Local-First Software: A Practical Privacy Upgrade for Private Practices

“The cloud” is convenient—until you’re storing the most sensitive parts of a person’s life. Mental health records carry a unique weight. They’re not just data; they’re stories, history, trauma, and vulnerability.

For years, the industry standard has been to upload everything to a centralized server owned by a third-party company. While convenient, this model creates a massive target for hackers: a single database holding millions of records. If that database is breached (as we’ve seen with major healthcare clearinghouses), your clients’ data is exposed, often through no fault of your own.

Local-first software is one practical way to reduce exposure without giving up modern workflows. It represents a shift back to ownership—where your tools serve you, and your data stays with you.

Who this is for

This guide is for mental health clinicians who are concerned about the rising tide of healthcare data breaches, frustrated by slow or internet-dependent EHRs, or simply uncomfortable with the idea that they don’t truly "own" their client records.

What you’ll walk away with

You’ll understand exactly what "local-first" means (and how it differs from "offline-only"), why it offers a distinct privacy advantage for therapy practices, the honest tradeoffs you need to accept, and the practical security steps required to use it safely.

What “local-first” actually means

There is a misconception that "local" means "offline and stuck on one computer like it's 1999." That is no longer true. Local-first means your device (your laptop, tablet, or phone) is the primary place your core data lives—by default. The "source of truth" is the encrypted file on your hard drive, not a database entry in a server farm three states away.

Modern local-first software can still use the internet, but it uses it differently. In cloud-first apps, you are effectively renting a window into someone else’s computer. If the internet cuts out, the window closes. If their server goes down, you can’t work. In local-first apps, you are working on your own machine. The internet is optional. It’s used to sync data between your devices or back it up, but the work happens locally. This distinction changes everything about how the software feels and how the data is protected.

Why it matters for therapists: The "Blast Radius" Concept

Local-first architecture isn’t just a technical detail; it aligns deeply with the ethical obligations of private practice.

One of the most compelling arguments for local-first is reducing the "Blast Radius." In a traditional cloud EHR, a successful hack can expose millions of patients at once. This is why they are such attractive targets for ransomware gangs. They are "Honeypots." In a local-first model, data is distributed across thousands of individual, encrypted devices. To steal data from 1,000 therapists, a hacker would need to hack 1,000 separate computers. This makes mass surveillance and mass breaches significantly harder. It doesn’t eliminate risk, but it changes its shape from a catastrophic central failure to a manageable individual responsibility.

Another benefit is speed and focus. Because the software runs on your computer’s processor, not a remote server, it is instant. There is no "loading..." spinner when you switch between client tabs. There is no lag when typing a note. This speed isn’t just about efficiency; it’s about flow. When your tools respond instantly, you stay focused on your clinical thinking rather than fighting the interface. You aren't distracted by "Attempting to reconnect..." messages in the middle of a session.

Finally, local-first offers true ownership and custody. If a cloud vendor goes bankrupt, changes their pricing to an unsustainable level, or suffers a catastrophic outage, you are at their mercy. Your data is held hostage on their servers. With local-first software, you have the files. You can export them, back them up to a hard drive, and open them even if the company disappears tomorrow. You retain custody of the clinical record, which aligns with your legal and ethical role as the custodian of records.

The Tradeoffs: With Ownership Comes Responsibility

Local-first is not a magic bullet. It shifts responsibility back to the practice. If you choose this path, you must accept three key responsibilities.

First, device security is non-negotiable. In the cloud model, you rely on the vendor’s security team. In the local-first model, you are the security team. This means your computer must be encrypted. NIST (National Institute of Standards and Technology) describes full disk encryption as the process of encrypting all the data on a hard drive used to boot a computer. This is a critical safeguard. If your laptop is stolen, full-disk encryption ensures the thief gets a brick, not a database of client secrets.

Second, backups matter more. If you drop your laptop in a lake, and you haven’t backed up your data, it’s gone. Cloud apps handle redundancy for you. With local-first apps, you must ensure your data is syncing to a secure backup location (like an encrypted cloud drive or a physical backup drive).

Third, multi-device sync requires setup. While possible, syncing data between a phone and a laptop in a local-first environment requires a secure "relay" or sync service. It’s not as automatic as logging into a website, though modern tools (like Soli) make it nearly seamless.

Security Basics for the Local-First Clinician

If you decide to go local-first, you need to implement what HHS (Health and Human Services) calls "technical safeguards." Here is the minimum viable security posture.

You must enable full-disk encryption. On a Mac, turn on FileVault. It’s free, built-in, and military-grade. On Windows, turn on BitLocker (available on Pro versions) or Device Encryption. HHS breach guidance explicitly states that encryption can render Protected Health Information (PHI) "unusable, unreadable, or indecipherable to unauthorized individuals," which provides a "safe harbor" in the event of device theft.

You also need strong authentication. Your computer password is the key to the castle. It should be long, unique, and not "Password123." Use a password manager to generate complex passwords. Additionally, keep your operating system updated. Security patches often fix vulnerabilities that hackers exploit.

Common Mistakes (and how to avoid them)

We see clinicians make several common errors when switching to local storage. One mistake is thinking "local" means "I don't need a BAA." The reality is if you use any cloud service to sync or back up that data (like Dropbox, iCloud, or Google Drive), you absolutely need a Business Associate Agreement (BAA) with that provider. Soli provides a BAA for its sync service, but if you use your own backup, you need one there too.

Another mistake is leaving the computer logged in. You should set your screen to lock automatically after 5 minutes of inactivity. Physical access is the biggest threat to local data. Also, avoid sharing a family computer. Your practice computer should be for your practice. If you must share, create a completely separate, password-protected user account for your clinical work.

Practical Next Steps

Ready to take control of your data? Here is what you can do this week.

Start by checking your current encryption status. Go to your computer’s settings (Security & Privacy on Mac, Update & Security on Windows) and confirm that FileVault or BitLocker is ON. Next, audit your backups. Where is your data currently backed up? Is it encrypted? Do you have a BAA with the backup provider? Finally, evaluate your workflow. Do you actually need to access client records from five different devices, or do you mostly work from one laptop? If the latter, local-first might be a perfect fit.

The bottom line

Local-first software isn’t a trend. It’s a practical privacy upgrade—especially for clinicians who want modern workflows without feeling like sensitive records are floating in too many places. It returns the "private" to private practice.

Sources

• NIST Special Publication 800-111: Guide to Storage Encryption Technologies for End User Devices
• HHS Breach Notification Rule: Guidance to Render Unsecured Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals
• HIPAA Security Rule: 45 CFR § 164.312 - Technical Safeguards