Present Progress of IT in Healthcare in Singapore
The National Electronic Health Record (NEHR) system allows sharing of medical info, mainly accessible in public institutions and a few selected private clinics on a trial basis.
The GP Clinic Electronic Medical Record and Operation System [“Project CLEO”] allows some GP clinics to view NEHR information.
In the long run, GPs are expected to contribute to the NEHR so that information flow can be in both directions
Current Status of Protection of Personal Information
The Personal Data Protection Act (PDPA) took effect recently. Many organisations are still trying to cope with full effects of the new Act. Advisory guidelines have been developed to help clarify the main legislation.
A public consultation on proposed Advisory Guidelines for Healthcare was held recently to gather comments.
The guidelines highlight Consent, Purpose Limitation and Notification Obligations, e.g. document verbal consent to referrals by making a note inside patient file, or when collecting for purposes unrelated to patient’s care, e.g. teaching purposes
On Access and Correction Obligations, patients can request for details on personal data kept by an organisation [e.g. via a medical report]. Patients can also request for correction of error(s) in personal data [for professional opinion, the organisation is not required to correct or alter]. Organisations can charge a reasonable fee for requests for access.
Regarding Protection, Accuracy, Retention Limitation, Transfer Limitation and Openness Obligations, the advisory guidelines acknowledge that there is no “one size fits all” solution. No specific retention period is prescribed.
Singapore Medical Association (SMA) dialogued with the Ministry of Health & PDPC before and after law came into effect, providing feedback on medical research, managed care companies, and medical records. SMA also organised seminars as part of educating its members on PDPA.
Use of the Citizen Numbering System
The National Registration Identity Card (NRIC) system is used extensively in Singapore, for verification of identity and other transactions. PDPC advisory guidelines on NRIC numbers highlight that consent is needed for collection, usage, and disclosure of NRIC numbers.
The SingPass system is a password that allows access to government e-services, and is used in conjunction with the NRIC. Services include car road tax, HDB flat, electrical, water and gas utilities, CPF, income tax, and medical records.
Merits and Demerits of Healthcare Supported by IT
Pros
Using a common database leads to fewer duplicate or unnecessary tests, reduced medication errors and adverse drug events. It is also easy to search and retrieve data in a digital format. IT also facilitates easier communication.
Cons
Doctors need to be mindful to ensure that patient confidentiality is not compromised. Assistance needs to be provided to less IT-savvy doctors, so that the move towards IT does not exclude a segment of doctors.
An example of the misuse of IT, involved a doctor from a government hospital, who accessed electronic medical records of two women who were not his patients, in 2007 and 2009. He was fined $10,000 and censured by the Singapore Medical Council (SMC)
It was the 1st time a doctor had been disciplined and convicted for such a breach of conduct. Following this case, Ministry of Health (MOH) assured that access to electronic medical records of patients in public hospitals is tracked and audited.
Conclusion
Ensuring patient confidentiality needs to be the priority, while the usage of IT spreads throughout all aspects of healthcare. IT is not a substitute for the fundamentals of medicine, e.g. clinical skills, doctor-patient communication, etc.
Footnotes
*1 This article is base on a presentation made at the Symposium “Health Database in an Information Society” held at the 29th CMAAO General Assembly and 50th Council Meeting, Manila, the Philippines, on September 24-26, 2014.