I think the solution is is for people to own their data, with cryptographic protections and audit trails. We should have the ability to grant JiT privileges to extremely narrowly scoped pieces, as needed, scrubbed of PII prior to egress. Patients should have to cryptographically sign temporary access, which is revoked immediately after the task... the ux should be as simple as a docusign... I could go on and on...
But, yeah, you're not alone.
I looked at this repository and tried running it: https://github.com/Mzhvnn-tch/sehati-apps. Maybe you can see how this workflow operates.