August 6, 1999

The APA Board of Trustees has decided to invest in the development of an Internet project to ensure that the Association is a major player in the exploding use of that medium to communicate health and medical information.

At its meeting in Washington, D.C., July 9 to 11, the Trustees voted to invest $250,000 in a start-up Internet health site whose content will be controlled by medical specialty societies and the AMA.

Called MyHealthSource.com, the new site will be controlled by a consortium of medical societies and is designed to remedy the problem created by the proliferation of medical information on the Internet from sources whose credibility may be questionable, according to APA Medical Director Steven Mirin, M.D. It is an opportunity to be a founding member and collaborate with other medical societies in developing "a quality health information supersite on the Internet," he told the Board.

"We absolutely must control mental health information that goes out over the Internet," Mirin emphasized. "If we don't control it, other [Internet] sites will contract with other mental health organizations" to post information related to psychiatry.

While noting the potentially vast market for "credible, trustworthy information" on the Internet, Mirin explained that despite promises of substantial financial backing from sources other than medical specialty societies, developing any Internet site involves considerable risk. "We are well aware that this is a risky business, but having a seat at the table and being able to control the content are significant," Mirin said.

The American Academy of Ophthalmology, American Medical Association, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics have already voted to participate. The boards of the American Academy of Orthopedic Surgeons, American Society of Plastic and Reconstructive Surgeons, and American Academy of Allergy, Asthma, and Immunology are scheduled to vote on joining the project sometime this summer. Several others are still considering whether to join the enterprise.

"The task is for the medical specialty societies, including APA, to form a company and to recruit leadership to both seek outside investors in the high-tech industry to move the project forward," said Mirin after the Board meeting. "The relative size of the investment that is needed over the first two years will be upward to $30 million, of which only a small portion will be put up by the societies." Several large and well-known technology and communications companies have expressed strong interest in funding the venture.

With no end in sight for the astounding growth of Internet use, APA will have the ability through this new site to educate and provide information to tens of millions of Americans, said Charles Killian, APA's chief information officer. He told the Trustees that of the 80 million to 90 million Americans who use the Internet, about 60 million seek health-related information, and about 30 million are looking specifically for mental health information. If MyHealthSource.com gets off the ground-and that is not assured-APA will gain the ability to define the mental health content for the entire site, he said.

Among the other advantages of participating in MyHealthSource.com, Killian noted, will be the ability of psychiatrists to have individual, customized Web sites and to have an effective and popular forum for communicating with patients and others seeking credible data about psychiatric treatment and illnesses. An APA survey earlier this year showed that 69 percent of psychiatrists use the Internet.

Investing in the venture does not come with a guarantee it will succeed. Killian explained that there are already several consumer-health-oriented Internet sites, all of which are losing money, and these sites may begin to consolidate. Success will depend in part on the continued willingness and ability of initial investors to stick with a risky enterprise and the ability to obtain income from advertisers.

Area 2 Trustee Herbert Peyser, M.D., asked Mirin whether APA would be asked to invest beyond the initial $250,000. Mirin responded that the $250,000 was necessary to participate now and that the need for future investment was not predictable. The success of the project, he noted, rests on the venture's raising sufficient capital from major investors beyond the participating medical societies.

Past Presidents

The Trustees also endorsed proposed amendments to the APA Constitution and Bylaws concerning the tenure of past presidents on the Board. Currently, each past president serves as a voting member of the Board for three years after his or her term as president ends. Following that three-year period, past presidents are ex-officio members of the Board for life, and APA pays their expenses for attending Board meetings.

The first amendment would change the bylaws to end past-presidents' tenure on the Board at the point they complete their three-year post-presidency term. The second amendment would "grandfather" past presidents who were elected president prior to the 2000 election to continue to be members of the Board for life with their expenses paid by APA, but as is now the case, they would become ex officio members after the three years following their presidency.

In May the Assembly overwhelmingly approved placing the two amendments on next year's election ballot.

Other Board Actions

In other actions, the Trustees

• approved a resource paper designed to guide psychiatrists in documenting psychotherapy. The paper is not a "rigid practice guideline," emphasizes the Commission on Psychotherapy, which developed the document, but rather a "suggested format" for documenting psychotherapy in light of variations in state laws, "the requirements of individual clinical situations," and the vulnerability of records that accompanies computerization.



Among the topics the paper addresses are the initial evaluation, content that should and should not be recorded, privacy considerations and patient consent when entering data into information systems, documenting psychotherapy with medical evaluation and management to comply with Medicare's CPT coding requirements, and psychiatrists' keeping "personal working notes" that contain intimate details of a patient's illness, psychiatrists' hypotheses and predictions, and information about others in the patient's life.

The resource paper can be obtained via the APAfastFAX service, document code 5801.



• voted to approve a payment of $7,700 to the New York State Psychiatric Association as part of the $20,000 APA promised the NYSPA to assist with its project to educate state legislators about the impact of a bill to expand the scope of practice of mental health professionals. The Board also ratified an earlier executive action in which APA sent the NYSPA $12,300 as the first part of the $20,000. The money comes from the Committee to Oversee the Fund to Support District Branch Initiatives of National Importance, which the Board created in 1997 with an appropriation of $250,000.

  The Trustees also ratified an executive action in which APA contributed $27,000 from the fund to the Georgia district branch for its fight against a psychologist-prescribing bill.




• heard reports from three district branch presidents-elect: Harold Rosen, M.D., Psychiatric Society of Delaware; Calvin Sumner, M.D., West Virginia Psychiatric Association; and Jeremy Musher, M.D., Pennsylvania Psychiatric Society.



• asked the Membership Committee to develop a mechanism to channel all partial member dues payments first to district branches and then to the APA national office. This action reverses the current procedure for processing partial dues payments.



• adopted a statement declaring that "APA is not in a position to enforce its ethical principles outside of the district branch structure, but in no case outside of the U.S. and Canada." Trustees agreed with a report from the Ethics Committee noting that APA lacks a mechanism to investigate comprehensively charges of ethics violations in countries with no district branches.



• endorsed APA's collaboration with other organizations "to develop a systematic response to ethical issues raised about medical research in general and psychiatric research specifically." The Board also voted to undertake "a coordinated, cohesive public affairs campaign" to address concerns by some in the public and research community about research involving human subjects.