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Singapore’s proposed Healthcare Services Bill to regulate telemedicine and make data contribution to the NEHR mandatory

Singapore’s Ministry of Health is currently inviting public feedback on a proposed Bill for regulation of healthcare services. The Healthcare Services (HCS) Bill will replace the Private Hospitals and Medical Clinics Act (PHMCA).

The PHMCA was enacted in 1980 to ensure patient safety through licensing of physical premises delivering healthcare, such as hospitals, medical clinics, clinical laboratories and other healthcare establishments. It was last amended in 1999.

But with an ageing population and increased prevalence of chronic diseases. MOH found a growing need for new care models and coordinated team-based care across healthcare settings and providers.

The HCS Bill is intended to better safeguard the safety and well-being of patients in the changing healthcare environment while enabling the development of new and innovative services that benefit patients. It is also supposed to strengthen governance and regulatory clarity for better continuity of care to patients, and addresses wider issues of patient welfare.

Telemedicine to be regulated

Previously, almost all healthcare services were provided from physical “brick-and-mortar” locations. With technological advances, new services are being delivered wholly or partially through mobile and online channels. In recognition of this, the HCS Bill will shift the regulatory basis from ‘premises-based’ licensing to ‘services-based’ licensing and include telemedicine which was not regulated under the PHMCA.

Mandatory contributions to the National Electronic Health Record (NEHR)

Licensees will be required to contribute to the NEHR, which enables patients’ health records to follow them wherever they go to seek treatment. This facilitates coordinated care across providers to meet patients’ complex needs. In an emergency, timely access to medical records saves lives. Moreover, it ensures that the records are not lost in the event of a service provider ceasing operations.

Only core data set containing critical patient health information will need to be uploaded via the NEHR. This core data includes: 1) Patient Profile; 2) Events; 3) Diagnosis; 4) Operating Theatre Notes/Procedures/Treatments; 5) Discharge Summary; 6) Medications; 7) Laboratory Reports; 8) Radiology Reports; 9) Immunisation; and 10) Allergies.

Contribution to the NEHR will be implemented in phases. The planned timeline is as seen below:

Source: Annex H to the HCS Bill (the marked licensees are those who can access but do not need to contribute to the NEHR)

In November 2017, Minister for Health, Mr. Gan Kim Yong, announced several support initiatives for healthcare licensees to contribute data to the NEHR. Over 4,000 licensees will be eligible for the support initiatives, which includes sharing of technical and clinical expertise through workshops and online resources, as well as financial support. Workshops and technical support would also be provided to IT vendors who provide clinic management or medical record software.

Ensuring data confidentiality

Safeguards will be put in place to ensure that patients’ NEHR records are kept confidential. The NEHR can be accessed only for purposes of patient care, and not for other purposes, including assessment for employment and insurance. Measures, including the provision of access logs to patients and regular audits on NEHR access, will be instituted to protect against illegitimate access. Penalties will be imposed for unauthorised access.

Opt-out option for patients 

All patients will by default have their specified health data contributed to the NEHR. However, patients who do not wish for their records to be accessed via the NEHR will be able to opt-out.

They will be advised of the implications of their decision, including in emergency situations, as healthcare providers will not be able to access their past healthcare information through the NEHR. Patients who have opted out will continue to have their information uploaded to the NEHR, but with access blocked (i.e. no healthcare providers can access their NEHR record). This will allow past information to be unlocked should the patient choose to opt back in at a later point in time.

A small number of patients who have opted out may prefer not to have their information uploaded to the NEHR. This can be considered on a case-by-case basis. As the impact of incomplete NEHR records is irreversible, these patients will be advised on the consequences. They will have to accept that their future care could be compromised even if they choose to opt back in subsequently due to permanent gaps in their NEHR records.

Enhanced powers for MOH to gather data

Through the new Bill, existing PHMCA powers will be enhanced to enable MOH to gather data for purposes of patient safety, care and welfare, as well as public health interest. This may include national surveillance for the prevention of public health emergencies and safety monitoring for newer services.

The public consultation will continue till February 2018. Access the complete text of the HCS Bill here (pdf download).

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