Downsides of having a national patient database

The planned mandatory National Electronic Health Record (NEHR) system has been presented in a largely positive light, with suggestions that it will bring cost-savings and convenience (MOH wants to make national patient database mandatory; Nov 9).

The downsides of this system have, unfortunately, not been adequately explained.

The forced implementation of the NEHR carries a cost which will likely be passed on to patients - not only do private doctors have to bear the cost of setting up electronic medical record (EMR) systems, they have to pay Internet subscriptions and EMR subscription fees, as well as the cost incurred in data entry.

If the emphasis had been on convenience, then all public healthcare institutions should long have implemented the practice of releasing to patients their investigation results.

Instead, they continue to withhold such results, and require patients to ask for their release.

More significantly, there is a need to consider the right to privacy, which we should all enjoy.

Singapore has implemented the Personal Data Protection Act. Yet it is stated that even patients who do not wish to have their NEHR accessed will have their data stored in the system.

More significantly, there is a need to consider the right to privacy, which we should all enjoy.

Health information constitutes one of the most important domains of personal data - so surely those who choose not to have their data accessed should have their privacy respected.

The potential for health insurance claims to be scuttled by medical reports based on the NEHR should also not be overlooked, especially when inaccurate data may be recorded in the system or when patients forget past history that may be found in the NEHR.

One perceived advantage, observing NEHR systems elsewhere, is the potential to tap such data for medical research - can the public be assured that the information will not be so utilised without their consent?

To mandate the implementation of the NEHR, while threatening punishment for non-compliance, also seems high-handed.

Sitoh Yih Yiow (Dr)

A version of this article appeared in the print edition of The Straits Times on November 15, 2017, with the headline 'Downsides of having a national patient database'. Print Edition | Subscribe