COMPUTERS, COMMUNICATION AND CONFIDENTIALITY - TALES OF BARON-MUNCHAUSEN

The aim was to examine the use computer and paper based systems accide nt and emergency (A&E) departments in the management of patients who a re frequent attenders. More than half of the A&E consultants in the Th ames regions who were sent a questionnaire responded (44 of the 80). 8 2% of the respondents use such systems predominantly to monitor violen t patients, those with Munchausen syndrome, and children on the ''at r isk'' register. Systems currently in use fail to fulfil many of the fu nctions that would be required of an ideal system. When using computer s to store and communicate clinical data, several ethical problems wer e identified but these appeared to be outweighed by the practical need and were also present with paper based systems. Safeguards could also be built into computer based systems to reduce some of the ethical pr oblems. Computer systems should be deliberately chosen and implemented in response to a specific management problem. The potential benefits should be weighed against possible damaging side effects, such as a br each of confidentiality.