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Extra safeguards for more sensitive medical info like mental health conditions: MOH
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With the passing of the Health Information Bill, all healthcare providers have to contribute patients’ key health information to the National Electronic Health Record system by early 2027.
PHOTO: LIANHE ZAOBAO FILE
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SINGAPORE – Diagnoses and confirmatory test results of two mental health conditions and all sexually transmitted infections are deemed by the authorities as more sensitive health information stored in the national repository.
Such information is much harder even for authorised persons to access through the National Electronic Health Record (NEHR) system
He was responding to MPs who aired their concerns in Parliament over the confidentiality of sensitive health data stored in the NEHR, such as that relating to mental health conditions.
Following the passing of the Health Information Bill
Jalan Besar GRC MP Wan Rizal Wan Zakariah said some types of information are more likely to be misunderstood, stigmatised or misinterpreted in the context of employment, and there was a risk of unfair treatment if such information were to be misused or even informally taken into account.
Mr Tan said the Ministry of Health (MOH) understands some patients are particularly concerned about access to health information that may be deemed more sensitive, including that on sexually transmitted infections, delusional disorders and schizophrenia.
The Straits Times understands that health information relating to substance abuse and domestic abuse is also deemed to be more sensitive.
As such, these cases’ diagnoses and confirmatory test results accessible through the NEHR are subject to additional safeguards, including restriction of access to only the healthcare professionals directly involved in caring for the patient with the health condition, said Mr Tan.
Even those with the relevant access rights will face a double login, where they will be asked to re-verify their credentials, to ensure such sensitive information is accessed only when needed, avoiding accidental access.
The third safeguard is that access to such sensitive health information is more closely audited by Synapxe, the national healthtech agency that operates the NEHR system, Mr Tan said.
He emphasised that cases of unauthorised access to NEHR information will be investigated and penalties imposed.
Beyond these key safeguards, ensuring that healthcare professionals abide by the regulations is also key, said Dr Giles Tan, a senior consultant and assistant chairman of the Institute of Mental Health’s medical board.
“It is also important to engage patients and the broader public... to build trust that their healthcare professionals follow professional and ethical standards in their practice, and have the patient’s best interests at heart,” he said.
The Straits Times looks at the impact of the new law.
Q: What health information will be contributed to the NEHR?
A: Allergies, vaccinations, diagnoses, medications, laboratory test results, radiological images and discharge summaries are some examples of health information stored. Relevant personal information such as a patient’s name, address and contact details will also be included.
Q: Which healthcare providers have to contribute patients’ information?
A: Public and private hospitals; nursing homes; private specialist, GP and dental clinics; dialysis centres; clinical and radiology laboratories; and retail pharmacies will contribute data.
Q: Whose information will be stored in the NEHR?
A: Health information of Singaporeans, permanent residents and those with long-term immigration passes will be added as they are more likely to seek care in Singapore over time. Transient visitors, such as medical tourists, will not have their information included.
Q: Why is the NEHR needed?
A: Singapore’s population is rapidly ageing, with more patients having chronic diseases or multiple conditions that require care from different providers, especially as more healthcare services are now offered in the community and nearer to homes.
Making a consistent set of patient information available to the different providers will ensure continuity of care, bring about time and cost savings as medical tests need not be repeated, and avoid situations like being prescribed medications that one is allergic to.
Q: Who can see my health information?
A: Only those who are directly involved in your care can access your records, including doctors, nurses, pharmacists and allied health professionals.
Q: How is my information protected?
A: There are several layers of safeguards, such as allowing authorised healthcare professionals to access only the types of health information required for their specific patient care role.
Technical safeguards include limiting the number of records accessible within a fixed period of time.
Those who contribute to and access the NEHR will need to meet stringent cybersecurity and data security requirements.
Regular audits are conducted, and more measures will be added to limit and detect unauthorised access.
The Health Ministry prohibits access to NEHR information for employment or insurance purposes, such as filling out medical reports required for insurance claims or pre-employment medical screening forms.
Heavier penalties will be imposed on those who do so.
Q: I desire privacy and prefer not to have my health information stored. Can I do so?
A: You can choose to set access restrictions, which will limit the providers that can view your records, such as giving access only to your registered Healthier SG clinic.
MOH advises against setting restrictions as this could adversely impact care delivery.
However, even with access restrictions, healthcare providers will still be able to view your critical allergy and vaccination information. This helps to ensure individuals’ safety as it prevents inappropriate prescriptions or immunisation.
During medical emergencies, doctors may be allowed to “break glass” and access your NEHR information despite access restrictions. All such instances will be subject to audits, with penalties in place for inappropriate “break glass” cases.
Q: How important is it for doctors to know what allergies I have?
A: Dr Rick Chan, a family physician with the Phoenix Medical Group, said there are common drug allergies, including to antibiotics such as penicillin, and to non-steroidal anti-inflammatory drugs, which include a broad class of fever medication or painkillers such as aspirin, ibuprofen and even paracetamol.
As these are commonly prescribed medications, it is important for allergy information to be available on the NEHR to prevent prescription errors by doctors who may not be familiar with patients newly referred to them, especially with the increase in elderly patients.
Dr Aziz Noordin, a family physician and director at the Tampines Family Medicine Clinic, said: “We quite often see patients who don’t fully remember or recognise past drug reactions, especially if these happened many years ago.”
He also cited examples of patients who recalled having a rash after taking penicillin in childhood, but were unsure of the details.
Q: How important is it for doctors to know the medications that I am currently taking?
A: Dr Aziz said having such information could prevent different doctors unknowingly prescribing the same medication.
“It also helps us avoid problematic combinations,” he said.
“For instance, multiple sedating medicines taken together can increase the risk of falls in older patients. Certain antidepressants can interact with other drugs affecting alertness or mood, and diabetes medications or antibiotics may interact with long-term treatments that patients are already on.”
Dr Chan said many older patients have common chronic conditions such as diabetes, hypertension and hyperlipidaemia, or high blood cholesterol levels. They are also more likely to be referred to hospitals for procedures such as cataract surgery and colonoscopy.
Armed with the medication information in the NEHR, doctors can avoid prescribing drugs which could interact with the patients’ existing chronic medications.
Q: Why are vaccination records important too?
A: Dr Chan said doctors can make the necessary recommendations to their patients when they are due for vaccinations.
