Singapore’s telehealth sector is driven by the growing telemedicine industry, which has seen an increase in digital self-help options to consult medical doctors through online web-based applications. Telehealth providers in Singapore are mainly focused on providing remote telemedicine and/or on-demand house call services.
To date, there is no over-arching legislation governing the telehealth sector in Singapore. The regulatory regime here revolves around a combination of various codes and guidelines, namely the following:
In January 2020, Singapore’s Ministry of Health (MOH) announced the telemedicine sector would be licensed in the upcoming Healthcare Services Act by the end of 2022. To better understand the operating environment and challenges of the growing telemedicine industry, MOH had collaborated with prominent telemedicine service providers to launch a regulatory sandbox in 2018.
To manage the impact of the coronavirus (COVID-19) pandemic, the Infocomm Media Development Authority and Enterprise Singapore expanded the range of preapproved teleconsultation digital solutions in May 2020 and announced grants and subsidies to encourage small and medium-sized healthcare providers to adopt these solutions.
Until the implementation of the upcoming Healthcare Services Act, telehealth and telemedicine providers in Singapore should take note of the following issues and guidelines.
MEDICAL DOCTORS’ QUALIFICATIONS AND DUTIES
Telemedicine services in Singapore can only be provided by Singapore Medical Council (SMC) registered medical doctors under the Medical Registration Act (Registered Doctors), regardless of whether the provider is based in Singapore or overseas. Registered Doctors are to abide to the ECEG, Handbook, and NTG when providing telemedicine services.
Registered Doctors should ensure that they (1) are properly trained in the use of communication platforms or telehealth devices, (2) acquire sufficient patient information, and (3) convey to patients the nature of remote telemedicine services and its limitations.
In prescribing medication and medical certificates remotely, Registered Doctors are to rely on their professional judgment in each case and only so prescribe if it is in the patient’s best interest. Overall, Registered Doctors providing telemedicine care are required to provide the same quality and standard of care as in-person medical care.
LEGAL LIABILITY ISSUES
There has not yet been a case involving telemedicine malpractice or negligence in Singapore. If telemedicine providers decide to engage the services of freelance Registered Doctors, it is currently unclear who bears the legal responsibility for any malpractice or negligence. In assessing legal responsibility, a Singapore court is likely to consider whether the Registered Doctor was an employee or contractor of the telemedicine provider.
To mitigate such risks, telemedicine providers may consider employing their own Registered Doctors who maintain the requisite malpractice or negligence insurance or maintaining such insurance on their behalf. For claims made against overseas telemedicine providers, the Singapore court may have to assess (1) whether it has the jurisdiction to hear the claim on Singapore’s connection to the dispute, and (2) whether there would be a denial of justice by hearing the claim in Singapore.
DATA PRIVACY ISSUES
Personal data in Singapore is protected under the Personal Data Protection Act (PDPA) and healthcare providers should take note of the specific advisory guidelines drafted for the sector. Telemedicine and telehealth providers that collect any medical or personal data have the obligation to make reasonable security arrangements to prevent unauthorized access, collection, modification, disposal, or similar risk of a patient’s personal data, including a patient’s medical data/records.
Unlike other forms of personal data, medical personal data of patients is regarded as sensitive personal data and demands a higher standard of protection. Therefore, telemedicine and telehealth providers are to ensure that there are sufficient security measures in the storage of personal data of their patients (physical or online cloud server). This extends to the teleconsultation platforms used by Registered Doctors when attending to their patients.
OTHER REGULATORY GUIDELINES
Service providers are to take note of the TP Guidelines if they are importing or developing devices or technologies for the purpose of investigation, detection, diagnosis, monitoring, treatment, or management of any medical condition, disease, anatomy, or physiological process. For providers intending to provide telepharmacy services, they are to adhere to the HPR and the Telepharmacy Guidelines and obtain the necessary approval from HSA.
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