SINGAPORE: One troublesome night, you’re unable to sleep due to severe stomach pain. You’ve already had some antacids, but they’re of no help. The nearest clinics and polyclinics are all closed, and you’re not sure if your condition deserves a visit to a hospital emergency room, where you may have to face long wait times. What do you do?
For many of us, the COVID-19 pandemic served as the catalyst for shifting away from the traditional model of primary care, typically involving an in-person visit to a general practitioner (GP) or polyclinic.
We quickly embraced telehealth apps, which could connect us to a doctor nearly 24/7 within a matter of minutes, obtain a diagnosis for select ailments, and even get medication delivered – all from the comfort of our homes. Telemedicine not only helped us observe safe distancing measures and avoid overcrowding in healthcare facilities, it also ensured that non-emergency conditions could be promptly treated by a suitable physician.
Five years on, while many of these benefits remain, even this level of technology remains inaccessible to some. For others, telemedicine has become little more than a convenient means of obtaining medical certificates (MCs), especially when getting out of bed to visit a GP feels impossible.
This issue has come under scrutiny, with several telehealth providers facing enforcement action from the Ministry of Health (MOH) following investigations into suspected unethical activities such as MCs and prescriptions being issued after inappropriately brief consultations.
Amid telehealth’s growing notoriety, a Dr Kart kiosk in a Tampines petrol station made waves online and in headlines last year. Public scepticism about an unmanned healthcare "vending machine" is understandable – but how sceptical should we be?
CNA reporters visited the Dr Kart kiosk in December 2024 to better understand how it worked. Based on their trial, one can justifiably expect that these kiosks offer a different user experience from that of telemedicine apps on our phones.
From a regulatory standpoint, however, they are basically the same.
MOH’s 2015 National Telemedicine Guidelines establish that telehealth services must meet a standard of care equivalent to that of traditional in-person consultations, within the inherent limitations of the virtual medium.
These guidelines apply to teleconsultations, whether through a kiosk or apps on personal devices. It doesn’t matter where the patient or the consulting healthcare professional is located, so long as they are not physically face-to-face.
Other legal and ethical frameworks, including the Singapore Medical Council's Ethical Code and Ethical Guidelines (ECEG), the Healthcare Services Act and the Personal Data Protection Act, are similarly applicable across all modes of telehealth delivery.
As for the specific question of MCs, MOH has reiterated multiple times last year the ECEG’s requirement that MCs be issued to patients based on proper medical grounds, only after a thorough clinical assessment. This is irrespective of the mode or location of consultation.
So, whether you see a doctor via your phone or a kiosk at the petrol station, you’ll likely receive an MC only after you’ve been properly assessed, just as you would be by a GP in a physical clinic.
The 2023 Healthcare Services (Outpatient Medical Service) Regulations (OMS) do introduce a degree of differentiation, largely in practical terms. For instance, Regulation 13 requires that remote service kiosks like the one in Tampines must meet specific standards for sanitation, maintenance, effectiveness and safety.
In truth, the Dr Kart kiosk is not the first of its kind.
In 2023, developer SmartRx launched a fully-automated telemedicine “clinic" at the Singapore University of Technology and Design in collaboration with healthcare group Minmed. Students and staff at the university could conveniently teleconsult with a doctor and check their vitals inside a private pod. Prescribed medication could also be obtained on the spot through an attached dispenser.
Later that year, a similar kiosk was set up at Jalan Besar Stadium as well.
Vending machines that can dispense competitively priced over-the-counter medication and other health supplies such as masks and first aid kits can now be found at various locations across the island, including the void decks of Housing and Development Board flats, condominiums and healthcare facilities.
Some are even able to dispense pharmacy-only medication after the patient completes a mandatory on-site teleconsultation with a registered pharmacist.
At its core, this emergent tier of healthcare services aims to enhance access to such care, particularly for those who may not be technologically adept.
Countries across the region including Malaysia, Thailand and India are similarly expanding their primary care infrastructure by deploying facilitated telehealth kiosks – especially in rural areas – to improve access to essential healthcare services.
These initiatives also have the potential to dramatically change both how healthcare is delivered as well as sought by the public.
Enabling the delegation of primary care services for non-emergency conditions can significantly reduce the burdens on acute hospitals and polyclinics.
In addition to shorter wait times and round-the-clock access, telemedicine also empowers patients to take charge of their own health by increasing the range of options from which they can seek timely care that best fits their needs. Incidentally, this is also in alignment with the goals of Healthier SG.
However, as self-service health technologies and telemedicine gain traction, their expansion must be accompanied by robust oversight to safeguard patient welfare.
For instance, the OMS mandates that providers should protect patients’ privacy and confidentiality during consultations. Teleconsultation kiosks raise concerns in this aspect, as onlookers in the vicinity can potentially observe consultations and access sensitive personal data.
A practical solution could be to incorporate private consultation pods as with other telemedicine clinics, so that patients can securely access care without compromising their personal data.
To ensure telehealth fulfils its promise, adherence to ethical and regulatory frameworks must take precedence over profit-driven motives. When implemented responsibly, these innovations can be transformative and must be encouraged.
The challenge is not just to embrace telehealth, but to shape it into a system that prioritises care over mere convenience, and integrity over expediency.
Mathavi Senguttuvan is a research associate at the Centre for Biomedical Ethics, at the National University of Singapore’s Yong Loo Lin School of Medicine.
