Collaborative tools are being developed to facilitate the interpretation of microarray and sequencing data. These are the result of the shifting paradigm in current clinical practice towards a more personalized approach. This trend of genomics becoming personal is expected to augment dramatically, catalyzed by the next generation of sequencing technologies as well as the standardization of microarrays in clinical genetics tests.
Genomic databases provide access to different levels of data as well as bioinformatics tool suites that facilitate its integration and visualization. Such databases may contain sensitive data from patients, including pictures, medical history, sex, age, etc. In the case of clinical diagnosis for developmental disorders, having pictures and phenotypic information may aid diagnosis of new syndromes. Morphological information can be especially useful to discriminate normal variation from structural changes in the DNA that may cause disease. Usually, this data, on its own, is not a threat to the privacy of patients. However, it has been shown by Homer et al [1] that the considerable push to make experimental data publicly available does not completely conceal identity, since it is straightforward to assess the probability that a person or relative participated in a study.
Many approaches and solutions have been suggested to ensure data protection for patients while enabling information sharing and access of scientific data. Here we summarize a set of measures that are being successfully implemented in current databases with sensitive data. This is the result of experiences and procedures that have been accumulated by MC, involving both developers and users. We do not expect these guidelines will eliminate every risk but hope that will reduce them dramatically.
1. Use password protection for access of data. This exerts control on who access data. Grant different privileges to users and depending on their privileges grant different levels of access to specific pieces of information.
2. Restrict access to sensitive data to qualified users. Allow only accredited centers/institutions for access to sensitive patient data. Accredited users may be those who prove that they work for a reputable institution, such as a hospital or university, have recent publications in the field and belong to a relevant professional society.
3. Use Encryption. The information stored in the database itself may be encrypted. Protocols for transfer of information may also be encrypted (https). Organizations may also run their own certificate authority, particularly if they are responsible for setting up browsers to access their own sites (for example, sites on a company intranet, or major universities). They can easily add copies of their own signing certificate to the trusted certificates distributed with the browser.
4. Use Data Access Agreements. Data access agreements may be useful for specifying allowed uses of the data and the ways in which research findings may be shared with the community. This may ensure that only users who have signed the agreement have access to the data.
5. Handle images in a special manner. Images may be some of the most sensitive pieces of information. Watermarking images with recognizable stamps may prevent attempts of sharing this information among unauthorized users. Access to image data may be only allowed to reputable institutions.
6. Consent. Publish only sensitive data that has been previously consented by the patient or person involved. A consent form should specify the uses of the data in an intelligible way for non experts.
7. Do never carry copies of your database in laptops or any portable devices. Database developers and administrators should never store backups or development databases outside their institution. Portable devices can be easily lost or stolen.
8. Do not make accessible the contact details of whoever entered or owns the data. Doctors or assistants will normally be the people who enter the data in their database. Their affiliations may be crucial information for determining the origin of the data deposited. Only allow accredited users to have access to this information.
9. Keep patient notified with any changes of use of data. Databases are likely to be in a continuous process of improvement, adding new features to them, allowing new uses and even moving locations. It is very important to notify your patients of the whereabouts of their data in a regular basis. It is not legitimate to provide new uses which where not initially anticipated in the consent form.
10. Have access to an Ethics Committee panel of experts. If your project is not big enough to have the resources to hire people for these purposes, at least it is recommended that any uses documents that regulate the use, access and publishing of data is reviewed by a panel of experts. Such a panel would ideally be composed by lawyers and scientists with experience in ethical handling of data.
We have presented here a set of rules that describe a starting point on handling and management of sensitive data. As personalized medicine starts delivering health care to patients, it is expected that databases containing potentially sensitive information will proliferate. A set of guiding principles have been exposed here that may help keep patient data from abuse. It is of paramount importance that database developers and administrators seek expert advice in any step of the development process.
- Homer N, Szelinger S, Redman M, Duggan D, Tembe W, et al. (2008) Resolving Individuals Contributing Trace Amounts of DNA to Highly Complex Mixtures Using High-Density SNP Genotyping Microarrays. PLoS Genet 4(8): e1000167. doi:10.1371/journal.pgen.1000167