The confidentiality of all information shared between yourself and your therapist is upheld to the highest level possible. We recognise that you may consider some information you give to us, and that may be recorded in the audio recordings of therapy sessions, as particularly sensitive. Relevant internal policies and procedures are designed to share the minimum information necessary to provide the best treatment, care and protection for yourself or others.

In delivering the Service to you, your personal information may be shared with:

• Your GP and/or your referring healthcare provider - Like all NHS service providers, it is important for us to work in collaboration with other healthcare professionals like your GP or your local psychological therapy service. This will be at the start and end of your treatment where we notify your GP or healthcare provider of the assessment and discharge, where the letter to the GP is sent by encrypted email (and where you also receive a copy of these letters), or where we transfer your care to another healthcare provider or refer you back to your original provider where an alternate provider is able to administer more appropriate care, where we provide them with a patient report so they have the details of your condition and the treatment provided by us. During registration we ask whether you are happy for your therapist to share information about your treatment with your GP and you may decline this. Some of our NHS contracts require us to update the referring provider’s patient management systems with information such as when you have sessions and clinical summaries of the sessions, and some also require audit meetings to review feedback which occasionally include the joint viewing of specific recordings from any internal investigations that have been conducted by us as a result of a serious clinical incident or significant complaint during the year. We also update your referring healthcare service to enable invoicing and/or during the investigation of any serious clinical incidents.

• NHS Digital - Providers of NHS-funded mental health services in England are required to provide a specified set of data (Minimum Data Set) to NHS Digital, who use this to create a picture of services delivered around the country to check that quality standards are similar everywhere. The data set includes NHS numbers, gender, age and ethnicity, but all reports published from this data are aggregated and contain no information that could reveal your identity.

• We share minimum personal data with systems we use to process the data: your email address for automated emails, your case reference number if the case is discussed in supervision sessions, and your IP address. (See sections 5 ‘How we store your information’ and section 7 ‘Cookies and tracking’ below.)

Outside the normal course of providing services

We also share the minimum necessary information where required or entitled by law, legal process, or professional ethical or law enforcement reporting purposes. This may include notifying appropriate authorities, regulators or law enforcement agencies, or allowing them confidential access to specific information as part of an inspection or review, or to prevent fraud or cybercrime or any threats. This would include the sharing of specific information required by government and/ or contracts with our NHS payers (e.g. specific employment information for the Department of Work and Pensions). If these circumstances arise, we will inform you wherever possible.

Where you have indicated to us on a questionnaire or in response to an email that you would be happy to share your experience of receiving therapy provided by Ieso to raise awareness of our service, we will use your contact details to give you more information and process your information further for this purpose if you subsequently give your consent, which would include wider sharing of your personal data as agreed with you.

If you agree to leave a review of our service on an external site, then the process will include giving a name, email address, star-rating, comment and optional photograph to the 3rd party site e.g. Trustpilot, who will then be the controller of this data. The third-party will not receive any data before your agreement.

In order to conduct research to improve treatment, we sometimes partner with researchers outside of Ieso, e.g. university research groups. When this happens, we remove directly identifiable information (including any names and locations) from the data we share with them, so they will be unable to identify anyone personally. All partners also sign a legal agreement that any data they receive is kept confidential and secure.

We have internal procedures in place to safeguard your privacy, so that only the minimum necessary information is used to conduct research on the most de-identified data possible. We will always seek your permission ahead of disclosing any information that identifies you directly to any other person or organisation or for any other reason than those set out in this policy without your knowledge or permission unless we have an overriding legal duty to do so.

Sharing your personal information without your consent

The sharing of information about you without your consent is strictly controlled by law.

In exceptional situations we may need to share information (only the minimum necessary) without your permission if:

• A serious crime has been committed

• Withholding information could endanger someone’s life

• A child or vulnerable adult is at potential risk or

• We are ordered to by a court of law

In such circumstances, we would inform you wherever possible.

Transferring data outside the UK, and holidays during treatment

We seek where possible to prevent any transfers of your personal information to countries which have not been assessed as having adequate data protection standards.

The European Commission makes the decisions on the adequacy of the protection of personal data in third countries, and have decided that personal data can flow safely between countries in the European Union, the European Economic Area (EEA), and 11 other territories without any further safeguards being necessary. https://ec.europa.eu/info/law/law-topic/data-protection/data-transfers-outside-eu/adequacy-protection-personal-data-non-eu-countries_en

Accessing our Services when outside the EEA is considered a transfer of data by data protection legislation. It is at your own risk if you decide to attend therapy sessions whilst you are visiting countries not listed at the web reference above. Our therapists are not permitted to access the Service from outside these territories, so will notify you of any necessary short breaks in your treatment due to travel.

We do not use or share your personal information for direct marketing or promotional purposes. 

We place great importance on the security of personal identifiable information associated with our patients. We have put controls in place to safeguard the personal information that you provide, applying physical, technical and procedural measures against the loss, misuse and alteration of personal information under our control. All information submitted by you is encrypted in transit using best-practice Transport Layer Security (TLS) with at least 128-bit encryption. All clinical data is encrypted using the industry-standard AES-256 cipher and stored at hosted facilities with dedicated physical access controls and restricted system access. Click here for more details about our current encryption levels and methodologies.

We have achieved the International Standard certification for information security (ISO 27001), Cyber Essentials Plus certification, and satisfy the requirements of the NHS Data Security and Protection Toolkit requirements.

Remember also that you are responsible for keeping your password secret at all times when accessing and using the Service.

