Which architectural approach supports privacy by design in health systems?

• A. Centralized database with open access
• B. Data duplication across many services without controls
• C. Public read access for all records
• D. Role-based access control, data minimization, encryption, audit trails

Answer: (D)

Privacy by design in health systems means building safeguards into how the system is created and operated from the start. The best approach combines several layered protections: role-based access control, data minimization, encryption, and audit trails.

Role-based access control ensures people only see the data necessary for their job, so sensitive health information isn’t exposed to unnecessary users. Data minimization means collecting and storing only what is truly needed, which reduces the amount of data at risk. Encryption protects data both when it’s stored and when it’s transmitted, so even if data is accessed, it remains unreadable without the proper keys. Audit trails provide a clear record of who accessed which data and when, supporting accountability and the ability to spot and respond to suspicious activity.

Other options would undermine privacy by design: open access to a centralized database would expose sensitive information to too many people; duplicating data across many services without controls increases the attack surface; public read access for all records would make confidential health information broadly available.