Continue reading...
For many of us, the COVID-19 pandemic served as the catalyst for shifting away from the traditional model of primary care, typically involving an in-person visit to a general practitioner (GP) or polyclinic.
We quickly embraced telehealth apps, which could connect us to a doctor nearly 24/7 within a matter of minutes, obtain a diagnosis for select ailments, and even get medication delivered – all from the comfort of our homes. Telemedicine not only helped us observe safe distancing measures and avoid overcrowding in healthcare facilities, it also ensured that non-emergency conditions could be promptly treated by a suitable physician.
Five years on, while many of these benefits remain, even this level of technology remains inaccessible to some. For others, telemedicine has become little more than a convenient means of obtaining medical certificates (MCs), especially when getting out of bed to visit a GP feels impossible.
This issue has come under scrutiny, with several telehealth providers facing enforcement action from the Ministry of Health (MOH) following investigations into suspected unethical activities such as MCs and prescriptions being issued after inappropriately brief consultations.
Amid telehealth’s growing notoriety, a Dr Kart kiosk in a Tampines petrol station made waves online and in headlines last year. Public scepticism about an unmanned healthcare "vending machine" is understandable – but how sceptical should we be?
“PHYSICAL” TELEMEDICINE CLINICS VS TELEHEALTH APPS
CNA reporters visited the Dr Kart kiosk in December 2024 to better understand how it worked. Based on their trial, one can justifiably expect that these kiosks offer a different user experience from that of telemedicine apps on our phones.
From a regulatory standpoint, however, they are basically the same.
MOH’s 2015 National Telemedicine Guidelines establish that telehealth services must meet a standard of care equivalent to that of traditional in-person consultations, within the inherent limitations of the virtual medium.
These guidelines apply to teleconsultations, whether through a kiosk or apps on personal devices. It doesn’t matter where the patient or the consulting healthcare professional is located, so long as they are not physically face-to-face.
Other legal and ethical frameworks, including the Singapore Medical Council's Ethical Code and Ethical Guidelines (ECEG), the Healthcare Services Act and the Personal Data Protection Act, are similarly applicable across all modes of telehealth delivery.
As for the specific question of MCs, MOH has reiterated multiple times last year the ECEG’s requirement that MCs be issued to patients based on proper medical grounds, only after a thorough clinical assessment. This is irrespective of the mode or location of consultation.
So, whether you see a doctor via your phone or a kiosk at the petrol station, you’ll likely receive an MC only after you’ve been properly assessed, just as you would be by a GP in a physical clinic.
The 2023 Healthcare Services (Outpatient Medical Service) Regulations (OMS) do introduce a degree of differentiation, largely in practical terms. For instance, Regulation 13 requires that remote service kiosks like the one in Tampines must meet specific standards for sanitation, maintenance, effectiveness and safety.
THE RISE OF “VENDING MACHINE HEALTHCARE”
In truth, the Dr Kart kiosk is not the first of its kind.
In 2023, developer SmartRx launched a fully-automated telemedicine “clinic" at the Singapore University of Technology and Design in collaboration with healthcare group Minmed. Students and staff at the university could conveniently teleconsult with a doctor and check their vitals inside a private pod. Prescribed medication could also be obtained on the spot through an attached dispenser.
Later that year, a similar kiosk was set up at Jalan Besar Stadium as well.
Vending machines that can dispense competitively priced over-the-counter medication and other health supplies such as masks and first aid kits can now be found at various locations across the island, including the void decks of Housing and Development Board flats, condominiums and healthcare facilities.
Some are even able to dispense pharmacy-only medication after the patient completes a mandatory on-site teleconsultation with a registered pharmacist.
MORE INVESTMENT NEEDED – SUBJECT TO CONDITIONS
At its core, this emergent tier of healthcare services aims to enhance access to such care, particularly for those who may not be technologically adept.
Countries across the region including Malaysia, Thailand and India are similarly expanding their primary care infrastructure by deploying facilitated telehealth kiosks – especially in rural areas – to improve access to essential healthcare services.
These initiatives also have the potential to dramatically change both how healthcare is delivered as well as sought by the public.
Related:
Enabling the delegation of primary care services for non-emergency conditions can significantly reduce the burdens on acute hospitals and polyclinics.
In addition to shorter wait times and round-the-clock access, telemedicine also empowers patients to take charge of their own health by increasing the range of options from which they can seek timely care that best fits their needs. Incidentally, this is also in alignment with the goals of Healthier SG.
However, as self-service health technologies and telemedicine gain traction, their expansion must be accompanied by robust oversight to safeguard patient welfare.
For instance, the OMS mandates that providers should protect patients’ privacy and confidentiality during consultations. Teleconsultation kiosks raise concerns in this aspect, as onlookers in the vicinity can potentially observe consultations and access sensitive personal data.
A practical solution could be to incorporate private consultation pods as with other telemedicine clinics, so that patients can securely access care without compromising their personal data.
To ensure telehealth fulfils its promise, adherence to ethical and regulatory frameworks must take precedence over profit-driven motives. When implemented responsibly, these innovations can be transformative and must be encouraged.
The challenge is not just to embrace telehealth, but to shape it into a system that prioritises care over mere convenience, and integrity over expediency.
Mathavi Senguttuvan is a research associate at the Centre for Biomedical Ethics, at the National University of Singapore’s Yong Loo Lin School of Medicine.
Continue reading...