SINGAPORE: For three decades, Dr Edmond Lie has run his Clementi clinic the same way – pen, paper and a workflow based on shorthand he knows by heart.
But that's about to change, as Singapore will soon require all clinics to contribute patient data to the National Electronic Health Record (NEHR), as part of a broader push to digitise healthcare.
While doctors CNA spoke to said they recognised the benefits of the NEHR, such as improving coordination of care and patient safety, some said the cost of compliance – particularly for smaller clinics – may be difficult to absorb.
Dr Lie recently spent S$10,000 (US$7,900) on a new IT system and now pays about S$2,000 a year in software subscription fees.
Even before joining the NEHR, the 61-year-old already spends up to two extra hours each day after clinic hours entering patient information into his computer.
"There’s a lot of shorthand that I use in my pen and paper, so it’s very quick," he said. "It’s a workflow that I’ve established for decades so it’s really very smooth for me. But now, with digitalising and computerising, it takes time (for me) to write things in a proper format."
He expects the workload to increase once he joins the NEHR.
Dr Lie estimated that if he needs to hire an additional staff member just to manage NEHR submissions, that could cost around S$24,000 annually.
"I suspect that there will be extra man-hours for me, unless I get my staff to bear some of the brunt of it," he said. "The problem is, my staff are also not computer-savvy because they’ve been with me for so many decades and we didn’t really need a (computer) system, so it wouldn’t be fair to them."
If he hires someone, the costs may translate to higher fees for patients, he added.
His clinic currently charges about S$25 per consultation, a rate that has risen only slightly over three decades. Many of his patients are elderly residents from nearby public housing estates.
Clementi Family Healthpoint Clinic, where Dr Edmond Lie practises. (Photo: CNA/Vanessa Lim)
Interviews with other general practitioners (GPs), aged between 61 and 81, reveal similar concerns about the financial burden, the time required to master new systems and the risk of penalties for non-compliance.
A 69-year-old GP who runs a clinic in East Coast and spoke on condition of anonymity said digital systems will slow down consultations and make his clinic "more expensive to run".
"We are fast with paper and pen but with the digital systems taking over, what I envisage is that this will jack up the price," he said. "Because now we have to spend more time with patients, and you have to charge more, because you can only see a certain number of patients a day, so costs will go up."
He currently charges S$18 to S$30 per consultation, depending on complexity and time taken.
Beyond costs, doctors expressed anxiety over what they described as “very heavy” penalties for non-compliance, particularly for older doctors who may be unfamiliar with IT systems.
Under the new requirements, healthcare providers must implement safeguards to protect patient data and promptly report cybersecurity incidents to the Ministry of Health (MOH).
Failure to comply carries a maximum fine of S$20,000 and up to one year in jail. Unauthorised access or disclosure of NEHR information can result in a S$50,000 fine and two years’ imprisonment – doubled for egregious breaches or repeat offences. Systemic cybersecurity failures can incur fines of up to S$1 million.
"We are basically a one-man show, not a corporation that has people who know how to do this. Even when our computer glitches now, we have a problem fixing it, so what will happen?" the 69-year-old East Coast GP said.
"If you’re a lay person and you don’t know how to handle a computer and now you have to handle the cybersecurity, which will need to be updated regularly ... I’m not sure if it’s worth it (to continue practising)," he said.
MOH said it will work with providers first to resolve issues such as incompatible systems. If necessary, the ministry may issue directions requiring them to take steps to remedy or prevent recurrence. For deliberate or persistent non-compliance, providers may face prosecution.
MOH said previously that training resources and programmes, as well as funding support, will be made available to support healthcare providers and professionals. However, it said that the amount of funding to be made available to providers is still being discussed.
Some doctors said they managed the transition with help.
Dr Liew Bee Leng, whose clinic in Marine Parade has already joined the NEHR, said it was her staff who helped to onboard the clinic and handle most of the IT work, acknowledging that it would have been challenging for her to do so herself.
“I still write in paper and pen, then my staff will key in the diagnosis and medicine,” said the 81-year-old.
Out of the six doctors CNA spoke to, half said they were still figuring out their next steps, which may include retiring.
A GP in his late 70s whose East Coast clinic still uses a paper-based record system said he is "looking for a way" to comply with the new requirements but acknowledged the challenges ahead.
“I’m supportive of what the government is doing but my clinic is getting old and I’m coming to my 80s and my staff is not very well-trained in (computers),” he said.
Another GP who has run a neighbourhood clinic in eastern Singapore for more than 40 years said learning to use computer systems at this stage of her career would be “very difficult”.
“I already handle most of the IT work like training my staff to do CHAS claims because my (partner) is ‘allergic’ to computers. But with the new requirements, I think it would be too much for me,” said the 69-year-old, adding that she is considering retirement.
“I feel a bit sad because I don’t want to retire … but if the requirement kicks in, we will either have to sell the clinic or maybe rent it out, but we can’t practise anymore,” she said.
While Dr Lie is not considering retirement, he said additional support – such as subsidies, clearer guidance and manpower assistance – could help ease the transition. Without this, he said, the financial burden of compliance may ultimately be borne by patients.
