Changing from paper-based systems to digital mechanisms means that personal information becomes more easily accessible and more difficult to control and secure. When the paper-based practice is in a sector such as healthcare, concerns for patient privacy protection are great. In paper-based prescribing in the United Kingdom's National Health Service (NHS), patients are responsible for protecting the privacy of their prescription information while it is in transit from the prescriber to the dispenser. The UK government has introduced a plan for future NHS reform that includes a change from paper-based prescribing to a national electronic transfer of prescriptions (ETP) system. 1 This brings with it concerns for patient data privacy and questions about the burden of trust placed on professionals in the ETP system. As recently seen in the Emilio Calatayud case in the United States, 2 systems that contain an aggregation of identifiable personal information can be abused. A similar case could result from malpractice in an ETP system. We have developed and implemented an ETP system for the UK NHS. 3 We present our system for protecting the privacy of patient data, describe how we implemented it in Java, and discuss how others can use our system for other applications both inside and outside the healthcare sector.

The presence and increase of challenges to eHealth in today's society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment.

Abstract. The UK government has stated within its plan of reform for the National Health Service that a secure system for the Electronic Transfer of Prescriptions will be available by 2004. The objectives of this paper are to highlight the significant barriers faced in securing an ETP system, to provide a critical analysis of the security mechanisms in the models currently being piloted and to suggest an alternative revised model which overcomes the identified deficiencies and security hurdles. To identify the significant security issues relevant to the adoption of ETP, the authors have combined their analysis of present prescription processing practice with their knowledge of computer security. The authors identify and describe how the issues of patient confidentiality, authorization, identity authentication, audit, scalability, availability and reliability are significant barriers to the adoption of ETP, particularly if they effect ease of use. The paper's contribution to the field of ETP is to suggest solutions to each of the identified security issues and to combine the solutions together in a revised and developed model.

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The UK National Health Service (NHS) is about to commence upon major computerisation of its processes as part of a government plan of modernisation. One of these is the Electronic Transmission of Prescription (ETP). To achieve success it is important to know what benefits are expected from the new system and what barriers to adoption the systems will face. This paper reviews substantial ETP published material, and identifies 17 issues that need to be addressed. These issues are categorised under four major headings of stakeholders, cost, technology, and current process and practice, and are then further classified as positive or negative influences on the project's success. Many of these influences will be common to most of the computerisation projects to be undertaken by the NHS, and therefore this paper has wider applicability than ETP.

Performance tests of XML and ASN.1 found that signed complex XML messages can be up to 1,000-percent slower to decode than an equivalent ASN.1 messageOver the past few years, Extensible Markup Language (XML) has become the preferred syntax for transferring business information across the Internet, receiving widespread endorsement from major IT industry players such as Sun Microsystems, IBM, and Microsoft, as well as many governments. The UK government, for example, is firmly committed to making XML the basis for electronic transactions through their e-Government Interoperability Framework, e-Government Metadata Framework, and GovTalk program. //Nancy: Do you know if one of the items in the "Resources" sidebar relates to this? If not, please ask the author for have a reference here on where you this info came from. We should have some of the references in parentheses within the body of the article, in addition to the Resources sidebar.//Indeed, many UK government agencies are investigating the adoption of XML as the protocol for e-services, such as medicinal prescribing, contract tendering, and personal health records.But although many have touted XML as a true e-business enabler, rarely does a single technology suit every IT scenario. In XML's case, the drawback is performance. XML is an uncompressed textual syntax that remains in human-readable form from creation to deletion. This characteristic degrades performance because it increases data-stream size, which in turn increases data transfer time, and it takes time to construct and deconstruct the syntax.In the Internet world, performance is one of user satisfaction's critical components , so having some quantifiable comparison with other transmission syntax would be valuable input to any XML adoption decision. Motivated by this concern, we devised a series of tests to compare XML messages with equivalent messages written in Abstract Syntax Notation One with Basic Encoding Rules (ASN.1/BER). ASN.1 is a protocol specification language, first standardized in 1984. The encoding rules, of which BER is only one variety, are used to condense the ASN.1 textual representation into a binary data stream. Many Internet-based applications, air and road traffic control systems, mobile phones, and power grids use ASN.1. Overall, ASN.1 (regardless of its encoding rule set) tends to emphasize efficiency, while XML is targeted more at facilitating application development.The goal of our tests was to gather data to inform the UK Department of Health, which has requested the use of XML for encoding electronic prescriptions. In short, we wanted to see if XML or ASN.1 was the more efficient mechanism. Our tests cover the creation, transmission, and retrieval performances of the two languages. The test bed was a trial electronic prescription system already in place that uses an application certificate to transmit a prescription. This certificate is similar to a public-key certificate-a fundamental component of Web security-but as its name suggests, an attribute certificate contains ...

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