20 January 2018
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Healthcare Services Bill proposed amid new healthcare scene

Business Times
06 Jan 2018
Nisha Ramchandani

With different care models emerging and technology breeding new healthcare services, the Ministry of Health (MOH) is introducing new healthcare legislation to enhance oversight and to better safeguard patients.

Currently, healthcare providers are licensed and regulated under the Private Hospitals and Medical Clinics Act (PHMCA), which was last substantially amended in 1999. The MOH, which is seeking public feedback on the draft Healthcare Services Bill between Jan 5 and Feb 15, plans to repeal the PHMCA and replace it with the new Act this year.

This comes as Singapore's ageing population and the growing incidence of chronic diseases give rise to a need for new care models, while new healthcare services - such as telemedicine and mobile medical services - are being offered.

Key features of the draft bill include broadening of the regulatory scope to cover healthcare services, nursing and allied health services, traditional medicine as well as complementary and alternative medicine. However, only healthcare services will be licensed for now.

Professionals such as traditional Chinese medicine practitioners and physiotherapists will be regulated under existing Professional Acts.

In addition, given today's new healthcare service models such as telemedicine, a services-based licensing framework has been proposed. Under the PHMCA, providers are licensed based on their physical premises.

The MOH also said that it will strengthen governance and oversight of licensed healthcare services. For instance, certain services, such as assisted reproduction service or gene therapy, will require the appointment of a clinical governance officer.

Meanwhile, where residential care services such as nursing homes and community hospitals are concerned, a step-in safeguard will be added to ensure patients continue to receive the care they need. This allows the MOH to temporarily take over providers who are failing, such as in the case of bankruptcy.

Under the new legislation, all healthcare providers will also be required to contribute patient data to the National Electronic Health Record (NEHR) to enable better care co-ordination and continuity of care for patients across licensed healthcare providers. This will take place in phases starting December 2019.

Patients can opt out of the NEHR but will need to be made aware of potential implications, such as compromised care in the case of emergencies. While their information will still be uploaded to the NEHR, access will be blocked to healthcare providers. Those who do not want their information to be uploaded to the NEHR at all will be considered on a case-by-case basis.

Safeguards will also be put in place to ensure that patients' NEHR records are kept confidential, emphasised the MOH. Records cannot be accessed for purposes other than patient care, such as assessment for employment and insurance. Measures - including regular audits on NEHR access and giving access logs to patients - will be implemented to guard against unauthorised access. In addition, penalties will be levied for unathorised access.

Some industry stakeholders flagged potential issues such as privacy rights as well as costs in relation to the required NEHR.

A GP in a private practice, Dr Chong Yeh Woei, stressed that patients should have full rights to control whether they want their data to be uploaded onto the cloud-based NEHR, and to determine what information is made available to which healthcare institution.

He said: "NEHR's ability to enable better continuity of care cannot be at the expense of erosion of privacy rights of each patient or the autonomy rights of each patient. Furthermore, hacking is a big concern and today's hackers are backed by rogue nations, not just criminal gangs."

In recognition of the benefits of robust electronic medical records (EMR), private healthcare group Parkway Pantai has been progressively rolling out its own EMR system here since 2012 and has been in talks with Integrated Health Information Systems (IHiS) to link its records with NEHR since June 2016.

"We have been facilitating access to NEHR for our doctors at Parkway Shenton and our hospitals, as well as specialist doctors in our network," said Phua Tien Beng, acting chief executive officer (Singapore operations). "Enhancing our systems to interface with NEHR and maintaining these systems would certainly come at a considerable cost." These and other concerns have been raised with IHiS.

Meawhile, to protect patient safety and welfare, the Healthcare Services Act will list unsafe and prohibited practices, such as bio-identical hormone replacement therapy, and authorises the ministry to obtain and publish information on non-compliant licensees and unlicensed providers.

There will also be provisions to impose restrictions on licensees employing staff to work in healthcare services catering to the frail or vulnerable, such as nursing homes or hospices. Anyone who has been found to cause harm to the elderly, for example, will not be allowed to work in these service sectors.

A spokesman for the Raffles Medical Group highlighted the group's overall support for the proposed Bill, describing many of the recommendations as timely.

MOH will also be conducting consultation sessions with both stakeholders and members of the public, who can sign up for these sessions through www.HCSA.SG. The full draft of the Bill was released online on Friday; feedback on the consultation paper and draft Bill can be offered on the REACH platform at www.reach.gov.sg.

Source: Business Times © Singapore Press Holdings Ltd. Permission required for reproduction.