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the longer there is delay, the greater will be the problem in trying to institute a more acceptable system than is now growing by chance at its current explosive rate".

Happily, the sense of urgency of the Task Force received the sympathetic attention of then APA President, Dr. Alfred M. Freedman, the Medical Director, Dr. Walter E. Barton and others, who called together a representative group of national organization people to explore their common interests in this problem area. This led to more formal organization of a planning group, on which the Task Force Chairman served, to plan a major working Conference on the Confidentiality of Health Records with the cooperative participation of about 50 national organizations and agencies, representative of organized medicine and all of the major medical specialties, the insurance industry, law, hospitals, nursing, medical record keeping, behavioral science, consumer groups, government, and many others. The need for consumer groups to participate in such efforts was paramount.

The Conference was held at Key Biscayne, Florida, November 6-9, 1974 after about six months of preparation in which many of the participating experts prepared working papers of high quality that were sent out to all participants in advance.* Approximately 110 persons were in attendance.

A full report of the important conference will be published by the Association in the spring of 1975. However, the most auspicious single result of the meeting was the unanimous resolution of all participants (with two abstentions) that there should be formed an independently incorporated body tentatively titled National Commission on the Confidentiality of and Access to Health Records to serve the following purposes:

1. To promote and preserve the confidentiality of health care records and to establish guidelines and recommendations for appropriate access to them.

2. To propose legislation and regulations to study and analyze legislation and regulations, in formation or already introduced, and to make recommendations for action and implementation by sponsoring organizations.

3. To engage in educational activities serving as an information exchange between participating organizations, to develop and/or disseminate materials for public education on confidentiality and

*The Task Force Chairman, Dr. Grossman, notes: "This is an outstanding example of the combined efforts of a Task Force, working through Councils and the APA Reference Committee, supported by officers and trustees, having a major plan brought to fruition through the dedicated efforts of the APA staff."

the access of records and to serve as spokesman for the adoption of guidelines and policies relating to these matters.

4. To develop through surveys and special studies methods for improved handling of health care information that will provide for appropriate access and preserve confidentiality.

5. To accomplish other appropriate objectives not inconsistent with those enumerated, by any lawful and ethical means.

In December 1974, the trustees of the Association voted unanimously to support the National Commission which is now in the process of formation under the aegis of an Interim Organizing Committee comprising representatives of the APA, American Academy of Pediatrics, American Medical Records Association, American Hospital Association, Mental Health Law Project, and the National Association for Mental Health. It is anticipated that the new Commission will be incorporated and fully underway before the end of 1975.



Education concerning the problems of privilege and confidentiality should be made available in various areas.

Inservice Education Within the APA Structure.

It would be helpful if the councils, committees and task forces dealing with areas related to privilege and confidentiality were informed of the findings and progress of this Task Force. Such action would add to the coordination of the efforts of the APA in safeguarding confidentiality of sensitive medical data.

Inservice Education to All Psychotherapists.

We would recommend that the APA publish a pamphlet to cover such topics as the difference between privilege and confidentiality, how to respond to a subpoena, appropriate methods of record keeping that will preserve confidentiality, and an explanation and a description of how to use the new coding system, were it adopted, for reporting to the insurance industry.

Education to the Lay Public.

Through the lay press, the APA should attempt to clarify physician-patient privilege, confidentiality, and the importance of these concepts.

Coordination with Other Agencies.

Developing insurance forms and coding mechanisms which protect confidentiality. Coordination with the Health Insurance Council and other groups of the insurance industry will be critical for the potential success of the proposed coding scheme. Excellent contacts have been established with these organizations, but continued effort will be necessary so that there can be no question as to the importance attached to confidentiality by the psychiatric profession and to our concern that confidentiality must also become important to the

health insurance industry. These efforts could be furthered with involvement of other medical organizations, including the American Medical Association.

Workshop dealing with data banks. Our discussions with representatives of various organizations have convinced us that such a workshop should involve the American Psychiatric Association in effective collaboration with a number of other groups. Through involvement of groups, including other medical organizations and representatives of the insurance and data processing industries, as well as consumer organizations, we would hope to increase the likelihood of effective legislative action which would aid patients who seek psychiatric help.

Need for a Specific Ongoing Group within the APA Concerned with Confidentiality and Particularly with Confidentiality and Third Party Payment.

The rapidity of developments involving confidentiality and third party payment, their complexity, and the needs for continuous active involvement for satisfactory resolution, prompt our conviction that a specific group within the APA be charged with responsibility for issues involving confidentiality. It is our belief that the activity would require a long-term group with both "watch dog" and active corrective force, with the strong backing of the APA.

In an immediate phase, the active negotiations in which the current Task Force is involved with the insurance industry are still in a delicate period with the outcome extremely promising but by no means certain. These extensive activities and contacts with the relevant aspects of the insurance industry must be furthered and continued by an ongoing group of the APA, in an atmosphere of mutual respect with the insurance industry, but with firm concern on the part of the APA group for the needs of the patients, both current and potential.

The current Task Force has accumulated a great deal of information regarding desirable and undesirable practices in relation to the insurance industry, and plans over the coming year to convert that material to monograph form. Consideration of the evolving practices of third party payment and their implications for psychiatric treatment with regard to confidentiality should be an active part of the role of an ongoing group.

Contacts with members of Congress have proved to be extremely helpful to the current Task Force and should continue to be so for any ongoing action group of the APA. Congress passed and the President signed S-3418 into Public Law 93-579 December 31, 1974,

The Privacy Act of 1974. This protects personal data in Federal agencies and creates a seven-member commission to explore similar problems in other governmental and private areas.

We believe that a separate group in the APA should be formed concerned with confidentiality, and that the task should not be divided among a number of groups which also have other responsibilities. The area of confidentiality is extremely topical, represents one of the most direct ways in which psychiatrists can aid their patients in the non-therapeutic situation, and requires the considerable effort that only a vigorous, single-focused group can provide.

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