SINGAPORE: Doctors who issue electronic medical certificates (MC) through telemedicine apps must go through proper procedures and ensure they are given for appropriate reasons, the Ministry of Health (MOH) said on Thursday (Sep 14).
“The issuance of a medical certificate by a doctor, regardless of whether it is in a paper or electronic format, carries with it the responsibility to ensure that the patient requires it on proper medical grounds and that such grounds have been arrived at through comprehensive clinical assessment,” an MOH spokesperson told Channel NewsAsia.
“When medical certificates are generated electronically and where doctors are in control of the systems, doctors must ensure that there are security protocols to prevent fraudulent issuance of the certificates.”
Amid the rise of telemedicine apps in Singapore, questions have been asked about whether MCs issued through virtual consultations (VCs) will be as credible as those handed out after a patient visits a doctor's surgery.
According to the Singapore Medical Council’s Handbook on Medical Ethics, which helps doctors address ethical issues concerning modern medical practices, the risk of MC fraud might be higher when “they are input into a computer system to be printed out elsewhere”.
“If you not in control of the systems, your responsibility would be to abide by the security protocols in place so that you do not inadvertently provide an unauthorised person access to the system,” the handbook added.
RESPONSIBLE USE OF VIRTUAL CONSULTATIONS
When it comes to VCs, MOH said doctors are responsible for ensuring that “they are able to remotely diagnose a condition to offer the most appropriate treatment”.
“Having disclaimers on such platforms will not absolve the doctors of any professional misconduct, negligence or incompetence,” it added. “If in doubt, doctors should offer to see the patients face-to-face, so that they are able to conduct a proper physical assessment of the patient.”
MOH also reminded doctors to uphold the quality of care provided when choosing VCs over face-to-face consultations.
However, it is not all down to the doctors.
“Patients should be aware that VCs cannot entirely replace face-to-face consultations,” MOH said. “There will be situations where face-to-face consultations are needed, so that the doctors are able to properly diagnose conditions through physical assessments.”
Patients should also seek medical advice on whether it is appropriate for their medical conditions to be monitored through VCs, it added.
Agreeing, Integrated Health Information Systems (IHiS) chief clinical informatics officer Low Cheng Ooi said physical examinations are crucial to maintaining a standard of care that “currently cannot be achieved through virtual means”. IHiS is the national technology agency for healthcare.
"TELEMEDICINE IS A GROWING FIELD"
Nevertheless, MOH acknowledged that as technology advances in Singapore, more telemedicine apps that could benefit patients will be developed.
“Telemedicine is a growing field in Singapore and can be useful in complementing other provision of care, such as chronic disease monitoring and management, and post-discharge care,” Associate Professor Low said.
VCs also enable patients to remotely consult their doctors, saving them travelling time and costs as well as waiting time at hospitals, he added. “It may be particularly useful for patients with mobility issues or post-discharge patients.”
To that end, Assoc Prof Low said IHiS is monitoring overseas trials on the use of “remote examination and vital signs monitoring technologies”.
However, he stressed that patient safety remains the top priority.
“While we encourage the market development of innovative technologies and also work with the industry to co-create relevant solutions to advance healthcare, we are mindful that these new technologies should be used cautiously for patient safety,” he said.
MOH said healthcare providers should refer to the National Telemedicine Guidelines, issued in 2015, as a guide to delivering telemedicine services in a safe and appropriate manner.
According to the guide, "any telemedicine service must be provided as part of a structured and well-organised system, and the overall standard of care delivered by the system must not be any less compared to a service not involving telemedicine".