By Cindy Yeast

Advancements made in the computer and telecommunications industries have simplified and enhanced daily living, says Rosalyn Carter. But there is a price to pay, she cautions?threats to our privacy.

Speaking at the 13th Annual Rosalyn Carter Symposium on Mental Health Policy in Atlanta Nov. 19?20, Carter noted that many factors complicate the protection of personal health information?consumers, providers, insurance companies, law enforcement agencies and others.

Carter challenged the symposium participants ?to find a balance among all the competing interests at hand? and to question who should have access to what information and for what purpose.

APA was one of 60 mental health organizations who sent representatives to the conference, which allowed mental health and other professionals to present their perspectives on confidentiality and privacy issues in today?s health-care system.

Protecting patients

Robert Gellman, a privacy and information policy consultant from Washington, D.C., discussed whether technology will help or hurt the health privacy. Gellman believes two issues are at the core of the privacy debate: that technology is not the problem or the solution to privacy and confidentiality issues, and that there is no real agreement on the meaning and goals of ?privacy,? or on the distinction between the terms ?privacy? and ?confidentiality.?

Gellman said that health records are not confidential for myriad reasons, such as third-party payment, use of billing services, outcomes research, fraud control and public health data collection.

?Health records are the most widely circulated records kept by third-party record keepers today,? he said. Because privacy or confidentiality of health records can no longer be guaranteed, the United States should implement ?fair information practices,? which European countries use to protect patients, he said. ?Fair information practices address the rights and responsibilities of record-keepers and record subjects.?

John Petrila, of the Florida Mental Health Institute, addressed the legal and ethical issues of privacy. He pointed out that while federal regulations protect the records of patients who seek substance-abuse treatment, state laws determine the level of protection for patients who seek mental health services. Petrila suggested that a single federal standard should govern both mental health and substance-abuse records.

Marcia Kraft Goin, MD, PhD, clinical professor of psychiatry and behavioral sciences at the University of Southern California Medical School, addressed the clinical issues of confidentiality and privacy. She recommended passage of legislation to protect confidentiality. Such legislation would require:

? Punishment for unauthorized disclosures.

? Advance notice of criteria used for authorizing payment of patient claims to prevent unnecessary disclosure of sensitive information.

? Removal of patient identifiers for reviews procedures and accreditation.

? Encryption of computerized health records.

? Informed consent from patients for use of their health records for research studies.

Confidentiality issues can be particularly thorny when family members are involved. APA member Harriet Lefley, PhD, professor of the department of psychiatry and behavioral sciences at the University of Miami School of Medicine, noted that generally a caregiver?s access to information about a family member?s treatment is much less than that of a managed-care company.

Providers are now realizing that it may be beneficial to share some of a patient?s information with family caregivers, she said. But, she noted, providers must develop ways to handle the confidentiality issues that arise in this instance.

?There are many ways of conferring with consumers about the boundaries of information and honoring their wishes in ways that will be acceptable to them and to the family,? she said.

During the second day of the symposium, break-out groups addressed the technological, legal and clinical arenas, as well as the perspectives of children, family members and consumers. Each group identified the three most important issues in a particular area of privacy and confidentiality and recommended at least one action to address each of these issues.

Preliminary findings were presented at a joint session at the end of the symposium and will be published in final format by the Carter Center in mid-1998.

For more information about obtaining a copy of the preliminary findings or for other information about the symposium, call the Carter Center Mental Health Program at (404) 420-5165.

Cindy Yeast is assistant executive director of public relations and communications for APA?s Practice Directorate.