[reureu]

Totally, and to extend that further, one employee may work on multiple projects for which the "minimum necessary" is different. Part of my job involves patient matching and reporting patient-level data to partners we have a BAA with. That means I need access to patient names and addresses. However, if I'm working on training some ML model to predict diabetic progression, it's not necessary for me to pull the names of patients.

I think there's an incorrect assumption in here that there exists a technical solution which entirely solves this problem; that we just need to figure out what the right set of rules are, or get the right column-level and row-level security policies in place and we're all set. It's necessary but not sufficient to have those kinds of safeguards in place. You also need to trust somebody in the organization, and you need to give those somebodies training and support to do the right thing.

In my case, I need access to all of the (clinical) data within the organization. I don't really care how that end is achieved: with one account that has every permission, with multiple accounts that are used for different purposes, or whatever. Ultimately, it's in the interest of the organization to make sure that I have the access I need to successfully do my job.