SingHealth to issue digital MCs from 2020; initiative gets mixed response amid data security concerns

SINGAPORE — Singapore’s largest healthcare cluster is making paper medical certificates (MCs) a thing of the past, aiming to roll out a digital medical certificate system by early next year.

It is hoped that the system, called DigiMC, will reduce administrative hassle and chances of MCs being forged or misplaced, even as some people interviewed by TODAY raised concerns about the level of security it affords.

Ms Joanne Loh, 29, said that she would use digital MCs only if the authorities can give the assurance that the necessary security measures are in place to ensure that personal information such as her National Registration Identity Card (NRIC) number and address would not be compromised.

SingHealth, which oversees several hospitals including the Changi and Sengkang general hospitals, generated one million hardcopy MCs in 2017.

It has piloted the DigiMC system at selected wards and clinics at the National Heart Centre Singapore (NHCS) since last June and the Singapore General Hospital (SGH) since March this year. In all, 7,000 digital MCs have been issued to date.

The system was built by Mr Chong Zi Xin and Ms Annabelle Ng and their team at Open Government Products, a division of the Government Technology Agency of Singapore (GovTech).

GovTech’s press release stated that the team wanted to create digital MCs that could be verified as true copies, be shared among healthcare providers, patients and employers, and be easily incorporated into a doctor’s existing workflow system.

A doctor can create the MC using an existing software interface, which then generates a URL, also known as a web address, that can be sent via Short Message Service (SMS) to the patient’s mobile phone.

The patient can access the MC by clicking on the URL. The SMS can also be forwarded to the patient’s employers.

The SMS can be backed up on commercial cloud services for later reference, allowing it to be accessed perpetually, Ms Ng said.

SECURITY FEATURES

The team has put in place several safeguards to prevent private data from being disseminated to the wrong person, such as if the SMS is sent to the wrong phone number.

For instance, patients are required to “unlock” the digital MC with their date of birth.

Once the digital MC has been unlocked, it can be forwarded without needing to be unlocked again, but the team is considering the implementation of a “re-lock” feature.

This means that if someone wishes to view the MC seven days after the digital MC is first unlocked, he must re-enter the patient’s date of birth.

To allay concerns by employers about the authenticity of the digital MCs, each document generated via DigiMC is hosted on a government-affiliated web domain (mc.gov.sg).

In addition, a unique string of alphanumeric characters is assigned to the end of the URL. This ensures that each digital MC has a uniquely identifiable key.

“Even if the digital MC is downloaded and saved as a PDF, employers can still validate the document using the URL printed at the bottom of the digital MC, to make sure that it has not been altered,” Mr Chong said.

SingHealth was hit by a major cyber attack last year, when hackers broke into its IT systems to steal the personal data of 1.5 million patients, as well as the outpatient medical records of 160,000 of them, including that of Prime Minister Lee Hsien Loong.

DIGITAL SYSTEM TO BE PHASED IN BY 2020

Mr Chong said that 95 per cent of 179 patients surveyed over a four-month period at SGH and NHCS noted that they were satisfied with the new system.

In an email response to TODAY, Associate Professor Loo Chian Min, the group chief medical informatics officer of SingHealth, said that feedback from patients at SGH and NHCS has been “generally positive”.

“Most found it easy to retrieve their digital MC using the unique online link provided, and forward it to their employer or relevant parties,” he said.

Commenting on plans to phase in DigiMC across all SingHealth institutions by next year, Assoc Prof Loo said: “This move will offer convenience to patients and reduce paper use, which is in line with efforts to be more environmentally friendly.”

To ensure a smooth transition, hardcopy MCs will be issued along with digital MCs for a few months before the former is phased out.

This will also allow time for employers to become used to DigiMC and adapt their internal MC submission procedures accordingly, GovTech said.

It added that patients may still ask for a hardcopy MC if required.

The team also plans to integrate DigiMC with other government applications such as HealthHub, an online portal and mobile application for Singaporeans to access their public health records and a range of e-services such as making medical appointments, Mr Chong said.

Responding to TODAY’s queries on whether it would consider rolling out a similar system, the National Healthcare Group declined to comment, saying that it preferred not to address the query for now.

The National University Health System (NUHS), which includes the National University Hospital and Alexandra Hospital among other institutions, told TODAY that while it does not issue electronic MCs at the moment, it may consider doing so.

"The ongoing pilots will be helpful for us to assess their outcomes,” said an NUHS spokesperson.

LITTLE DIFFERENCE FOR PRIVATE DOCTORS

Ms Melissa Tham, 29, believes that the system will be successful only if employers are on-board with the digital MC system.

“It would be good if I can just forward the SMS to my employer, but my employer will need to accept it, too. If not, there’s no point,” she said.

And while there are no plans yet for a similar system to be rolled out among private clinics, several general practitioners approached by TODAY said that a digital MC system “would not make a difference” to their work.

Dr Philip Koh from Healthway Medical in Tampines questioned if going digital would really reduce administrative hassle.

“Do the companies file their employees’ MCs digitally or do they still print them out and file them? If they do (the latter), then patients might as well take the hardcopy from the clinic,” Dr Koh said.

Dr Vincent Chua of Chua and Partners Family Clinic in Tiong Bahru said that he would have to consider the cost involved in introducing technology that could be incorporated into his computer software system.

Dr Chua also has concerns about the security features of a digital MC. “I am traditional and I believe having your signature on the MC makes it more legitimate and legal,” he said.

Dr Kay Wee Choo of A Life Clinic in Novena said that there was not much difference other than “saving paper” if he were to adopt a digital MC system.