Using Zoom or Google Meet internationally
 

I use Google Meet to see patients online in the US. If I am in Germany, does know if Google Meet or Zoom works back to the US? Do I need a VPN?

Your location doesn’t matter, as long as access to the service isn’t blocked. The only places where that’s likely are China, Russia, perhaps the UAE, and maybe a few others.

I am pretty sure no medical facility will allow patient records to be taken out of country on a laptop or accessed from overseas.

I have clients meetings using Google Meets from countries in Europe and Asia.

Germany to US should not be an issue. You may have issues with latency (ie: you say something and it will take the other side a few moment before responding... if you watch interviews with reporters in Ukraine on CNN for example, you will know what I mean). I would avoid VPNs for this type of stuff as it will increase the delay part and often will cause stutters and stuff like that.

Keep in mind, I'd probably try to avoid taking such calls as there may be security/privacy issues as stated by another member. There is legislation that is supposed to cover this (eg, HIPAA or PIPEDA or GDPR), This is why most physicians assign another physician to cover for them while away. There is encryption, but that often doesn't factor into these things.

Re: Privacy. Can't the patient always consent to sharing the patient's confidential info with the medical professional over a potentially "unsecure" communications method regardless of the communications method? If I consent to talk about something medically confidential with my physician on a public street corner (v. a private in-person examining room) or with me in Fiji and my physician in Finland, what's the difference? If I consent (granted, knowledgeable consent), what's the problem?

Also, I've participated in Zoom's where somewhere on the screen it says something along the lines of "hosted over servers located in the US" (that's not a direct quote) which I presume is supposed to indicate that everything is "happening" so to speak in the US rather than all over the globe. Granted these were Zoom's involving only US-located participants (in multiple US States). But, maybe that's a potential indicator of stuff not being spread all over the globe.

Finally, I have zero doubt that my medical records are hosted, reviewed and accessible in any number of data sites/call centres around the globe and that somewhere, I've tacitly consented to that when I scrawled my signature across a dozen+ forms upon arrival at a physician's office or hospital ER.

It depends on if you are sufficiently informed of the risks. You are unlikely to be talking to a doctor in public about your medical history regardless of if you give consent as that could be an issue for them in a professional sense (their certification authority could take them to task and even take away their credentials if the violation is severe enough). For the average citizen it's unlikely to escalate unless the person gets really compromised, but for medical staff, it could become a nightmare for tracking purposes (eg, you give consent, but is it between you and him? You and her nurse? Between the nurse and the doctor while out to grab a coffee, etc...) there can be so many scenarios that it is simpler to just limit it to the office. That's why in many places, if there needs to be a discussion of a patient, it's done behind closed doors.

For zoom, that was partly to avoid sanctions. Zoom was storing a huge amount of information in China. The concern was that the meetings/recordings could be accessed by the chinese government and considering that the data (initially) wasn't encrypted, private discussions would be compromised. That's why many tech companies have different rules for China (and presumably soon if not already) Russia. India is also moving towards that as well. All under the the guise of national security/privacy.

Actually that is a mixed bag. In the US (and the EU and Canada), the data is kept "in-house" and depending on the competency of the application and administrators, encrypted. If done properly, those that use managed service providers for the infrastructure will not provide the admin access to the data (so for example, a database admin in India will be able to manipulate the US-based database in terms of keeping it running, but will not have the ability to read the data itself). Additionally many of the large service providers have two teams, the remote team to do the day to day stuff and a slightly more privileged local team for more heavy lifting stuff.

Your data is somewhat protected (there are always exceptions) and there are access logs that are often reviewed (or supposed to be). I know up here, people who weren't supposed to view a person's medical records have been disciplined/fired for doing so.

My Google Meet is the Workforce HIppa Compliant. For medical records, I can either VPN to web based electronic medical record or Chrome Remote Desktop back to my desktop back at work.

I also ask patients before I see them if they consent to telemedicine.

So then you should be good. You will likely have latency issues, but beyond that, you should be able to connect from Germany without too many issues.

I'm in Dubai at the moment. Zoom calls and Citrix both work perfectly, with no lag. I'd expect Germany would be equally as good.

The miracle of fiber optics. :D

Though as I recall the UAE mobile carriers block Whatsapp and some other calling apps. Or at least they did, I think.

Are you using a commercial VPN? (or even an enterprise VPN) Just curious as the performance difference between those and a non-VPN connection is often quite different (might not make a difference depending on how much data is being pushed at a given time, but still curious)

Weirdly… I changed hotels today, and my Citrix wouldn’t connect (Zoom was fine). Both hotels Marriott brand.

Anyway, I have a pi-vpn server (using WireGuard) at home in the UK, so connected to that. Everything fine after that - no lag that I noticed.

I'd be curious to see what the difference would with a TATL VPN connection. Even accounting for a pause to think about a reply, any x-ocean connection I've had, there has always been some form of latency (less so with some of the more "advanced" countries, but still noticably there)

Wiregrass is the vpn you use? I have done research and so lots of recommendations for nordvpn. Are there other ones you suggest?