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Medicine is one field in which serious attempts are underway in a number of countries to build large-scale decentralised trusted systems over the Internet to support a number of aspects of patient care, administration and research. Medical informatics has made unique contributions to the general pool of security know-how, and as medical practice is highly decentralised, many of these lessons may be applicable to Internet applications in general. Examples include the following.

The previous work that directly concerns us is Wax [Wax97a]. This is a proprietary hypertext system used for medical publishing; its goal is the secure and timely electronic distribution of information used to support clinical practice, such as treatment protocols and drug formularies. It will also be used for government circulars ranging from purely administrative information such as advice on coping with the Y2K bug to notices of newly discovered adverse drug reactions; and for local information such as hospital waiting lists.

Wax is already used in several health trusts in the UK for providing a mixture of trust-specific and general information. It is also used in the US for delivery of medical knowledge relating to HIV and AIDS by Intelligent Medical Objects, Inc. (Northbrook, Illinois, USA). There are clear safety and medico-legal reasons why the authenticity, integrity and timeliness of the information it distributes should be protected, and a project was undertaken during 1996-8 to design and implement this. That project is described in [Wax97a], but we will describe it here briefly so this article is self-contained.

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Fabien A.P. Petitcolas, Computer Laboratory, University of Cambridge