Ieso Digital Health headquarters are in the United Kingdom (UK), and information about you submitted via the Services is used by us and hosted by our service provider, Microsoft Azure, on secure servers in the UK. As detailed in the Security section of these Privacy Notices, such information is stored in an encrypted state, both in transit and at rest, meaning the provider cannot lawfully access identifiable information.

We use a small number of well-known SaaS (Software as a System) providers to store subsets of your information and enable the uses of information described in these notices. We have Data Processor Agreements in place with each. These providers either store the data in the UK or EEA, or have in place Binding Corporate Rules, EU-US Privacy Shield self-certification, or EU Model Clauses to uphold your legal data protection rights.

We retain your information and health record as a resource that you can return to at any time you wish. This can help you remember coping strategies, techniques or processes that you learnt in therapy. If you were to experience a setback between sessions or after you’ve completed treatment, you may find it useful to refer to your therapy sessions and messages. Also, if you were to require further therapy sessions at any time in the future, your therapist would be able to access all your therapy notes. We retain your clinical record by reference to the IGA Records Management Code of Practice for Health and Social Care guidance for managing health records https://digital.nhs.uk/information-governance-alliance and to support our legal obligations to be accountable for your care.  The Code is based on current legal requirements and professional best practice.

Research records and data are kept for a minimum of 20 years in accordance with Medical Research Council guidance.

Our data retention practices are reviewed at least annually in conjunction with industry standards and best practice.

You can access specific details relating to your treatment through the Service online at any time directly through your account. This includes your treatment goals, score graphs and messaging, and will remain a resource available to you after the conclusion of your treatment. You may also request the audio recordings of your therapy sessions. You can also update or amend some key registration and contact details directly through your account.

Clinical and personal information will also form part of your wider medical record and, subject to certain exemptions, you can obtain access to your health records by prior arrangement with your referring healthcare service or GP.

If you feel there is an error of fact on your health record held by us, you can contact us, or in respect of your wider medical record your referring healthcare service or GP. If we or they agree the information is incorrect, the alteration will be made. If we or they are not satisfied the information is factually incorrect, a note will be made of the information you consider is inaccurate, and you will be notified of either the correction or the note.

Data protection law also includes the right to data portability and to make other requests to seek to erase, object to and restrict personal data processing where certain limited grounds apply. Note however that data processed for health/treatment and legal purposes, or where other legitimate grounds for the processing apply, are examples of circumstances where some of these rights can be restricted or not apply in practice. Specifically, the right to erasure does not apply when processing is necessary for the provision of healthcare or the management of healthcare systems or service.

If you need assistance or have an enquiry about accessing, updating or amending your records, or where applicable, about receiving or transmitting a file of the data you have provided (for example to your GP) please write to:

The Chief Clinical Officer, Ieso Digital Health,

Jeffreys Building, Cowley Road, Cambridge, CB4 0DS

Or by email, For the Attention Of the Chief Clinical Officer, to [info@iesohealth.com](mailto:info@iesohealth.com]

Our complaints procedure is available on the site, and there is a link to it here.

If you remain unhappy with a response you receive, you can also refer the matter to the Information Commissioner's Office.

We use cookies or similar technologies such as device IDs, pixel tags and web beacons (collectively described here as 'cookies') to collect information about the access to and use of the Ieso site and Service. These typically include a unique reference code that relates to, or is accessed from, a user's device and that enables that device to be remembered when next visiting the site or using the Service and that sometimes track information about a user.

We use cookies for the following reasons:

• Secure login and navigation - we use necessary session cookies to help verify and authenticate your access to the Services and to let you smoothly navigate the Service and use its features.

• Functionality - these cookies allow us to optimise the Service to you. For example, you can shut your browser but not be logged out, as long as an hour of inactivity does not pass, to enable you to complete questionnaires, ‘homework’ etc.

• Analytics and performance - we use cookies to collect information about how you use the site and Service or engage with communications about the Service and which enables us to improve the way each works. These cookies provide us with overall statistics about the number of unique interactions there are with the Site and Service and provides aggregate information on overall patterns of usage. We use a third-party provider, Google Analytics to collect and provide this information by reference to the cookie id and IP of your device and the log information about the use of the site or Service affiliated to that cookie id to measure these activity levels. This information is transmitted to and stored on the servers of Google. You can opt-out from the collection of this information by Google by downloading and installing a browser plug-in at https://tools.google.com/dlpage/gaoptout.

Computers and mobile devices may automatically accept cookies, but you can change your browser to prevent that or to notify you each time a cookie is set. You can also learn more about cookies by visiting www.allaboutcookies.org which includes additional useful information on cookies and how to block cookies using different types of browser. Please note however, that by blocking or deleting cookies you may not be able to take full advantage of the site or Service.

You can also learn more about our use of cookies by visiting our cookies policy.

Our contract with your healthcare provider determines the lower age limit for our services. As standard it is 18, but specific contracts also include 16 and 17 year olds.

If you have any questions or comments about these notices, please let us know:

By email: info@iesohealth.com (or for technical support questions contact our technical support team: support@iesohealth.com

By telephone: on 0800 074 5560

Or by post to:

Ieso Digital Health, Jeffreys Building, Cowley Road, Cambridge, CB4 0DS

To reach our data protection officer please use the above details and mark your communication for the attention of:  Helen Simpson

In an emergency please contact:

• Your GP surgery or local A&E

• Your referring healthcare provider

• Urgent Care (for out of hours access to GP):111

• The Samaritans 116 123 or jo@samaritans.org

• Emergency Services 999

It is important that the personal data we hold about you is accurate and current. Please keep us informed if your personal data changes during your relationship with us.