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

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

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.

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

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

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