病歷資訊是醫療系統中最重要的資訊，而在開放的網路環境，病人的私密性必須透過存取控制與授權管理機制予以確保。存取控制主要是判斷醫療使用者是否有權使用或更動病歷資訊，而授權管理則規範使用者可以擔任之醫療角色及每個醫療角色之權限。本研究根據所分析的各種病歷資訊使用角色與其對於病歷資訊之使用權限，整合資訊安全技術及網路上之身分識別技術，設計以角色為基礎的存取控制機制於網路上病歷資訊之安全管理。所設計的安全機制規範了使用者被授權擔任之角色，以及每個角色所賦予的存取病歷資料之權限，並且整合身份識別來確認使用者身份及可擔任的醫療角色，進而依據其啟動擔任之角色決定存取權限．以進行安全控管。安全機制並且使用加解密技術，以確保病歷資料在網路傳輸的安全性。研究結果顯示整合角色存取控制機制、身份識別及加解密技術，可有效的提供網際網路存取病歷資料之安全控管。此外，訂定標準規範與政策是相當重要的，本文建議主管衛生單位需針對醫療角色及其存取權限制訂各醫療組織需遵循之標準規範與政策。

　　　　　Patient records are the most important information for health care systems. The prevalentuse of Internet makes the access to patient records more convenient. However, as an openenvironment on the Internet, it is necessary to protect the privacy of patients. To achieve securityrequirements, security mechanisms are required to implement access control and authorizationmanagement of patient records. Access control determines whether a medical user has theprivilege to access patient records. Authorization management enacts the assignment of users toroles and the assignment of permissions to roles. This work analyzes various medical roles andaccess permissions on patient records. Integrated with the technologies on information securityand identity authentication, a role-based access control scheme is developed to control the accessto patient records on the Internet. The authorization of roles to users as well as the authorization ofpermissions to roles is enforced. The scheme integrates identity authorization to verify a user'sidentity and authorized roles. The user's access privileges are further determined according to the permissions of authorized roles. Data security on the Internet is enforced by encryption. The resultshows that secure Internet access to patient records can be achieved effectively by integratingrole-based access control, identity authentication and encryption technologies. Furthermore, ourstudy suggests that it is important to develop organization-wide policies for the enactment ofmedical roles and corresponding legal permissions on patient records.