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But that's about to change, as Singapore will soon require all clinics to contribute patient data to the National Electronic Health Record (NEHR), as part of a broader push to digitise healthcare.
While doctors CNA spoke to said they recognised the benefits of the NEHR, such as improving coordination of care and patient safety, some said the cost of compliance – particularly for smaller clinics – may be difficult to absorb.
Dr Lie recently spent S$10,000 (US$7,900) on a new IT system and now pays about S$2,000 a year in software subscription fees.
Even before joining the NEHR, the 61-year-old already spends up to two extra hours each day after clinic hours entering patient information into his computer.
"There’s a lot of shorthand that I use in my pen and paper, so it’s very quick," he said. "It’s a workflow that I’ve established for decades so it’s really very smooth for me. But now, with digitalising and computerising, it takes time (for me) to write things in a proper format."
He expects the workload to increase once he joins the NEHR.
Dr Lie estimated that if he needs to hire an additional staff member just to manage NEHR submissions, that could cost around S$24,000 annually.
"I suspect that there will be extra man-hours for me, unless I get my staff to bear some of the brunt of it," he said. "The problem is, my staff are also not computer-savvy because they’ve been with me for so many decades and we didn’t really need a (computer) system, so it wouldn’t be fair to them."
If he hires someone, the costs may translate to higher fees for patients, he added.
His clinic currently charges about S$25 per consultation, a rate that has risen only slightly over three decades. Many of his patients are elderly residents from nearby public housing estates.
Clementi Family Healthpoint Clinic, where Dr Edmond Lie practises. (Photo: CNA/Vanessa Lim)
Interviews with other general practitioners (GPs), aged between 61 and 81, reveal similar concerns about the financial burden, the time required to master new systems and the risk of penalties for non-compliance.
A 69-year-old GP who runs a clinic in East Coast and spoke on condition of anonymity said digital systems will slow down consultations and make his clinic "more expensive to run".
"We are fast with paper and pen but with the digital systems taking over, what I envisage is that this will jack up the price," he said. "Because now we have to spend more time with patients, and you have to charge more, because you can only see a certain number of patients a day, so costs will go up."
He currently charges S$18 to S$30 per consultation, depending on complexity and time taken.
ANXIETY OVER HEAVY PENALITIES
Beyond costs, doctors expressed anxiety over what they described as “very heavy” penalties for non-compliance, particularly for older doctors who may be unfamiliar with IT systems.
Under the new requirements, healthcare providers must implement safeguards to protect patient data and promptly report cybersecurity incidents to the Ministry of Health (MOH).
Failure to comply carries a maximum fine of S$20,000 and up to one year in jail. Unauthorised access or disclosure of NEHR information can result in a S$50,000 fine and two years’ imprisonment – doubled for egregious breaches or repeat offences. Systemic cybersecurity failures can incur fines of up to S$1 million.
"We are basically a one-man show, not a corporation that has people who know how to do this. Even when our computer glitches now, we have a problem fixing it, so what will happen?" the 69-year-old East Coast GP said.
"If you’re a lay person and you don’t know how to handle a computer and now you have to handle the cybersecurity, which will need to be updated regularly ... I’m not sure if it’s worth it (to continue practising)," he said.
MOH said it will work with providers first to resolve issues such as incompatible systems. If necessary, the ministry may issue directions requiring them to take steps to remedy or prevent recurrence. For deliberate or persistent non-compliance, providers may face prosecution.
MOH said previously that training resources and programmes, as well as funding support, will be made available to support healthcare providers and professionals. However, it said that the amount of funding to be made available to providers is still being discussed.
Some doctors said they managed the transition with help.
Dr Liew Bee Leng, whose clinic in Marine Parade has already joined the NEHR, said it was her staff who helped to onboard the clinic and handle most of the IT work, acknowledging that it would have been challenging for her to do so herself.
“I still write in paper and pen, then my staff will key in the diagnosis and medicine,” said the 81-year-old.
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CONSIDERING RETIREMENT
Out of the six doctors CNA spoke to, half said they were still figuring out their next steps, which may include retiring.
A GP in his late 70s whose East Coast clinic still uses a paper-based record system said he is "looking for a way" to comply with the new requirements but acknowledged the challenges ahead.
“I’m supportive of what the government is doing but my clinic is getting old and I’m coming to my 80s and my staff is not very well-trained in (computers),” he said.
Another GP who has run a neighbourhood clinic in eastern Singapore for more than 40 years said learning to use computer systems at this stage of her career would be “very difficult”.
“I already handle most of the IT work like training my staff to do CHAS claims because my (partner) is ‘allergic’ to computers. But with the new requirements, I think it would be too much for me,” said the 69-year-old, adding that she is considering retirement.
“I feel a bit sad because I don’t want to retire … but if the requirement kicks in, we will either have to sell the clinic or maybe rent it out, but we can’t practise anymore,” she said.
While Dr Lie is not considering retirement, he said additional support – such as subsidies, clearer guidance and manpower assistance – could help ease the transition. Without this, he said, the financial burden of compliance may ultimately be borne by patients.
Continue reading...