Singapore’s national patient database not easy to achieve, but necessary

The move to compel the private healthcare sector to join the shared national patient database sends a clear message – the Singapore government is done waiting.

Next year, a Bill is expected to be introduced in Parliament to pass the requirement into law. Private healthcare operators will then have to link their computers to the National Electronic Health Record (NEHR) system, failing which they are likely to face penalties.

The proposed rules will impact more than 4,000 private operators, including general practitioners (GPs) and dentists, specialist clinics and hospitals, as well as community care facilities such as nursing homes.

It will be a massive exercise for all of them to get on board.

Yet, the NEHR is not an alien concept to the medical community here, including the private sector. It has been up and running since 2011.

Today, public healthcare institutions, such as restructured hospitals and polyclinics, are linked to the database, which is a trove of more than six million unique patient records.

A polyclinic doctor treating a chest pain, for example, can check if the patient has been hospitalised before for heart issues. He can also check for drug allergies and test results, such as X-ray scans.

The system holds much promise in promoting seamless healthcare and helping patients save money by cutting down on repeat tests.

In 2012, it was reported that the NEHR was expected to be fully up by 2015 and involve the private sector and step-down facilities.

But till today, the vision of “one patient, one health record” has yet to materialise.

While private operators were urged to join on a voluntary basis, few did. Only a few dozen GP clinics signed up, out of the more than 1,600 here. No inputs came from all nine private hospitals.

The barriers, it seems, are pragmatic. Upgrading computer systems or buying new software to synchronise with the NEHR can be costly.

About 30 IT vendors provide such a service, and even among them, the software specifications may differ.

Linking up to the database is also not something that would boost the clinic’s or hospital’s revenue.

In fact, it has been suggested that private medical practices may fear losing their patients to rivals, as doctor-hopping would be easier.

The financial impact could hit small clinics hard, too.

That is why a S$20 million (US$14.7 million) kitty has been set up by the Health Ministry to fund the transition. Each private operator can get a one-time payout, ranging from S$2,400 to S$200,000.

This would be helpful for many practices. But the money tides them over only temporarily. Eventually, for instance, they will have to pay the IT vendor monthly fees for the upkeep of the software.

It will be good to explore support measures after this initial period to help doctors make meaningful use of the NEHR. For example, some GPs who are linked to the NEHR said that they do not use it actively as it can be tedious to digitise their records. The authorities may want to look more deeply into this.

Health Minister Gan Kim Yong said yesterday (Nov 8) that workshops on the new requirements will be offered to doctors and IT vendors.

This is a positive move and could be made even better if these sessions include a strong ethical element of using the data responsibly.

Patient privacy and confidentiality are a valid concern that has been raised by doctors and patients. The authorities have said there are safeguards, such as tracking and stratified access among healthcare staff.

With so many more doctors able to call up a patient’s record, it must be impressed upon all users that one cannot search for data willy-nilly.

As with every man-made system, there is a chance that someone will find a way to misuse it undetected.

It is important for providers to have strict rules on how they use the information, on top of the in-built stringent access to the system.

Some patients may still baulk at the thought of their healthcare data being more accessible, but even so, the benefits cannot be denied.

Doctors cannot rely on a patient’s memory of his drug allergies or vaccines. Worse still, if that patient is in no state to talk in times of emergency, it might be a matter of life and death.

Things are even more complex now with the greying society – people are seeing more doctors and have multiple health ailments.

A national shared patient database is not just a noble vision, but also a necessary one.

Such a move will fall in line with technology initiatives in the healthcare sector. One example is a national telemedicine plan launched this year that allows more patients to have e-consultations with doctors.

As Singapore marches to the Smart Nation beat, the database must keep pace – with sufficient safeguards to maintain its integrity.