Medical database security plays an important role in the overall secur
ity of medical information systems. The development of appropriate sec
ure database design and operation methodologies is an important proble
m in the area and a necessary prerequisite for the successful developm
ent of such systems. The general framework for medical database securi
ty and a number of parameters of the secure medical database design an
d operation problem are presented and discussed. A secure medical data
base development methodology is also presented which could help overco
me some of the problems currently encountered.