MOH to compel private doctors to submit info for national healthcare database

SINGAPORE — Six years after a national database of patients’ medical history was started to make visits to the doctor even safer and more efficient, few doctors in private practice (3 per cent) are submitting data, causing a “huge gap” in records.

To address the problem, the authorities will table legislation next year to mandate all doctors to do so. Those who fail to may face penalties.

Announcing the move at a conference on Wednesday (Nov 8) to dicuss innovations in healthcare, Minister for Health Gan Kim Yong said: “Patients will benefit from the NEHR (National Electronic Health Records System) when their doctors and care teams are able to access their key medical history when necessary and, work across settings to provide them with coordinated, holistic and safer care. This is particularly important during emergencies.”

He cited how officers at Tan Tock Seng Hospital’s emergency department were able to prescribe the appropriate treatment to an unconscious patient with the NEHR at its fingertips.

And with Singapore’s population ageing, more patients may be consulting multiple doctors for varying needs, so having an extensive database of patients’ medical history can help make care safer, said the authorities. It will also help doctors seeing patients who are unable to articulate their conditions comprehensively and help them cut duplicate tests.

Currently, only about 3 per cent of private healthcare licensees, including general practitioners, private hospitals and nursing homes, are contributing to the national repository. This includes 19 out of over 100 residential care providers and 72 out of more than 4,000 ambulatory care providers, including GPs, specialists and dental providers.

About one in five GPs today still do not have an IT system, according to a survey by the Integrated Health Information Systems (IHiS), the MOH’s IT arm.

All public healthcare providers are accessing and contributing to the NEHR.

“As our healthcare landscape evolves, it is important for clinicians to obtain a view of their patients’ medical history from the NEHR to make better-informed diagnoses and treatment decisions,” said the MOH’s chief medical informatics officer Low Cheng Ooi in a media briefing ahead of the announcement.

The authorities plan to make data submission a licensing requirement under a new Healthcare Services Bill expected to be tabled in Parliament in the second half of next year.

What information doctors need to submit will depend on the nature of the health service. For instance, a typical GP clinic will be asked to share its patients’ demographics, number of visits, diagnoses, allergies, medications prescribed and procedures they have undergone, where applicable.

Some private practitioners have resisted coming on board due to costs of upgrading their IT systems and misconceptions that updating the records will call for more time and effort, said IHiS chief executive officer Bruce Liang.

To facilitate the transition process — which the authorities expect will take up to three years after proposed amendments are debated and passed — the MOH will offer funding support to help defray costs of upgrades or subscription fees incurred for licensees who start contributing to the NEHR by June 2019.

It will fund up to 40 per cent of system upgrades for private hospitals and nursing homes, clinical laboratories and radiological laboratories, capped at S$200,000, S$140,000 and S$40,000 per system, respectively.

Other private outpatient care providers who opt for a subscription-based system, will receive S$2,400 if they come on board the NEHR by June 2019. Currently, average subscription fees range from S$200 to S$300 per month.

IHiS will offer technical support to vendors to ensure that their solutions are “NEHR-ready”, so that practitioners can contribute data seamlessly and securely. It will also advise practitioners on which solutions are compatible with the NEHR.

“If it leads to better care, whether it translates to other costs or not, patients should not be penalised,” said Assoc Prof Low.