Instances of Non-compliance of Telemedicine Guidelines

The following question stood in the name of Dr Lim Wee Kiak –

44 To ask the Minister for Health (a) how many instances of non-compliance of telemedicine guidelines have been reported to or identified by the Ministry in the past year given the recent findings of potential lapses in telehealth consultations; (b) what are the primary reasons for these lapses; (c) what steps have been taken to minimise such lapses; and (d) whether there is a protocol for patients to seek support and advice if they have concerns and wish to report a telehealth consultation.

45 Mr Sharael Taha asked the Minister for Health (a) in light of the revocation of MaNaDr Clinic’s licence to provide outpatient medical services, whether the Ministry has observed any similar trends of unethical telemedicine practices by licensed providers of outpatient medical services, particularly of short consultations; (b) whether there is any evidence of misuse in the dispensation of drugs in this case; and (c) what other penalties or disciplinary actions have been imposed on the licensed medical practitioners associated with the clinic.

46 Mr Ang Wei Neng asked the Minister for Health (a) in the last year, how many medical clinics providing teleconsultations have been audited or investigated for irregularities; (b) of these, how many clinics have been issued warnings or subject to more severe penalties; and (c) what are the common irregularities committed by such clinics.

Dr Tan Wu Meng (Jurong): Question No 44, please.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, may I have your permission to address Question Nos 44 to 46 together, please?

Mr Speaker: Please go ahead.

Dr Janil Puthucheary: Sir, arising from the Ministry of Health's (MOH's) regular audits and enforcement actions, eight telemedicine providers have been or are currently being investigated for non-compliance related to the provision of teleconsultation services. The issues of non-compliance fall largely into two categories: one, lapses in clinical care, such as doctors issuing prescriptions and medical certificates without proper clinical assessment or not conducting video consultations for first-time patients; or two, inappropriate advertisements, such as those promoting the unnecessary use of telemedicine services.

Investigations on three of these cases have been concluded and enforcement actions have been taken. One of the cases, which is MaNaDr, has had its outpatient medical service licence revoked. The others involve a short suspension and a stern warning, commensurate with the severity of the breaches. In addition, medical practitioners have also been referred to the Singapore Medical Council (SMC) for potential lapses in professional standards. SMC’s review is currently underway.

It is important to recognise that telemedicine can bring tremendous benefits to patients, especially those who are immobile or doing regular follow-ups. It makes healthcare much more accessible and convenient to our patients. However, as in any new service delivery model, there will be potential for abuse and misuse, especially in the initial period of implementation. MOH will take the necessary enforcement actions so that, over time, best practices become normalised. In the meantime, the public should raise concerns regarding the provision of telemedicine to MOH via the public feedback channels available on the Ministry’s website.

Mr Speaker: Mr Ang Wei Neng.

Mr Ang Wei Neng (West Coast): Thank you, Speaker, and thank you to the Senior Minister of State for the comprehensive reply. Can the Senior Minister of State also elaborate whether MOH can name the other two companies that provided telemedicine and where action has been taken, and for the remaining five, what is the status of the investigation? That is the first question.

The second question is, how many cases were there where the telemedicine consultations lasted less than a minute? And finally, whether there were cases where there were actually no patients, but they have recorded that there were patients?

Dr Janil Puthucheary: Sir, can I just ask Mr Ang to repeat his first question?

Mr Ang Wei Neng: The first question is that the Senior Minister of State said three companies were investigated and actions were taken for their lapses. We know that one or two have been mentioned in the press. How about the other company? The second part is of the remaining five that were investigated, what was the status of the investigations?

Dr Janil Puthucheary: Sir, some of the investigations are still ongoing, so I do not think I can answer the second part of the first question that Mr Ang had asked.

There are a number of licensees involved and, indeed, there were some very short teleconsultations. As I said, the investigations are still ongoing, so we are trying to establish the exact number.

A short teleconsultation is not automatically incorrect, if it is a regular patient, if it is a follow-up, if the necessary information has been obtained. So, I think we have to look at the entire clinical care that has been provided and make sure it is appropriate. It is not the fact of telemedicine that is necessarily the problem. It is whether correct clinical care has been provided through this modality and that sometimes requires an inpatient consultation, sometimes it requires the appropriate breadth and time for the interaction so that the correct information is provided, and, in some cases, it is an issue of whether or not the correct documentation of the process has been carried out. So, all of these things are part of the investigation process.

Mr Speaker: Mr Sharael Taha.

Mr Sharael Taha (Pasir Ris-Punggol): Thank you, Speaker, and thank you to the Senior Minister of State for the reply, and I agree with the benefits of telemedicine.

I have two supplementary questions. The Senior Minister of State has shared that eight telemedicine providers are under investigation. How many clinics offer these services? This is just to get a feel of what is the percentage of the providers that are under investigation.

Second, some of my residents in Pasir Ris have brought up that the contacts of telemedicine clinics have been shared as a means to get easy medical certificates. In fact, a concerned parent shared that some students are using this as a means to avoid taking tests. So, how do we monitor that this modern convenience of telemedicine services is not abused? And how do we then proactively monitor it? What are the avenues for us to report such cases?

Dr Janil Puthucheary: Sir, to answer Mr Sharael Taha's first question, in 2024, we received a total of 59 complaints regarding telemedicine and this involved more than 20 licensees. So, that is the number that we are dealing with.

The monitoring of the quality of care is an important issue that Mr Sharael Taha brought up. There are a variety of ways that we can do this. Some of it is through the professional route and some of it is through public complaints. The issue of whether or not a clinical service is being abused for the purposes of a medical certificate that may or may not be necessary, again, is not a telemedicine issue. This type of inappropriate use can occur in-person as well. And so, there is a variety of things we look at, the metrics in terms of the numbers, the type of patient mix and the justifications for the medical certificate or any other therapeutic intervention. Ultimately, has a correct assessment been provided and is the treatment, whether it is medication, investigation or a medical certificate, appropriate to the clinical condition that has been detected and appropriately documented?