Singapore healthcare providers may soon be mandatorily required to contribute patient data to the National Electronic Health Record (NEHR).

At the inaugural FutureHealth conference on 8 November, Minister for Health, Mr Gan Kim Yong announced that the Ministry of Health (MOH) “intends to take the next major step for the NEHR to require mandatory data contribution by all licensees, such as healthcare providers and laboratories, so as to improve data comprehensiveness for better patient care.”

Initiatives include enhancing clinical and technical expertise among healthcare providers, as well as providing financial support through an Early Contribution Incentive scheme. According to Mr Gan, a SGD20 million kitty will be allocated to offset the costs of system upgrades among private healthcare providers.

Associate Professor Low Cheng Ooi, chief medical informatics officer at MOH also reckoned that many Singaporeans interchange between the public and private healthcare sectors throughout their lifetimes.

The lack of private sector data in the NEHR may therefore lead to gaps in a person’s medical history, he highlighted. The scheme may also help patients save costs of repeated tests at various healthcare providers.

The proposed amendments will be tabled through a Healthcare Services Bill, in Parliament in the second half of 2018. Upon approval, a two to three-year grace period will be granted to healthcare providers to make the necessary preparations.

Singapore has yet to fully utilise NEHR

NEHR is a platform shared across healthcare providers, which compiles all patients’ records, including every aspect of a patient's medical history, including visits to private practitioners, chronic medication, laboratory reports, allergies and vaccination records.

First proposed by the former health minister in 2004, the NEHR was only rolled out in 2012 – with an expected completion of the system by 2015.

How the healthcare system will be connected by the NEHR. Photo credit: The Straits Times/Integrated Health Information Systems
How the healthcare system will be connected by the NEHR. Photo credit: The Straits Times/Integrated Health Information Systems

Currently, the data contribution to NEHR is voluntary – mainly from public sector institutions, such as hospitals and polyclinics, with more than six million patient records.

However, a mere 3% of more than 4,000 private healthcare providers – including GPs, specialist clinics, nursing homes and hospices – have linked their database to NEHR.

Representing more than 1,600 clinics in the country, GPs, in particular, are often regarded as the primary point of contact for the public. Yet, a quarter of them have access to NEHR where existing patient records are available.

“To effectively upgrade and connect all these systems to NEHR, in a way we want it to be, in a safe and secure manner, with the right standards – it is a tall challenge by itself," remarked Mr Bruce Liang, CEO of Integrated Health Information Systems (IHiS), the national healthcare technology agency.

"Firstly, there is the human factor about a certain amount of resistance, and the technical challenge is another aspect. So, overall, it is going to be a challenging project to get everyone on board," he added.

Challenges faced by private practitioners

Among private healthcare providers, one major challenge for the lack of data synchronisation to NEHR is that not all GPs use an electronic system – the conventional written medical records were preferred for some. IHiS had investigated that out of 1,500 private healthcare licensees, two in 10 private GPs and specialist clinics are still relying on pen-and-paper system.

Singapore is one of the first countries to establish such a comprehensive system. Photo credit: Ariffin Jamar/The Straits Times
Singapore is one of the first countries to establish such a comprehensive system. Photo credit: Ariffin Jamar/The Straits Times

In addition, some are using certain IT systems that are yet to be compatible with NEHR. There are about 30 IT vendors which could aid private practitioners in upgrading computer systems or purchasing new software; nonetheless, software specifications may differ among them.

Furthermore, many private healthcare providers resisted the change as it can be costly to upgrade their IT systems, on top of a possibility for undetected system or data abuse for a national-level database.

There are also misconceptions that updating the records will call for more time and effort, Liang further remarked.

Certain private practitioners responded to the announcement by stating that the centralised use of NEHR may cause them to lose ‘personal touch’ with patients.

“My patients don't like it when during a consultation, I am facing the computer to look at their medical records and key in the data," expressed Dr Auw Tiang Meng, who runs T M Auw Clinic in Hougang. "They are my regulars, so I know their background."

It is also time-consuming for data entry at the clinics, especially among practitioners who have been used to writing medical records.

Considerations on these limitations should be addressed, where the authorities could pinpoint measures to improve current private practices and adjust the system accordingly – e.g. to enable voice recognition function or scanning apps for handwritten notes. MIMS

Read more:
Singapore MOH may mandate the joining of private sectors in the national health database
Private and public hospitals in Singapore: Doctors working together for better healthcare services
"Patient-centred, face-to-face” approach towards a more effective medicinal communication