Telemedicine: Many issues still not dealt with

Patients can use telemedicine apps on their phones to consult doctors and get MCs without even leaving their houses.
Patients can use telemedicine apps on their phones to consult doctors and get MCs without even leaving their houses.PHOTO: ST FILE

While telemedicine is a convenient way to meet a doctor to solve simple medical problems, many issues remain unresolved (Telemedicine: Putting the 'app' in appointment, Sept 8; Telemedicine subject to same medical standards, Sept 18).

First, the Ministry of Health (MOH) mandates that all clinics keep adult patients' paper medical records for a minimum of 15 years, and electronic medical records for the lifetime of a patient, plus six more years.

Second, clinics are expected to keep all medical records in a safe, locked cabinet.

Yet the records must still be available to other doctors seeing the same patient.

The telemedicine app is a new entity, and MOH ought to define if it is a clinic establishment, or just a platform (that is, middleman) linking up clinics and doctors.

If the telemedicine app is a clinic, then the app is responsible for keeping all patients' records securely and indefinitely.

Video and call recordings during telemedicine consultations should also be stored in a similar manner.

If the telemedicine app is merely a platform, matching patients and clinics, then the doctors involved must set up a separate clinic for storage of medical records.

Telemedicine apps should not just hire freelance or locum doctors, but should engage established clinics.

Start-ups come and go, and if the telemedicine app fails, the licensee must still continue to keep the records securely.

Patients ought to be aware that unlike clinic consultation, where the doctor would document medical records by writing them down, telemedical consultation would involve video and voice recordings, which would invariably show patients' appearance and even sensitive body parts. Keeping such multimedia records secure, yet indefinitely, would be a huge challenge.

The public ought to know how their medical information is being handled by these apps.

Lastly, currently medical clinics must list all their doctors on the MOH and Singapore Medical Council (SMC) registries.

Patients can verify the identity, qualification and place of work of the clinic doctors on the MOH or SMC websites.

If the telemedicine app functions as a clinic, it must also similarly register its doctors.

MOH is wise in experimenting with telemedicine in Singapore. But much trial and error is needed before it becomes a mainstream option.

Desmond Wai (Dr)

A version of this article appeared in the print edition of The Straits Times on September 20, 2019, with the headline 'Telemedicine: Many issues still not dealt with'. Print Edition | Subscribe