Measures and Frameworks to Ensure Telehealth Services are Appropriate and of Quality to Safeguard Patient Outcomes

1 Dr Wan Rizal asked the Minister for Health (a) what preventive and oversight measures are in place to ensure telehealth providers meet patient care standards consistently; and (b) whether additional regulatory frameworks will be developed to monitor the quality and duration of teleconsultations to safeguard patient outcomes.

2 Ms Hany Soh asked the Minister for Health in light of the Ministry's announcement on 24 October 2024 to revoke a medical clinic's licence (a) how may the Ministry assure the public that teleconsultation services provided by medical clinics meet the appropriate standards; and (b) whether the Ministry has been receiving feedback on potentially errant medical clinics.

The Minister for Health (Mr Ong Ye Kung): Sir, may I answer Question Nos 1 and 2, and also oral questions filed by Mr Melvin Yong¹ and Mr Yip Hon Weng², and a written question filed by Dr Wan Rizal³ for a subsequent Sitting, on the regulation of telemedicine services, please?

Mr Speaker: Please proceed.

Mr Ong Ye Kung: Telemedicine providers are required to be licensed under the Healthcare Services Act, or HCSA, and comply with requirements and standards. In the case of healthcare, medical practitioners themselves also need to adhere to the ethical and professional standards set out in the Singapore Medical Council's (SMC's) Ethical Code and Ethical Guidelines (ECEG). Under the guidelines, they must obtain sufficient information from their patients, conduct appropriate clinical assessment and ensure that any provision of medical care, prescription of medicines and issuance of medical certificates (MCs) are justified on proper medical grounds.

In other words, the regulation of telemedicine is not different from regulation of all other economic activities. We set standards, we require licensing, we conduct periodic audits for each clinic, investigate complaints and take offenders to task. Such regulatory frameworks cannot eradicate offenders – that is not possible. But instead, it ensures that when practices have gone astray, especially with the advent of new technology and business models, they can be corrected promptly.

This is exactly what happened with the MaNaDr case. The doctors were issuing medical certificates in a way that fell foul of HCSA and the Ministry of Health (MOH) had made known our intention for MaNaDr's outpatient medical service licence to be revoked. Several doctors also appeared to have breached the SMC guidelines and are therefore referred to SMC for further disciplinary actions.

Mr Speaker: Dr Wan Rizal.

Dr Wan Rizal (Jalan Besar): Sir, I thank the Minister for sharing on this issue on the MaNaDr. I do believe quality assurance mechanisms are important. In that regard, how does the Ministry currently assess the quality of telehealth consultations? Are there metrics or periodic audits in place to monitor performance? And are these criteria laid out specifically to all these telemedicine providers?

The other question I have, Sir, is really on patient feedback. I have had students who used telemedicine as the form of them getting a medical certificate (MC) in school; and sometimes, I do hear they have complaints and feedback. Could the Minister share if there are specific feedback mechanisms or complaint channels in place for telehealth services and how patients' concerns are addressed within this framework?

Mr Ong Ye Kung: The Member asked if there are standards, if there are audits and if we receive complaints and feedback. The answer is yes, yes, yes.

I would say, in terms of standards and audits, all the clinics know – we have some doctors in the House – you know the standards, you know we audit you. And if, despite knowing all these, you still fall foul of the regulations and the SMC's Ethical Guidelines, then, you are in trouble, because we will catch you. And even if we do not catch you, people will complain – which is the case here, people complained about MaNaDr, that the turnaround was too fast and MCs are issued; employers are suffering, particularly, because their employees are not coming to work, applying for MCs, sometimes, while they are overseas through telemedicine. So, we took prompt action.

Be mindful that while the offence went on for awhile, it was not a long while. It was a matter of months. We investigated, took action and corrected the situation.

Mr Speaker: Ms Hany Soh.

Ms Hany Soh (Marsiling-Yew Tee): I thank the Minister for the response. I have two supplementary questions. The first is, for the purposes of the audit, whether the Ministry has been conducting any mystery shopping consultations? Otherwise, is this something that it will consider doing amongst other measures for auditing purposes?

Secondly, understanding from Minister that the medical practitioners are subject to SMC's Ethical Code and Ethical Guidelines, but in view that we are recognising that there are more telemedicine consultations that are happening now, post-COVID-19, are we also looking to review the existing ethical code and guidelines to specifically address some of these concerns that may arise from telemedicine?

Mr Ong Ye Kung: I am not entirely familiar with the operational aspects of enforcement, but I think we take the attitude that if mystery shopping is required, we will do so, bearing in mind the public are our eyes and ears. When they see something is wrong, they will usually whistle-blow and let us know. And when you see a pattern of complaints, we will take action quite promptly, which is what happened in this case.

Whether there needs to be a review, I do not think so. While telemedicine is due to new technology, post-COVID-19, and it is a new business model, the principles and standards and requirements lay out – whether under HCSA or SMC's Guidelines – I think they are still applicable. For that matter, HCSA was just recently enacted, taking into account technology and taking into account a post-COVID-19, ageing population healthcare system, where technology is being used.

I should add one more point. In the polyclinics, we were hesitant to allow telemedicine for acute treatment precisely because we want to be quite careful about the issuing of MCs. So, if you want an MC from the polyclinics, you would still have to turn up in person.

Mr Speaker: Mr Yip Hon Weng.

Mr Yip Hon Weng (Yio Chu Kang): Thank you, Mr Speaker. I thank the Minister for his response. Many of my Yio Chu Kang residents are seniors and many of them have mobility issues. Hence, telehealth services would be useful for them. In fact, we are working with National Healthcare Group (NHG) Polyclinic to get some of my seniors to use telehealth services rather than make a physical trip to the polyclinic. I hope this incident will not hinder the push for telehealth services, which will benefit many residents on the ground.

My question is, given this incident, can the Ministry share how we can continue to promote telehealth services amongst the seniors and continue to build trust and confidence in this mode of service delivery?

Mr Ong Ye Kung: I thank the Member for raising this. It is actually the key point here.

I thank the Member for working with NHG to use telemedicine for the benefit of his, especially, senior residents. I think when we have new technology, we have an opportunity to make service better, to serve patients and residents better. But just like all new technology, all new business models, someone will try to abuse it. And then, questions will be raised: is the Ministry stepping up audit, enforcement, regulation, doing a clamp-down? There is always a temptation to do so. When you do so, you stop being able to seize the opportunities that new technology can present you.

That is why I want to be quite honest with Members. I think the current requirements and standards are valid and our enforcement has been effective. So, something gone wrong, we corrected it straight away. MaNaDr has been notified that their outpatient licence will be revoked. Now is still the period for them to appeal.

So, I think it is by good enforcement, following up on our standards, enforcing them, taking necessary actions, then we can fully utilise and leverage opportunities that new business models and technology can offer us. And what Mr Yip Hon Weng mentioned, I think, can come true.