Intended for healthcare professionals

The Impact Of Informatics

Computerisation and health care: some worries behind the promises

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1295
  1. Roderick Neame, managing director (,
  2. Eike-Henner Kluge, headb
  1. a Health Information Consulting, Homestall House, Faversham, Kent ME13 8UT
  2. b Department of Philosophy, University of Victoria, Victoria, BC, Canada
  1. Correspondence to: R Neame

    Most clinical facilities are looking towards achieving seamless integration of services based on a clinical “intranet” and deployment of full electronic records. These developments open a wealth of opportunities and promise benefits; however, they bring with them several important concerns and risks, at the root of which are security issues.1

    Computerised and hard copy information differ in two fundamental ways. One difference relates to perception: hard copy is something we are all familiar with and feel that we understand. By contrast, information that is stored in electronic form is mysterious and therefore a source of anxiety. Understandably, therefore, professionals and the public alike are more concerned about the security of electronic records, especially not knowing where they are stored or who controls them. The various well publicised failures of computerised systems have contributed to this unease.

    Summary points

    Security remains a critical issue in respect of health information management systems: too few people understand the risks inherent in the technology, although anxiety is widespread

    Patients assume that care providers are in control of the technology they use and that the technology is fit for the purpose, but there is no process of certification for this

    The law can offer little useful help: it has always trailed reality, often by a considerable margin

    The goal must be to prevent security breaches, because once they have happened the damage is already done as far as …

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