Background

During the parliamentary debates on the White Paper on Healthier SG, the MOH raised that one of the key tools for successfully implementing Healthier SG is the National Electronic Health Record (NEHR), a central repository of patient summary health records. The NEHR is intended to establish a network between public and private healthcare institutions to improve the flow of data across the healthcare ecosystem.

To facilitate the proper collection, use and sharing of health data among healthcare providers in a safe and secure manner through the NEHR, the MOH announced its intention to introduce the HIB in 2023.

Further background is set out in our previous client alert of March 2023.

Main objectives of the HIB

The HIB serves to fulfill three main objectives.

1. Ensure that health information is kept updated, accurate and accessible

It will be mandatory for all licensed healthcare providers and approved contributors to contribute patient health data to the NEHR.

Access to a patient's summary medical records will be provided to licensed healthcare providers and approved users.

This facilitates more coordinated, efficient and appropriate care as patients will not need to repeat their medical history to different healthcare providers or go for repetitive health tests, ultimately saving time and costs.

2. Establish a robust framework for sharing health information

The HIB aims to simplify the health data sharing framework and set out the boundaries of data sharing.

For care transition to be made as seamless as possible, the NEHR should only contain accurate and up-to-date key health information of the patients and be shared with necessary healthcare providers.

Under the HIB, the MOH will set out the types of information that healthcare providers must contribute and the individuals to which the requirement will apply (e.g., health information of short-term visit pass holders will not be required as they are transient residents). Categories of key health information include patient demographics, visits, medical diagnosis, allergies, operating theater notes, discharge summaries, medications and investigation reports.

Further, sensitive health information will be subject to additional access requirements and therefore not be readily accessible compared to other key health information. Sensitive health information is information that risks subjecting individuals to discrimination or social stigma, such as sexually transmitted diseases, schizophrenia, substance abuse and addiction, etc.

The purposes for which the data from the NEHR may be used will also be set out clearly, and individuals can place access restrictions on the sharing of their health data.

Shared health information would improve the efficiency and quality of patient care and support continuity of care for patients moving between primary or specialist care and acute and community care providers.

3. Set out data security and cybersecurity requirements that healthcare providers must comply with

Healthcare providers contributing to or accessing the NEHR will have to comply with data security and cybersecurity requirements set out in the HIB.

These requirements build on existing data security and cybersecurity guidelines and standards, such as the MOH's Healthcare Cybersecurity Essentials Guidelines.

Healthcare providers will be required to report cybersecurity incidents or data breaches that meet prescribed thresholds to the MOH within two hours upon confirmation that the incident is notifiable. This allows the MOH to take prompt action to limit the impact to patient safety and privacy, and detect early patterns that signal a larger-scale attack. There will also be notification requirements to affected individuals.

This set of data security and cybersecurity measures ensures protection of patient privacy and guards against any leakage of health information.

Enforcement of the HIB

To ensure that the HIB requirements are complied with and noncompliance is dealt with swiftly and appropriately, the MOH will have powers under the HIB to issue directions for entities to rectify breaches of the HIB, such as stopping unauthorized access to health information on the NEHR, destroying all health information collected in an unauthorized manner, stopping further unauthorized sharing of health information under the data sharing framework, and strict compliance with cyber and data security requirements.

Additionally, the MOH will also have emergency powers to perform remediation measures in severe situations. There will be a penalty framework aligned to other applicable legislation, and fines of up to SGD 1 million or 10% of the organization's annual turnover (whichever is higher) may be imposed for severe noncompliance.

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From 11 December 2023 to 11 January 2024, members of the public, patients, healthcare providers and data intermediaries can submit their feedback through the HIB consultation form.

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