On March 28, 2019, the Council of Europe* issued a new Recommendation on the protection of health-related data. The Recommendation calls on all Council of Europe member states to take steps to ensure that the principles for processing health-related data (in both the public and private sector) set out in the Appendix of the Recommendation are reflected in their law and practice.

This Recommendation is likely to be of interest to both public sector and private sector organizations that are seeking to use health-related data in innovative ways, including developing digital health solutions that involve genetic data, scientific research, data sharing or mobile health applications.

The Recommendation builds on Convention 108, which is an international treaty first ratified in 1981 and the first legally binding international instrument on protecting individuals’ privacy. The Convention 108 has recently been updated to be aligned to the GDPR (see the text of the consolidated text of the modernized Convention 108+), but contains less granular obligations than the GDPR. The Recommendation complements the modernized Convention 108+ by introducing specific definitions (such as “health-related data” and “genetic data”) and specific principles for processing health data.

Most of the principles on processing health data set out in the Recommendation reiterate the position under the EU General Data Protection Regulation (“GDPR”) and relevant guidance issued by European data protection authorities and the European Data Protection Board (the “EDPB”, previously known as the “Article 29 Working Party”). The Recommendation does, however, provide some specific guidance on processing health-related data that is more detailed than, and in some aspects, goes beyond, the requirements of the GDPR, as described below:

  • Genetic data. The Recommendation provides that genetic data should only be collected subject to appropriate safeguards where it is either prescribed by law, or on the basis of consent (except where such consent is excluded by law). Genetic data used for preventative health care, diagnosis or treatment of patients or scientific research should only be used for those purposes, or to enable the individuals concerned by the results of the genetic tests to take an informed decision on these matters. Genetic data used in the employment context, for insurance purposes and for judicial procedures or investigations are specifically called out as areas requiring further consideration by member states on laws to provide appropriate safeguards.
  • Sharing health-related data for secondary purposes. In relation to sharing health-related data for purposes other than providing and administering health care, the Recommendation states that only recipients who are authorized by law should have access to health-related data, with no mention of patients’ consent as a way of legitimizing such access. This position is potentially more restrictive than the current approach under the GDPR, where third parties not involved in providing health care to patients (such as research or academic institutions or commercial companies) may receive health-related data as long as they do so in compliance with the GDPR. Whether national laws implementing this Recommendation will provide that third parties lawfully receiving health-related data in compliance with the GDPR (such as with patients’ consent) will be considered to meet this “authorization” requirement remains to be seen. The Recommendation also states that recipients of health-related data must be subject to the rules of confidentiality incumbent upon a healthcare professional (or equivalent) unless other safeguards are provided by law.
  • Scientific research. The Recommendation takes a contextual approach to scientific research, providing that the need to process health-related data for scientific research should be weighed against the risks to the data subject (and to their biological family if genetic data is involved). Unlike the GDPR, the Recommendation does not automatically qualify scientific research as being compatible with the original purposes for which the data was collected. As a general principle, health-related data should only be processed for research purposes where the data subject has consented, unless the law provides that health-related data can be processed without consent. Individuals should also be provided transparent and comprehensible information about the research project. The Recommendation adds that conditions in which health-related data are processed for scientific research must be assessed, where necessary, by the competent independent body, such as an ethics committee, and such research projects should be subject to safeguards set out in law. Fundamentally, the three-part requirements of consent/law, notice and safeguards for using health-related data for research is the same as under the GDPR However, in some respects Recommendations appear to call for a strengthened regime for scientific research using health-related data that goes further than the GDPR.
  • Digital health. Several principles in the Recommendation are clearly relevant for digital health applications, particularly those involving artificial intelligence, machine learning and mobile devices. The Recommendation provides that systems storing health-related data should be “auditable”, meaning that it should be possible to trace any access to, modification of, and actions carried out on the information system, so that the author can be identified. The Recommendation also encourages the adoption of “reference frameworks”, which are coordinated set of rules and state-of-the-art processes adapted to practice and applicable to health information systems, covering areas of interoperability and security, which should apply to information systems hosting or processing health-related data. The Recommendations also specifically mentions professionals who are not directly involved in providing individual patient health care, but may have access to health-related data to provide “smooth operation of information systems” (such as cloud systems?). Such professionals must have full regard for professional secrecy and comply with security requirements laid down by law to guarantee the confidentiality and security of the data. In relation to mobile devices, the Recommendation makes it clear that information collected on mobile devices can constitute health-related data and therefore should have the same legal protections as other health-related data processing.
  • Individuals’ rights. The Recommendation provides that individuals should have the right to be informed and exercise control over their health-related data and genetic data, in line with the GDPR. However, three areas of deviation are: (1) individuals should have the right not to be informed of medical diagnoses or the results of genetic tests, as they may have their own reasons for not wishing to know, subject to limited exceptions where they must be informed by law; (2) when individuals withdraw from a scientific research project, individuals should be informed that their health-related data processed in the context of that research will be destroyed or anonymized in a manner which does not compromise the scientific validity of the research – which appear to be more nuanced than recent guidance form the EDPB; and (3) individuals should have the right to be informed the reasoning that underlies data processing involving health-related data where the results of such processing are applied to them, particularly if profiling is involved. This second right is similar to the one in the GDPR (Article 15(1)(h)) but applies more broadly to include processing other than those that fall within solely automated decision-making with significant effects (as described in Article 22 of the GDPR).

To the extent that the GDPR does not already impose the same obligations as in the principles of the Recommendation, the Recommendation is not binding on any private sector or public sector organizations. The member states of the Council of Europe or the European Union, however, are expected to use the Recommendation as guidance when adopting national laws that deal with health data. These principles also provide some insight into how European data protection authorities are likely to interpret the provisions in the GDPR that apply to health-related data and genetic data, and the direction of future guidance and legislation on the topic.

* The Council of Europe is an international organization, which is distinct from the European Union, founded in 1949 to promote democracy and protect human rights and the rule of law in Europe. The Council of Europe consists of 47 member states, which includes all of the 28 EU Member States. Recommendations issued by the Council of Europe are not binding until the EU or national governments of Member States implement legislation, but EU laws often build on Council of Europe standards when drawing up legislation.