The aim of this qualitative study was to investigate the impact of a CPOE system on pathology departments with particular emphasis on the implications for information exchange processes at the laboratory and hospital ward interface. The study was carried out over the period August 2005 to August 2008 in a pathology service located in a large Australian suburban tertiary hospital that introduced the Cerner PowerChart (version 2004.01) electronic ordering system in January 2006. The results of the study highlight the contrasting scientific and organisational tasks of the different pathology departments (Haematology, Clinical Chemistry, Central Specimen Reception, Blood Bank and Microbiology) and their effect on information and communication processes. The study also shows how the trustworthiness of CPOE systems is an important consideration underpinning patient safety.

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 Patients’ access to and use of personal health data are important aspects of patient care, which could result in greater patient empowerment and would also contribute to the overall improvement in health outcomes. Given the limitations of the existing health records, such doctor-patient information sharing with proper data partition can lead the patients to misconstrue doctors’ diagnostic and therapeutic decisions. Mental health introduces additional challenges, namely issues concerning privacy and risks associated with providing patients with access to sensitive evaluative information. In particular, adolescent patients’ access to their mental health records (MHRs) raises more concerns about the appropriateness of allowing the patients to view their complete medical part of records. We propose a formative research design framework that has implications for developing information architecture (IA) for improving the comprehensibility of patient health records, in the context of adolescent depression, such that patients can access “appropriate” versions of their records. Such an empirical framework based on cognitive methods and consumer health informatics will help in abstracting culturally sensitive health information from physicians’ versions of patients’ MHRs and can aid in thoughtful design of patient health records. This approach can reduce the probability of misinterpretations caused by the information embodied in MHRs by providing patients with access to an alternative version of their own MHRs, which can be accessed by their physicians.

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 With the spread of electronic health records, patients’ privacy concerns rise greatly. In response, many organizations advocate that healthcare information systems (HIS) should have an opt-in capability and a way for people to segment sensitive information, if they choose to. Currently, employing a proper access control mechanism to protect patients’ electronic health records is a well-accepted discipline in HIS development. However, the design of such mechanisms hardly includes the requirement of supporting patients’ preferences regarding the use of their personal information. It is therefore highly desirable to extend a HIS’s access control to handle patients’ privacy preferences. On the other hand, as the principle and practice of patients’ privacy preferences are still emerging, instead of replacing existing mechanisms with new ones, techniques for adapting existing mechanisms to quickly reflect patients’ privacy preferences can be a worthwhile solution. In particular, we argue that aspect-oriented programming (AOP) can be part of the solutions and has the potential to provide fine-grained privacy protection to cater to the privacy needs of each individual. Aspect-oriented approach enables separation of concerns which are better designed independently, but must operate together. We propose an aspect-based preference management framework that collects and manages patients’ preferences independently yet can integrate with the underlying HIS to support patients’ privacy preferences effectively. The proposed mechanisms are loosely coupled with the underlying system. It is thus easy to adapt them and employ them for migrating existing systems to support patients’ privacy preferences.

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 The privacy-aware patient-controlled personal health record (P³HR) system protects privacy even when the personal health records (PHR) are stored into untrusted third-party-managed databases. It differs from other pseudonym-based protection systems in term of the selection of attributes for using pseudonyms, the method of handling anamnesis data and the method of controlling secondary usage of data. The stored PHRs in P³HR become anonymous to unauthorized entities but unanonymous to authorized entities. This paper first presents a novel method for graphically representing the overall privacy level of a system. Then, the performance evaluation of P³HR system was carried out in terms of ‘privacy level’ and ‘scope for secondary use’ of the stored health records. The privacy level was assessed based on the level and number of (i) standard security threats handled, and (ii) legal and technical objectives achieved. The scope for secondary use was measured based upon the availability and accuracy of data for secondary use. Analytical results show the superiority of P³HR system over other systems in both of the above metrics.

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