Optimising Health Information Privacy in NEHR

Ng Chee Kwan

When I see patients for the first time, an important part of my consultation is obtaining a history of the patient's medical conditions, current medications and previous test results. The information that I obtain by taking a thorough history, and by reviewing physical or electronic copies of their test results, is usually sufficient for a proper assessment. In theory, it would be more convenient for both me and my patient if this information were summarised and stored as a single electronic medical record (EMR), easily retrieved at the point of consultation.

The National Electronic Health Record (NEHR) was set up as a central repository of patients' summarised health records drawn from and shared across healthcare providers. All public healthcare institutions currently contribute patient data and have access to NEHR. The proposed Health Information Bill (HIB) intends to make it mandatory for all licensed healthcare providers to contribute patient data to NEHR.1 This means that in the future, all patients seeking healthcare in the private sector will have their health information uploaded onto NEHR as well.

In 2018, reviewing the implications of mandatory contribution to NEHR, the College of Family Physicians Singapore, Academy of Medicine, Singapore and SMA conducted a survey of 2,100 respondents to evaluate public sentiments towards NEHR.2

Respondents generally agreed that NEHR was a good idea, with 92.2% of respondents supporting the implementation of the NEHR to varying extents. Despite the general support for NEHR, only 27.7% of respondents indicated that they would definitely like to have their records maintained in NEHR, and 56% indicated that they would like to have their records maintained in the NEHR but did not want any healthcare provider to access them without their explicit consent except during emergencies. 11.3% of respondents indicated they wanted to opt out of NEHR to varying extents, and 45.3% were concerned that their medical information would be seen by all attending doctors.

If NEHR contribution becomes mandatory, NEHR will contain a complete record of patients' health information summary, whether patients seek treatment in the public or private sector. This is good for the continuity of healthcare. However, in the current NEHR model, there is no mechanism for patients to grant or deny any participating licensed healthcare provider the right to access their health information. While some patients may not mind this and trust that healthcare providers will not abuse their access privileges, there will be others who prefer to have control over which healthcare provider can view their EMR.

Access to information about a person's financial assets is not automatically granted to financial institutions by default. Why should access to a person's EMR be granted to healthcare providers by default?

Could patients be given the option of logging onto an NEHR portal or app with their Singpass, thereby allowing them to actively grant or deny healthcare providers access to their EMR? For patients who wish to opt out of NEHR, could the opt-out process be made easier and more widely accessible? At present, the only way to opt out is to go to a government polyclinic or hospital to register for it.

It is stated that the HIB will put in place safeguards for data sharing to protect patient confidentiality and respect patient autonomy.1 As the EMR system of a First World nation, I hope the current NEHR model will be modified to ensure that these important principles are upheld. This will give patients the confidence to make NEHR the repository of choice for their health information.

  1. Ministry of Health. Reviewing System Enablers to Support Healthcare Transformations - Health Information Bill. Available at: https://bit.ly/3ONwQTX. Accessed 16 February 2024.
  2. College of Family Physicians Singapore, Academy of Medicine, Singapore, SMA. Joint Survey on the Public Sentiments towards the National Electronic Health Record. SMA News 2018; 50(8):15-9.

Ng Chee Kwan is a urologist in private practice and current President of the SMA. He has two teenage sons whom he hopes will grow much taller than him. He has probably collected too many watches for his own good.