The Ministry of Health (MOH) might soon make it compulsory for private healthcare institutions to join the National Electronic Health Records (NEHR). Launched in 2013, the NEHR is being used by all public healthcare facilities and a few private ones.

Under a new Healthcare Services Act, ministry officials have been deliberating making participation in the NEHR a licensing requirement. Thus, all clinics and hospitals may have to provide patient information to the system.

Only a few private institutions involved at present


The 21,000 doctors, nurses and pharmacists who have access to NEHR make over 760,000 patient searches every month. The ministry has been trying to get more private sectors involved in this initiative for some time with little success. Just 40 clinics out of over 2,500 general practitioner (GP) and specialist clinics have agreed to join the NEHR.

“These policies are currently still under evaluation and review, and we are targeting for a public consultation on the Healthcare Services Act by the end of 2017,” shared an MOH spokesman. They added that that they are still collecting feedback on this matter, when speaking to The Straits Times.

Since 2016, MOH officials have been gathering feedback from various doctors' groups on this decision. They met with the Singapore Medical Association (SMA) in November 2016. In March this year, SMA conveyed their uncertainties to the MOH.

SMA raises privacy concerns in light of current process


SMA president Wong Tien Hua expressed concern over the privacy and confidentiality right of patients in a letter published in the June edition of SMA News.

The NEHR works in such a way that people can opt out of the database. However, their records will still remain in the system but healthcare professionals will not be able to access it. During this time, their medical information continues to be gathered but is inaccessible. If they decide to opt in later on, their medical data can then be made available again.

The SMA agrees that this process ensures confidentiality but they believe it is inadequate. Healthcare professionals who are not managing the patient have accessed some patients’ information even though it is not permitted.

It was quoted in the letter by SMA, “Even though a doctor or healthcare professional can be punished for accessing a patient's records without valid justification, such measures are punitive and retrospective in nature, after the transgression and damage has already been done.”

Hence, SMA is in favour of the national involvement in NEHR but they would prefer if the privacy concerns are tackled first.

Nation-wide NEHR involvement for the greater good


Government Parliamentary Committee for Health head Dr Chia Shi-Lu added, “Considering that a majority of our patients seek primary care from GPs – and a significant number from private specialists and hospitals – the impact of the NEHR system would be significantly curtailed if these records from the private healthcare sector are excluded.”

MP Joan Pereira also encouraged the licensing requirement and considered it a step in the right direction as “patients would ultimately be better off”. She added that “more support can be given, especially to the GPs” because it requires investment.

The NEHR allows healthcare professionals to access a patient's medical history, allergies, hospital discharge summaries and laboratory and radiology results. This initiative aims to produce better management, prevent duplication of tests or medications and avoid the administration of a drug the patient is allergic to. MIMS

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Sources:
http://www.straitstimes.com/singapore/health/moh-to-spur-private-sector-input-for-health-database
http://www.straitstimes.com/opinion/national-electronic-health-records-need-a-check-up