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The National Commission for Data Protection (CNPD) could not be more demanding: medical students cannot legally access clinical data of patients. In an opinion issued at the request of the Faculty of Medicine of the University of Lisbon, within the framework of a protocol to be established with the Centro Hospitalar Universitário de Lisboa Norte, more specifically with the Hospital Santa María, which aimed to create a specific profile so that students could access within the scope of their academic training software SClinical, which adds the patients’ medical records, the CNPD concludes that such access lacks legal basis. And, in an opinion of December 30, it makes it clear that such access can only be made by medical graduates enrolled in the Ordem dos Médicos.
This decision, with repercussions that extends to all university hospitals in the country, astonished the coordinator of the Council of Portuguese Medicine Faculties (CEMP), Henrique Cyrne de Carvalho, who says that he is “blind and unaware of the reality” of the training. In Portugal. “It is with great sadness that we welcome this opinion, which represents a new delay in a process that has been evolving for more than three years and that aims precisely to regulate access to this data, which today is done in a hybrid way, since safeguard and protect personal data of patients, by creating a specific access profile to the electronic system for students and that makes them responsible, “he reacted in statements to the PUBLIC.
“Students must be able to access the clinical data of patients to be able to exercise at the end of their training,” agrees Catarina Dourado, president of the National Association of Medical Students (ANEM), pointing out that said protocol, like others in the meantime , signed in other university hospitals, envisaged the creation of an access profile to the electronic system “exclusively for students”, that is, with restricted powers and mere data visualization.
However, recognizing that a 2019 legal amendment obligates medical students to a duty of confidentiality when accessing personal health data, the CNPD understands that such duty cannot function as a standard to legitimize electronic access to such data. Furthermore, “the interest of medical students in knowing personal health data in the context of their learning is not enough to legitimize access to data that fall into the category of specially protected personal data”, emphasizes the entity that controls the treatment of the data. personal.
To the PUBLIC, the CNPD spokesperson, Clara Guerra, recalls that access to said data is only protected by law when it aims to provide medical care. And these can only be provided by health professionals registered in the Ordem dos Médicos. “As they are not health professionals, medical students can never have an autonomous access profile to a database of this nature: they do not make diagnoses or define therapies,” he stated, recalling that, in the scope of their training, “The students are always accompanied by a doctor and that the duty of confidentiality that binds them is to protect the information they access when they contact patients.”
The CEMP coordinator does not agree. “We have been working on the legal framework for this access for years and that is why we have made progress with the confidentiality oath signed by students. We were now at the stage of creating a password access to software specific for students and of limited use, that is, that students can view the information of hospitalized patients or in consultation but without the ability to intervene, so as not to run the risk, which would be serious and very serious, that someone may propose changes therapists without the ability to do so ”, contextualizes Henrique Cyrne de Carvalho, explaining that each student would have a non-transferable code“ that would make them responsible ”and that each access would be identified, with date and time.
Projects stop
At the São João University Hospital Center (CHUSJ), an “institutional commitment” was signed in October 2019, which already provides medical students access to medical records, in an initiative signed by the Ordem dos Médicos and SPMS (Servicios Shared by the Ministry of Health), which developed the SClinical, OR software which aggregates patient data. The objective then raised was to regulate access to the medical history by students of the most advanced years of the subject, linking them to the aforementioned duty of secrecy. The same thing happened, in fact, and in December of the same year, at the Faculty of Health Sciences of the University of Beira Interior (UBI).
Questioned by the PUBLIC, those responsible for CHUSJ deny, however, having committed any illegality, since no student has been able to access clinical data on “real patients”. “There is no student access to SClinical at CHUSJ ”, they say, explaining that this did not happen because the tool created by SPMS lacked a“ piece ”for managing user consent. Furthermore, neither is the possibility for students to have access to a SClinical “Formative”, with data from fictitious patients, also advanced, according to those responsible for that university hospital center.
Faced with the obstacles raised by the CNPD, the heads of the medical schools will meet in the coming days to try to establish “a joint position”, according to Henrique Cyrne de Carvalho, also president of the Abel Salazar Institute of Biomedical Sciences (ICBAS), for whom the proposal that was on the table is “more transparent and reliable” than what is currently happening in university hospitals: “When the files were on paper, the students could go to the nurses ‘or doctors’ room and consult the files of each patient. When the processes became electronic, access was made through the password of the assistant or the teacher, with the due authorization of the ethics committee, because the students are doing more and more clinical research and have their master’s thesis to present at the end, for the conclusion of the integrated master’s degree in Medicine ”, he describes, saying Rest assured that “access with a specific student profile, in addition to being more transparent and secure, would already serve as training for the responsibility they will assume once they graduate.”
