Today’s question comes from Queensland and raises the issue of student access to ‘The Viewer’.  My correspondent says they are advised that students:

… should not access patient information [on the Viewer] unless there is clear lawful authority to do so. However, we are finding that an overwhelming majority of students report being shown information from The Viewer by supervising paramedics during placement. The practice appears sufficiently common that many students regard it as a routine and accepted part of clinical learning.

This has prompted several questions:

1. Does a student have any lawful authority to view information from The Viewer simply because it is shown to them by a supervising paramedic?

2. Can a supervising paramedic lawfully disclose information obtained through The Viewer to a student for educational purposes?

3. If a patient complained about such disclosure, would responsibility rest solely with the supervising paramedic, or could the student also face scrutiny?

4. More broadly, how should the legal and ethical boundaries around The Viewer be interpreted when educational benefit is weighed against patient confidentiality?

For posts on ‘The Viewer’ see 

I refer to readers to those earlier posts for details about the Viewer and access rights. For this post, and to give a simplified answer, I will only refer to the Hospital and Health Boards Act 2011 (Qld) s 161C. That section says:

(1) A prescribed health professional may access a prescribed information system.

(2) A prescribed health professional must not access information contained in a prescribed information system unless—

(a) the information is necessary for the prescribed health professional to facilitate the care or treatment of an individual; or

(b) the prescribed health professional accesses the information incidentally while accessing information mentioned in paragraph (a) .

Penalty—

Maximum penalty—600 penalty units.

(3) A prescribed health professional must comply with all conditions prescribed by regulation in relation to accessing a prescribed information system and any information contained in the system.

Penalty—

Maximum penalty—600 penalty units.

To understand who is a ‘prescribed health professional’ and what is a ‘prescribed information system’ we go to the Hospital and Health Boards Regulation 2023 (Qld) rr 48 and 49.  Regulation 48 refers us to schedule 7 that confirms a paramedic is a ‘registered health professional’. Regulation 49 says

… the information system provided by the department called ‘The Viewer’ and with asset number 604333 is prescribed.

We can therefore rewrite s 161C(2) so that it says:

A paramedic must not access information contained in The Viewer unless—

(a) the information is necessary for the paramedic to facilitate the care or treatment of an individual; or

(b) the paramedic accesses the information incidentally while accessing information mentioned in paragraph (a) .

Penalty—

Maximum penalty—600 penalty units.

It seems pretty clear that accessing information to provide clinical education to a student is not accessing the information for reasons set out in s 161C(2). 

We can then turn to the questions:

1. Does a student have any lawful authority to view information from The Viewer simply because it is shown to them by a supervising paramedic?

It is not an offence it ‘view’ confidential information, it is an offence to access it and share it. I assume the student does not have access to The Viewer ie they cannot ‘log on’, so the paramedic preceptor is logging on.  Clearly the paramedic is in breach of s 161C. 

Further, the Act (s 142A) says:

A prescribed health professional must not disclose, directly or indirectly, confidential information to another person unless the disclosure is required or permitted under this Act.

The paramedic preceptor is not allowed to access The Viewer to get information to share with a student and are not allowed to share the information with the student.  Sharing information with a student would only be permitted if it was with the patient’s consent (s 144) or where the student is involved in the care of the patient (s 145). 

2. Can a supervising paramedic lawfully disclose information obtained through The Viewer to a student for educational purposes?

No, see above. 

3. If a patient complained about such disclosure, would responsibility rest solely with the supervising paramedic, or could the student also face scrutiny?

Assuming the student cannot access the information without the paramedic preceptor then responsibility will fall on the supervising paramedic. They are the person duty bound not to access or share the information. That’s not to say a student would not face ‘scrutiny’ in the sense of questions asked about what happened and did he or she say anything but students are students, they are not registered health professionals, and they are in a very vulnerable position vis-à-vis their trainers.  Unless the student was logging in either with their own log-in, or the preceptor’s log-in, then I would suggest that responsibility rests with the supervising paramedic.  They are meant to be supervising, training, and modelling professional behaviour. 

4. More broadly, how should the legal and ethical boundaries around The Viewer be interpreted when educational benefit is weighed against patient confidentiality?

There may be ethical boundaries. One could can argue that access to The Viewer to assist in student education or allow paramedics to follow up on patients is a good thing and perhaps the net good would outweigh any harm. If you were a consequentialist, you may argue that ethically it is permissible and want to argue that the boundary is where the net good is outweighed by any harm. If you are a deontologist there is no ‘boundary’. Health professionals are duty bound to maintain their patient’s confidentiality.

Although law and ethics are related, they are not the same. The legal boundary is clear. A health professional – a paramedic – can only access patient information on The Viewer to assist in the delivery of care to the patient.  Accessing The Viewer to benefit the paramedic (eg patient follow up) or to benefit a student is not permitted. There is no boundary to be negotiated.

It might be worth thinking of The Viewer as you would the medical records departing in a hospital. I anticipate that if a paramedic went to the medical records department and asked for the records of a patient they had delivered to the hospital sometime before because they wanted to see ‘what happened’ or they wanted to ‘show my student’, the records clerk would deny access.  If the situation is one where you would not be given access to the patient’s printed medical records, then it is a situation where you cannot access that information on The Viewer.

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.