In the last few years, the protection of computerised medical records,
and of other personal health information, has become the subject of both
technical research and political dispute in a number of countries. In
Britain, the issue arose initially as an argument between the British
Me- dical Association and the Department of Health over whether
encryption should be used in a new medical network. In Germany, the
focus was the issue to all patients of a smartcard to hold insurance
details and facilitate payment; while in the USA, the debate has been
whether federal law should preempt state re- gulation of computerised
medical records, and if so, what technical and legal protection should
be afforded the patient. Whatever the origin and evolution of this
debate in specific countries, it has become clear that policy and
technical matters are closely intertwined. What does 'computer security'
mean in the medical context? What are we trying to do? What are the
threats that we are trying to forestall? What costs might reasonably be
incurred? To what extent is the existing technology - largely developed
to meet military and banking requirements - of use? And perhaps hardest
of all, what is the right balance between technical and legal controls?
As the debate spread, it became clear that there was little serious
contact between the people who could state the requirements - clinical
professionals, medical ethicists and patients - and the people who could
explore how to meet